High tibial osteotomy may delay need for total knee replacement for patients with osteoarthritis

1. 5 and 10 years after undergoing a high tibial osteotomy procedure, 95% and 79% of knee osteoarthritis patients respectively did not require a total knee replacement.

2. Preoperative factors associated with an increased rate of conversion to total knee replacement included greater radiographic severity, female sex, greater knee pain, higher BMI, and older age.

Evidence Rating Level: 2 (Good)

Knee osteoarthritis (OA) has a peak prevalence at age 50 worldwide, which dramatically impacts middle-aged individuals in terms of quality of life and ability to work. Currently, the use of total knee replacement (TKR) is on the rise for middle-aged patients, although TKR done too early has been linked to lower patient satisfaction and greater risk of prosthesis infection. In fact, 25% of TKR procedures are classified as “likely inappropriate”, underlying the need for alternative knee OA treatments. A procedure known as high tibial osteotomy (HTO) has been used to postpone the need for a TKR, although it is not commonly performed in Canada. In this single-center prospective cohort studies, researchers aimed to quantify the conversion time from HTO to TKR and examining pre-HTO characteristics associated with the conversion time. From 2002 to 2014, 643 knees in 556 patients had a medial opening wedge HTO procedure done, and by the end of the study in 2019, 103 TKRs (16.0%) were done. At 5 years, the cumulative incidence of conversion to TKR was 5%, and at 10 years, the incidence was 21%. Furthermore, for female patients the incidence was 7% and 32%, and for early-stage disease patients it was 2% and 13%, at 5 and 10 years respectively. In terms of pre-HTO characteristics, greater radiographic disease severity was the largest predictor of TKR conversion (adjusted hazards ratio 1.96, 95% CI 1.12-3.45). Other predictors of increased conversion rate include female sex, greater knee pain, higher BMI, and older age. Overall, the study showed that HTO is a procedure that can delay the need for a TKR in knee osteoarthritis patients, with 79% of patients not requiring a TKR 10 years after an HTO.

Click to read the study in CMAJ

Image: PD

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