Article Text

Download PDFPDF
Medial opening-wedge high tibial osteotomy affects leg length whereas a lateral closing-wedge osteotomy does not: a systematic review
  1. Joong Il Kim1,
  2. Hyuk Soo Han2,
  3. Sahnghoon Lee2,
  4. Myung Chul Lee2
  1. 1 Department of Orthopaedic Surgery, CM Hospital, Seoul, Korea
  2. 2 Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
  1. Correspondence to Myung Chul Lee, Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea; leemc{at}


Importance High tibial osteotomy (HTO) produces valgus limb alignment, and this alignment change can affect leg length. However, there is little reported evidence on changes in leg length after HTO.

Objective We conducted a systematic review to identify the currently available evidence on the effects of HTO on leg length.

Evidence review A literature review was performed according to the PRISMA guidelines. PubMed was searched from January 1967 to September 2016. Studies were identified using synonyms for ‘high tibial osteotomy’ or ‘proximal tibial osteotomy’ and ‘leg length’ or ‘limb length’. The search yielded 151 publications. After reading the full-text articles, we included two retrospective studies and two randomised controlled trials that evaluated changes in leg length after HTO.

Findings In most of the studies (three of four), the change in leg length was smaller after a closing-wedge HTO (CWHTO) than after an opening-wedge HTO (OWHTO). Higher number of patients reported discomfort and were aware of the leg length discrepancy after OWHTO compared with after CWHTO. Leg length was increased proportionally to the degree of correction after OWHTO. Changes in length were correlated with preoperative hip–knee–ankle angle after CWHTO.

Conclusions and relevance The change in leg length was negligible after a CWHTO, whereas leg length increased after OWHTO. CWHTO is better than OWHTO in minimising the discrepancy in leg length, particularly in knees requiring large corrections.

Level of evidence Level I.

  • high tibial osteotomy
  • closing wedge
  • opening wedge
  • leg length
  • leg length discrepancy
View Full Text

Statistics from


  • Contributors JIK involved in article collection and selection, data analysis, manuscript writing and table editing. HSH and SL involved in article collection and selection supervision. MCL is responsible for supervision during all the literature analysis, table editing, planning of the work, manuscript writing and revision.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.