Summary
Our study showed that the HTO was more effective in pain reduction and knee function compared to usual care treatment. The 12-month results for HTO compared to brace treatment shows a difference in favor of HTO for pain, but no difference in function. These findings question the benefits of a surgery over brace treatment.
Abstract
Title:
Is a high tibial osteotomy superior to non-surgical treatment or valgus unloader bracing in patients with varus malaligned medial knee osteoarthritis? A propensity matched study using 2 RCT datasets.
Authors: M.V. van Outeren MD, J.H. Waarsing PhD, M. Reijman PhD, R.W. Brouwer MD PhD, J.A.N Verhaar MD PhD and S.M.A. Bierma-Zeinstra PhD
Abstract:
Background
Patients with a varus alignment and medial knee osteoarthritis (OA) can be treated with a usual care treatment program, an unloader brace, or a valgus high tibial osteotomy (HTO). To date no RCT has compared the HTO and the non-surgical treatment. In this study, we compared the HTO to non-surgical options, by combining the data of two RCTs using propensity score matching, to compare the effectiveness of the interventions at 12 months follow-up regarding pain, and knee function.
Methods
One RCT (n=117) compared a valgus brace to a usual care treatment program. The other RCT (n=92) compared a closing-wedge to an opening-wedge osteotomy.
Propensity score matching, based on baseline covariates, was used to equalize the patient characteristics. One-to-many propensity score matching was performed.
The effectiveness of the interventions at 12 months follow-up was assessed by VAS-pain and HSS (knee function). To compare the effectiveness we used mixed model analysis.
Results
At 12 months follow-up HTO had more gain (pain was lower (p=0.001, mean of 3.6 (SD ±2.6) for HTO vs. mean of 5.3 (SD ±2.4) for usual care), knee function was also better (p=0.005, mean of 79.6 (SD ±13.2) for HTO vs. mean of 72.2 (SD ±14.4) for usual care) than usual care treatment. Both groups had similar baseline characteristics (gender, age, BMI, hip-knee-ankle angle, VAS-pain and HSS-function score).
At 12 months follow-up pain was lower (p=0.016, mean of 3.8 (SD ±2.6) for HTO vs. mean of 5.1 (SD ±2.7) for brace treatment) after a HTO than after brace treatment. The knee function was similar (p= 0.308, mean of 79.3 (SD ±12.7) for HTO vs. mean of 76.1 (SD ±10.9) for brace treatment). Both groups had similar baseline characteristics (gender, age, BMI, hip-knee-ankle angle, VAS-pain and HSS-function score).
Interpretation:
Our study showed that the HTO was more effective in pain reduction and knee function compared to usual care treatment.
The 12-month results for HTO compared to brace treatment shows a difference in favor of HTO for pain, but no difference in function. These findings question the benefits of a surgery over brace treatment.