Alternate type of surgery may prevent total knee replacement

February 01, 2021

An underused type of knee surgery in younger patients, called high tibial osteotomy, shows considerable success in reducing the need for total knee replacement, according to new research 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," says coauthor 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."

Knee osteoarthritis is a common cause of pain and disability and puts 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 afterwards. 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% did not need a total knee replacement within 5 years, and 79% did not get a total knee replacement within 10 years. Even in patients traditionally not considered ideal candidates for high tibial osteotomy (e.g., women and patients with later-stage disease), about 70% 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," says Mr. Codie Primeau, lead author. "There is a treatment gap between exhausting nonoperative treatments and appropriateness for joint replacement, resulting in many years of pain, lost productivity and associated costs."

"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," says coauthor Dr. Robert Giffin, professor of surgery at Western University's Schulich School of Medicine & Dentistry and the Bone and Joint Institute.

"Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors" is published February 1, 2021.
-end-


Canadian Medical Association Journal

Related Knee Replacement Articles from Brightsurf:

Study compares racial disparities in unilateral versus bilateral knee replacement
Analyzing data from the NIS - Healthcare Cost and Utilization Project database, researchers at Hospital for Special Surgery (HSS) found that African Americans were much less likely to undergo bilateral knee replacement compared to white patients.

Steroid injections do not hasten the need for knee replacement
New research shows that corticosteroid injections for knee OA treatment do not hasten a patient's progression to a total knee replacement when compared with hyaluronic acid injections.

Warfarin use significantly increases risk of knee and hip replacement in people with OA
New research shows that use of warfarin is associated with a significantly greater risk of knee and hip replacements in patients with OA.

Younger knee replacement patients more likely to require reoperation
Knee replacement surgery, also known as total knee arthroplasty (TKA), is increasing among patients 65 and younger.

Osteoarthritis: Conservative therapy delays need for knee and hip joint replacement surgery
With implementation of conservative treatment methods like physiotherapy and individually tailored, adjusted exercises, quality of osteoarthritis care can improve and patients can delay the need for an artificial hip or knee joint.

Changes in opioid use after hip, knee replacement
Researchers looked at changes in opioid prescribing rates and level of pain control in patients who had hip or knee replacement in the U.S. from 2014 to 2017.

Knee replacement timing is all wrong for most patients
The timing of knee replacement surgery is critical to optimize its benefit.

Study: 'Pre-habilitation' by peer coaches before knee replacement may improve outcomes
HSS researchers launched a study to see if a 'pre-habilitation'' program - counseling by a peer coach who has already had knee replacement - could empower and inform patients scheduled for the surgery and lead to better outcomes.

Study finds racial variation in post-op care after knee replacement surgery
A large study analyzing 107,000 knee replacement surgeries found that African Americans were significantly more likely than white patients to be discharged to an inpatient rehabilitation or skilled nursing facility rather than home care after the procedure.

Race and poverty not risk factors for total knee replacement revision or failure
In a new study published in Arthritis Care & Research, HSS investigators found race and poverty are not risk factors for total knee replacement revision or failure at a high-volume orthopedic hospital.

Read More: Knee Replacement News and Knee Replacement Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.