Alternate type of surgery may prevent total knee replacement

The findings of the research were published in 'CMAJ (Canadian Medical Association Journal).'

"High tibial osteotomy is a knee surgery aimed at younger patients in the earlier stages of knee osteoarthritis. One of its goals is to prevent or delay the need for knee replacement," said co-author Dr. Trevor Birmingham, Canada Research Chair in the Faculty of Health Sciences and the Bone and Joint Institute at Western University, London, Ontario.

"In some ways, it's like performing a front-end alignment on your car to stop asymmetric wear on your tires and increase their longevity," added Birmingham.

Knee osteoarthritis is a common cause of pain and disability and puts a tremendous burden on health care systems. Total knee replacement is frequently performed on older patients with end-stage disease and limited mobility.

In Canada, rates of total knee replacement are high and increasing, while rates of high tibial osteotomy are low and decreasing. One reason for this is the perception that high tibial osteotomy is not warranted if the joint is going to be replaced soon afterward. The findings of this new study contradict this perception.

Of the patients in this study getting high tibial osteotomy in London, Ontario (643 knees in 556 patients), 95 percent did not need a total knee replacement within 5 years, and 79 percent did not get a total knee replacement within 10 years. Even in patients traditionally not considered ideal candidates for high tibial osteotomy, about 70 percent did not get a knee replacement within 10 years.

The procedure is particularly suitable for people who are younger, have less severe joint damage, and who may be more physically active.

"Those patients especially contribute to the burden of knee osteoarthritis. There is a treatment gap between exhausting non-operative treatments and appropriateness for joint replacement, resulting in many years of pain, lost productivity, and associated costs," said Mr. Codie Primeau, the lead author.

"Given these findings, high tibial osteotomy may be underused in Canada and could be performed more often to delay or prevent the need for total knee replacement," said co-author Dr. Robert Giffin, professor of surgery at Western University's Schulich School of Medicine & Dentistry and the Bone and Joint Institute.