Biplanar medial open-wedge high tibial osteotomy ımproves proprioception and balance in the postoperative period: A prospective case series.

Abstract

To evaluate knee proprioception and balance in the postoperative period following medial open-wedge high tibial osteotomy (HTO) and analyze the effects of patient characteristics on these parameters. This prospective case series included 40 patients who underwent medial open-wedge HTO for medial compartment arthritis between 2022 and 2025. Assessments were performed preoperatively and at 1 year postoperatively, comprising proprioception, evaluated by absolute angle error (AAE) at 30° and 60° of knee flexion; balance, assessed by sway index on firm and foam surfaces under both eyes-open and eyes-closed conditions; and fall risk. Regression analysis was conducted to determine how patient demographic and radiologic characteristics affect these parameters. At 30° flexion, the AAE decreased from 8.0° ± 4.4° to 2.5° ± 2.0° (P < 0.001), and for 60° flexion, the AAE decreased from 5.3° ± 2.7° to 1.6° ± 1.7° (P < 0.001). Postoperatively, significant improvements were observed in the overall stability index, reflecting fall risk (P = 0.016), as well as in eyes-open balance parameters on the firm and foam surfaces (P = 0.041 and P = 0.001, respectively). In the regression analysis, BMI was determined to be a significant negative predictor of proprioceptive improvement at 30° knee flexion (β = -1.014, P = 0.002). Improvements in proprioception and balance could be achieved following medial open-wedge HTO, and high BMI was a negative predictor of proprioceptive function. These improvements are encouraging for surgical decision-making. However, greater consideration and counseling should be given to patients with higher BMI during the management process.