Simultaneous bilateral medial opening wedge high tibial osteotomy with early weight bearing results in low adverse event rates, satisfactory early recovery and high return to work rate

Abstract

Abstract Background Bilateral medial compartment knee osteoarthritis with varus alignment may be treated with staged or simultaneous medial opening wedge high tibial osteotomy (MOWHTO). Simultaneous bilateral MOWHTO may reduce the overall rehabilitation burden, but concerns remain regarding complications, early mobility, and return to work. This study evaluated adverse events, radiographic correction, functional recovery, and return to work after simultaneous bilateral MOWHTO with early weight bearing. Methods A retrospective case series was performed of 15 patients who underwent simultaneous bilateral MOWHTO between January 2002 and December 2023 at a single specialist sports medicine centre. Demographic, operative, radiographic, complication, mobility, return-to-work, hardware removal, and conversion-to-total-knee-arthroplasty data were extracted from medical records and imaging. Adverse events were classified using the Martin et al. framework (Class I–III). Results Fifteen patients underwent 30 osteotomies. Mean age was 50 years, and minimum follow-up was 18 months. Mean operative time was 107 min, mean hospital stay was 4.5 days, and mean osteotomy opening was 12.0 mm. Mean hip-knee-ankle angle improved from 169.8° pre-operatively to 180.9° post-operatively. Radiographic union was confirmed at the 6 month radiograph in 28 knees and at the 9 month radiograph in 2 knees. Three undisplaced lateral hinge fractures and 2 delayed unions occurred, all resolving without surgical intervention. Two superficial infections resolved with oral antibiotics and local wound care. There were no Class III adverse events, deep infections, thromboembolic events, cardiac events, hardware failures, losses of correction, or reoperations. All patients discontinued mobility aids by 12 weeks. Among 9 patients employed pre-operatively, 8 returned to work at a mean of 165.1 days. Conclusions Simultaneous bilateral MOWHTO with early weight bearing was associated with low serious adverse event rates, reliable radiographic union, early functional recovery, and high return to work. These findings support simultaneous bilateral MOWHTO as an effective option for patients seeking a single operative and rehabilitation episode.