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High tibial osteotomy may reduce need for total knee replacement

Reuters Health - 03/02/2021 - Many patients with knee osteoarthritis who undergo high tibial osteotomy may not require a total knee replacement for at least a decade, a Canadian study suggests.

Researchers examined data on 556 adults who underwent a total of 643 high tibial osteotomy (HTO) procedures from 2002 to 2014 at a large academic teaching hospital in Ontario. Among these patients, the cumulative incidence of total knee replacement was 5% at 5 years and 21% at 10 years, researchers report in CMAJ.

Patients were most likely to require total knee replacement during follow-up when they had greater radiographic severity of knee osteoarthritis prior to HTO (adjusted hazard ratio 1.96). The chance of needing total knee replacement also increased with each additional 10 years of age (aHR 1.50), and each 5-point increase in BMI (aHR 1.31).

"This study suggests the vast majority of patients do not go on to get a total knee replacement within 10 years of undergoing HTO," said lead study author Codie Primeau of the School of Physical Therapy and Bone and Joint Institute at the University of Western Ontario, in Canada.

"High tibial osteotomy should not be avoided because of a perception that the patient may undergo total knee replacement anyway," Primeau said by email.

Most of the patients in the study were male (77.5%), with a mean age of 46.9 years. They were typically overweight or obese (mean BMI 29.7).

Women had a greater risk of total knee replacement than men (aHR 1.67).

One limitation of the study is that it might not have captured total knee replacement procedures that patients underwent outside of London, Ontario, the authors note. Results also might not be generalizable to other regions where high tibial osteotomy isn't regularly offered and performed. And the study lacked a non-operative comparison group.

"Nonoperative treatment of osteoarthritis can be very successful in delaying the need for total knee replacement," said Dr. Greg Erens, an assistant professor in the Department of Orthopedic Surgery at Emory University in Atlanta, who wasn't involved in the study.

While nonoperative treatments do not reverse the progression of arthritis, they can help manage the symptoms, Dr. Erens said. However, as arthritis advances, nonoperative treatments may become insufficient.

Some patients can go for years with conservative, nonoperative treatments, while others may fail conservative options in less time, especially if arthritis is advanced, Dr. Erens said.

"Intervention with high tibial osteotomy is best when symptoms are significant, but arthritis is confined to a single compartment," Dr. Erens advised. "Intervention with high tibial osteotomy would typically be earlier than knee replacement."

SOURCE: https://bit.ly/3to4ymO CMAJ, online February 1, 2021.

By Lisa Rapaport

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