High tibial osteotomy: The past, present, and future

High tibial osteotomy (HTO) is an effective treatment for knee osteoarthritis (OA) with varus deformity and has recently become one of the most prominent surgical techniques. The present study reviewed the past, current topics, and problems associated with HTO. The history of HTO, long-term outcomes, associated factors after HTO, and current issues and topics are discussed. HTO can achieve relatively stable mid-to long-term results in OA with varus alignment. However, results for >15 years remain uncertain, with several studies reporting poor results after HTO at long-term follow-up. Factors associated with poorer clinical results include insufficient alignment correction resulting in varus deformity and advanced OA severity at initial surgery. HTO is required to achieve stable and better long-term results to be adopted more widely in the future. To establish long-term HTO outcomes, more evidence is warranted, and treatment procedures, including combination therapies, must be improved.