Description
Objectives: The two most commonly used techniques for performing a knee valgus osteotomy are the opening wedge high tibial osteotomy (OW-HTO) and the closing wedge high tibial osteotomy (CW-HTO). The objective of this study was to compare cost-effectiveness between these two surgical procedures.
Methods: This is a retrospective cohort study. All OW-HTO and CW-HTO procedures operated on between 2018 and 2020 in our institution were included. We analysed their functional outcomes (KOOS-12, Tegner activity scale, pain and satisfaction) and radiological outcomes (HKA, MPTA, tibial slope and patellar height). Cost analysis included operating room, implant, graft and hospital admission costs for each technique. The cost-effectiveness ratio was obtained by dividing the overall procedure cost for each point of KOOS-12 improvement.
Results: Fifty-one patients met the inclusion criteria (27 OW-HTO and 24 CW-HTO). Our study showed good to excellent functional outcomes, significant pain reduction (>6 points) and high patient satisfaction (>9/10) in both groups. Both techniques yielded excellent radiological outcomes. No significant differences in functional or radiological outcomes between both procedures were found. However, the OW-HTO group presented a higher total cost than the CW-HTO group (3553.02±693.92€ vs 1410.13±633.70€; p<0.001). The cost-effectiveness ratio was 73.68±46.80 €/KOOS-12 for CW-HTO procedure and 217.52±115.15 €/KOOS-12 for OW-HTO procedure (p=0.025).
Conclusions: Both techniques seemed to be equally effective in improving clinical and radiological outcomes. However, the CW-HTO procedure presented a cost-effectiveness ratio almost three times lower than the OW-HTO procedure.
