Research trends and hotspots of alignment in high tibial osteotomy: a bibliometric analysis

Objective To analyze the literature on lower limb alignment in high tibial osteotomy, highlighting development trends, the current research status, and potential emerging frontiers. Methods A comprehensive search was conducted in the Web of Science Core Collection for literature on lower limb alignment in high tibial osteotomy, covering the period from January 1, 1981, to June 30, 2025. Bibliometric tools, including VOSviewer, R Bibliometrix, and CiteSpace, were employed to assess the research landscape and evaluate core authors, journals, and contributing countries. Keyword co-occurrence and cluster analyses were performed to identify global research trends and hotspots. Results A total of 1270 articles published between January 1981 and June 2025 were included, showing a gradual increase in annual publications. Knee Surgery Sports Traumatology Arthroscopy presented the highest publication volume and influence. Lee YS was the most prolific author. Western University in Canada was the most productive institution. South Korea contributed the most publications, followed by the United States, which demonstrated the most extensive international collaboration network. Current research focuses primarily on patellar height changes, gait analysis, and open-wedge high tibial osteotomy. Future research trends are expected to concentrate on long-term outcomes, individualized strategies, and artificial intelligence-assisted planning and navigation. Conclusion In recent years, significant advancements have been achieved in research on alignment in HTO. With increasing patient expectations regarding long-term surgical outcomes, there is a growing imperative for systematic long-term follow-up and evaluation of postoperative alignment changes. The optimization of individualized treatment strategies has emerged as a pivotal direction for enhancing surgical efficacy. The integration of artificial intelligence into surgical planning and navigation holds substantial promise for improving operative accuracy, patient satisfaction, and overall success rates. Collectively, these developments are expected to catalyze higher-quality research and yield superior clinical solutions for HTO.