Surgical procedure slows progression of knee osteoarthritis

A clinical trial led by London Health Sciences Center Research Institute (LHSCRI) and Western University has found that a knee surgery called high tibial osteotomy (HTO) can slow the progression of osteoarthritis. The study, published in Annals of Internal Medicine, showed that HTO reduced knee joint damage and improved pain and function among patients with knee osteoarthritis and bowed legs.

Osteoarthritis is the most common form of arthritis, affecting more than 500 million people worldwide. The knee is the most commonly affected joint, causing substantial pain and disability. Although exercise, weight management, and pain medications can help, no treatments have been shown to alter the progression of the disease and lead to long-term benefits for the patient until now.

“Our study shows that changing how the knee bears load during walking can improve the natural course of osteoarthritis—a first for the field,” says Dr. Trevor Birmingham, Professor and Canada Research Chair in Musculoskeletal Rehabilitation in Western’s Faculty of Health Sciences and Co-Director of the Wolf Orthopaedic Biomechanics Lab at Western and the Fowler Kennedy Sport Medicine Clinic.

Having bowed legs is a strong risk factor for knee osteoarthritis progression. By straightening the limb, HTO can limit that progression. During an HTO procedure, surgeons straighten the shinbone to take pressure away from the most damaged part of the knee.

The study compared outcomes over two years in patients who underwent the surgical procedure in addition to non-surgical management to those who only received non-surgical management. The study used advanced measures of gait analysis (which assesses how someone loads their knees during walking), magnetic resonance imaging (MRI), and patient-reported outcomes to demonstrate that HTO changed the way people walk, lessened further joint damage, reduced pain, and improved quality of life.

For patients who received HTO surgery, MRI showed a loss of an average of 2% of articular cartilage, the tissue that lines the ends of bones to absorb impact and allow smooth movement, compared to a loss of 9% in patients who did not receive the surgery.

“Our research has shown HTO has the potential to be disease modifying, meaning it can change the way the disease progresses,” says Dr. J Robert Giffin, Orthopaedic Surgeon at London Health Sciences Center (LHSC), Associate Scientist at LHSCRI, Professor at Western’s Schulich School of Medicine & Dentistry, and Co-Director of the Wolf Orthopaedic Biomechanics Lab at Western and the Fowler Kennedy Sport Medicine Clinic.

“We are hopeful that additional centers will follow our lead in training surgeons and adopting this procedure, based on the benefits highlighted by our research.”