A clinical trial has discovered that high tibial osteotomy (HTO) knee surgery can slow the progression of osteoarthritis.
The study, conducted by the London Health Sciences Centre Research Institute (LHSCRI) and Western University and published in Annals of Internal Medicine, demonstrated that HTO decreased knee joint damage and enhanced pain and function in patients with knee osteoarthritis and bowed legs.
Dr Trevor Birmingham, Professor and Canada Research Chair in Musculoskeletal Rehabilitation at Western’s Faculty of Health Sciences, and co-director of the Wolf Orthopaedic Biomechanics Lab at Western and the Fowler Kennedy Sport Medicine Clinic, said: ‘Our study shows that changing how the knee bears load during walking can improve the natural course of osteoarthritis – a first for the field.’
Having bowed legs is a significant risk factor for the progression of knee osteoarthritis. By straightening the limb, HTO can limit that progression.
During an HTO procedure, surgeons realign the shinbone to shift pressure away from the most damaged part of the knee. The study compared outcomes over two years between patients who underwent the surgical procedure along with non-surgical management and those who received only non-surgical management.
The study used advanced gait analysis measures (which assess how individuals load their knees during walking), magnetic resonance imaging (MRI), and patient-reported outcomes to show that HTO changed walking patterns, slower joint deterioration, reduced pain, and enhanced quality of life.
For patients who underwent HTO surgery, MRI scans revealed an average loss of 2% of articular cartilage, the tissue that lines the ends of bones to absorb impact and facilitate smooth movement, compared to a 9% loss in patients who did not undergo the surgery.
Dr J Robert Giffin, orthopaedic surgeon at London Health Sciences Centre (LHSC), Associate Scientist at LHSCRI, Professor at Western’s Schulich School of Medicine & Dentistry, and co-director of the Wolf Orthopaedic Biomechanics Lab at Western and the Fowler Kennedy Sport Medicine Clinic, added: ‘Our research has shown HTO has the potential to be disease modifying, meaning it can change the way the disease progresses. We are hopeful that additional centres will follow our lead in training surgeons and adopting this procedure, based on the benefits highlighted by our research.’
The study was supported in part by the Canadian Institutes of Health Research (CIHR), the Canada Research Chairs Programme, Arthritis Society Canada and the Bernard and Norton Wolf Family Foundation.
