High tibial osteotomy may ‘reduce risk’ for total knee replacement
Click Here to Manage Email Alerts
High tibial osteotomy leading to large changes in knee dynamics may reduce the likelihood of total knee replacement in patients with knee osteoarthritis, according to a speaker at the 2022 OARSI World Congress.
“Varus alignment is associated with medial osteoarthritis progression, as well as increases in pain and reduced function for patients,” Codie A. Primeau, MSc, of the school of physical therapy at Western University, in London, Canada, told attendees.
Primeau added that external knee moments during gait, such as induction and flexion, can be a surrogate measure of dynamic knee loading. These moments have been targets of various biomechanical interventions. However, it is unclear how those interventions have improved clinical outcomes.
With this in mind, the researchers aimed to assess the efficacy of medial opening wedge high tibial osteotomy (HTO).
“HTO is a surgical procedure with the goal of correcting malalignment and redistributing aberrant knee joint loads of the affected compartments of the knee,” Primeau said.
This procedure may slow disease progression, improve pain and function, and potentially minimize the likelihood of total knee replacement, Primeau said.
In the current study, the researchers assessed the cumulative incidence of total knee replacement after HTO at 5 and 10 years. They also sought to evaluate the association between changes in gait biomechanics achieved by HTO with subsequent total knee replacement.
The long-term prospective cohort is ongoing, and currently includes 610 patients with symptomatic and/or radiographic knee OA. Patient enrollment began in 2002. Follow-up for current presentation continued through July 31, 2019.
“Overall, patients were middle-aged, male, varus aligned, overweight and had moderate radiographic disease,” Primeau said.
The group conducted a 3D gait analysis assessing knee moments using a 12-camera system.
Total knee replacement served as the primary outcome measure.
According to Primeau, the 5-year cumulative incidence of the primary outcome was 5% (95% CI, 3% to 7%). At 10 years, the rate was 20% (95% CI, 16% to 25%).
Examining changes in knee gait before and after the HTO procedure, the researchers observed that knee induction moments in both the sagittal and frontal planes were reduced after surgery. However, the analysis also included an assessment of how these changes in knee induction moments impacted the primary outcome of total knee replacement.
“We saw that changes in knee induction impulse were not significantly associated with a future total knee replacement in our unadjusted model,” Primeau said. “However, when we adjusted for certain patient characteristics, we saw that individuals who experienced larger changes or larger reductions in knee induction impulse were at a reduced risk of a total knee replacement in the future.”
The researchers subsequently concluded that HTO may delay or prevent the need for total knee replacement in patients with medial symptomatic or radiographic disease.
“Changes in dynamic knee loading may play an important role in contributing to future risk of knee replacement,” Primeau said.
Collapse
Primeau CA. Association of changes in gait biomechanics after high tibial osteotomy with subsequent total knee replacement. Presented at: OARSI 2022 World Congress on Osteoarthritis; April 7-10; Berlin, Germany (virtual meeting).
Click Here to Manage Email Alerts