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High Tibial Osteotomy for Medial Compartment Knee Osteoarthritis : A Randomized Trial With Parallel Preference Arm
Trevor B Birmingham1, Codie A Primeau1, Rebecca F Moyer2
1Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre and University of Western Ontario; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario; and Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada (T.B.B., C.A.P.).
Medial opening wedge high tibial osteotomy (HTO) surgery slowed cartilage loss and improved knee function in patients with osteoarthritis. This surgical intervention demonstrated superior outcomes compared to non-surgical management alone.
Area of Science:
- Orthopedics
- Biomedical Engineering
- Radiology
Background:
- Knee osteoarthritis (OA) with varus alignment affects joint structure and function.
- Medial opening wedge high tibial osteotomy (HTO) is a surgical option to realign the knee and redistribute load.
- Evaluating HTO's efficacy is crucial for managing medial compartment knee OA.
Purpose of the Study:
- To assess the effectiveness of medial opening wedge HTO in patients with knee OA and varus alignment.
- To compare the progression of medial tibiofemoral articular cartilage thickness between HTO and non-surgical management.
- To evaluate the impact of HTO on patient-reported outcomes using the Knee Injury and Osteoarthritis Outcome Score (KOOS).
Main Methods:
- A single-center, randomized trial with a parallel preference arm was conducted.
- 145 adults with symptomatic medial compartment knee OA and varus alignment were included.
- Intervention involved HTO plus non-surgical management versus non-surgical management alone over 2 years.
Main Results:
- HTO group showed significantly less cartilage loss (2% vs. 9%) over 2 years compared to the control group.
- The HTO group experienced a greater improvement in total KOOS scores (24.95 vs. 9.06 points).
- Outcomes favored HTO in both the randomized and preference arms of the study.
Conclusions:
- Medial opening wedge HTO is effective in slowing structural joint damage progression in medial compartment knee OA.
- HTO significantly improves clinical outcomes and knee function in patients with varus alignment.
- The findings support the use of HTO as a treatment for medial knee OA.
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