Is a high tibial osteotomy (HTO) superior to non-surgical treatment in patients with varus malaligned medial knee osteoarthritis (OA)? A propensity matched study using 2 randomized controlled trial (RCT) datasets

Outeren, M. V. van; Waarsing, J.H.; Brouwer, Reinoud W; Verhaar, Jan A N; Reijman, Max; Bierma-Zeinstra, Sita M A

doi:10.1016/j.joca.2017.09.003

Cited by 28 publications

(16 citation statements)

References 26 publications

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“…Ways of finding associations with a positive outcome to distraction are currently limited 13 . These observations show the potential to define biomarker(s) associated with positive clinical responses to this and similar interventions aiming to off-load the joint surfaces 42,43 . Biomarker stratification, identifying individuals most likely to respond in clinical trials or usual care would increase the utility of this already apparently cost-effective intervention 44 .…”

Section: Discussionmentioning

confidence: 79%

The molecular profile of synovial fluid changes upon joint distraction and is associated with clinical response in knee osteoarthritis

Watt

Hamid

Garriga

et al. 2020

Osteoarthritis and Cartilage

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Objective: Surgical knee joint distraction (KJD) leads to clinical improvement in knee osteoarthritis (OA) and also apparent cartilage regeneration by magnetic resonance imaging. We investigated if alteration of the joint's mechanical environment during the 6 week period of KJD was associated with a molecular response in synovial fluid, and if any change was associated with clinical response. Method: 20 individuals undergoing KJD for symptomatic radiographic knee OA had SF sampled at baseline, midpoint and endpoint of distraction (6 weeks). SF supernatants were measured by immunoassay for 10 predefined mechanosensitive molecules identified in our previous pre-clinical studies. The composite Knee injury and OA Outcome Score-4 (KOOS 4) was collected at baseline, 3, 6 and 12 months. Results: 13/20 (65%) were male with mean age 54 ± 5yrs. All had KellgreneLawrence grade !2 knee OA. 6/10 analytes showed statistically significant change in SF over the 6 weeks distraction (activin A; TGFb-1; MCP-1; IL-6; FGF-2; LTBP2), P < 0.05. Of these, all but activin A increased. Those achieving the minimum clinically important difference of 10 points for KOOS 4 over 6 months showed greater increases in FGF-2 and TGFb-1 than non-responders. An increase in IL-8 during the 6 weeks of KJD was associated with significantly greater improvement in KOOS 4 over 12 months. Conclusion: Detectable, significant molecular changes are observed in SF following KJD, that are remarkably consistent between individuals. Preliminary findings appear to suggest that increases in some molecules are associated with clinically meaningful responses. Joint distraction may provide a potential opportunity in the future to define regenerative biomarker(s) and identify pathways that drive intrinsic cartilage repair.

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Section: Discussionmentioning

confidence: 79%

The molecular profile of synovial fluid changes upon joint distraction and is associated with clinical response in knee osteoarthritis

Watt

Hamid

Garriga

et al. 2020

Osteoarthritis and Cartilage

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“…Currently, non-surgical mechanical interventions, including the use of joint unloader bracing, and orthotic devices, such as wedged insoles or orthotics in footwear, are generally recommended. A surgical procedure, high tibial osteotomy (HTO), is also widely practiced by clinicians for the purpose of correcting varus deformities [ 110 , 111 ].…”

Section: Therapeutic Strategies For Obesity-related Oamentioning

confidence: 99%

“…HTO is frequently used for unicompartmental knee OA, particularly in young patients with medial compartment OA. HTO was shown to be superior to non-surgical treatment in patients with varus malalignment, with better pain reduction and functional improvement [ 110 ]. HTO redistributes weight loading on the knee by correcting the mechanical axis of the knee, in order to relieve pain, slow disease progression and delay or prevent knee replacement [ 126 ].…”

Section: Therapeutic Strategies For Obesity-related Oamentioning

confidence: 99%

Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading

Chen

Zheng

et al. 2020

Journal of Orthopaedic Translation

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Summary Obesity-related osteoarthritis (OA) is a complex, multifactorial condition that can cause significant impact on patients’ quality of life. Whilst chronic inflammation, adipocytokines and metabolic factors are considered to be important pathogenic factors in obesity related OA, there has been limited investigation into the biomechanical impact of obesity on OA development. This review aims to demonstrate that mechanical factors are the major pathological cause of obesity-related OA. The effect of obesity on pathological changes to the osteochondral unit and surrounding connective tissues in OA is summarized, as well as the impact of obesity-related excessive and abnormal joint loading, concomitant joint malalignment and muscle weakness. An integrated therapeutic strategy based on this multi-factorial presentation is presented, to assist in the management of obesity related OA. The translational potential of this article Despite the high prevalence of obesity-related OA, there is no specific guideline available for obesity-related OA management. In this review, we demonstrated the pathological changes of obesity-related OA and summarized the impact of biomechanical factors by proposing a hypothetical model of obesity-related OA change. Therapeutic strategies based on adjusting abnormal mechanical effects are presented to assist in the management of obesity-related OA.

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“…Van Outeren, et al, discussed the results of 2 Randomised Controlled Trials (RCT) assessing the outcomes of HTO compared to conservative management of knee joint medial compartment OA. HTO provided better pain control, while, functional outcomes of HTO compared to unloader brace didn't show a statistically significant difference [19].…”

Section: Surgical Management Of Knee Oamentioning

confidence: 80%

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ORP

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The objective of this review is to evaluate the relevant evidence-based biomechanical principles that may be applied for the management of knee OA (mainly the MC, as it is the most commonly affected). Different management options will be outlined with respect to biomechanical principles, and then the role of knee braces for the management of knee OA will be critically discussed from a biomechanical point of view. MethodsA comprehensive search of the most relevant literature was conducted using the following keywords: knee osteoarthritis, biomechanics, conservative, brace, osteotomy and arthroplasty. The search was performed using the following search engines: Midline, Cochrane, Springer, ScienceDirect, google scholar and Web of Science. The search included papers published between 2005 and 2019. Only papers that discussed the biomechanical principles behind the management of primary uni-compartmental knee OA were included. Results of Literature Review Knee joint biomechanics and knee OA patho-mechanicsThe knee joint alignment is one of the most commonly investigated factors when considering knee joint OA. Varus or valgus knee

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Is a high tibial osteotomy (HTO) superior to non-surgical treatment in patients with varus malaligned medial knee osteoarthritis (OA)? A propensity matched study using 2 randomized controlled trial (RCT) datasets

Abstract: Our data suggest that HTO was more effective in pain reduction compared to both non-surgical treatments. Function improved only when HTO was compared to usual care treatment. These small differences question the benefits of surgical treatment over the brace treatment.

Cited by 28 publications

References 26 publications

The molecular profile of synovial fluid changes upon joint distraction and is associated with clinical response in knee osteoarthritis

The molecular profile of synovial fluid changes upon joint distraction and is associated with clinical response in knee osteoarthritis

Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading

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