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Osteoarthritis Cartilage. 2017 Dec;25(12):1988-1993. doi: 10.1016/j.joca.2017.09.003. Epub 2017 Sep 10.

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.

Author information

1
Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands. Electronic address: markvanouteren@gmail.com.
2
Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
3
Department of Orthopaedics, Martini Hospital, Groningen, The Netherlands.
4
Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.

Abstract

OBJECTIVE:

No randomized controlled trial (RCT) has compared the high tibial osteotomy (HTO) with non-surgical treatment in patients with medial knee osteoarthritis (OA) and varus malalignment. The aim was to compare the effectiveness of an unloader brace treatment or a usual care program to the HTO regarding pain severity and knee function.

DESIGN:

Surgical treatment (HTO) to two non-surgical options was compared by combining the data of two RCTs. One RCT (n = 117) compared an unloader brace to usual care treatment; the other RCT (n = 92) compared closing to opening wedge HTO. One-to-many propensity score matching was used to equalize patient characteristics. We compared clinical outcome at 1 year follow-up (VAS pain (0-10) and knee function (HSS, 0-100)) with mixed model analysis.

RESULTS:

Propensity score matching resulted in a comparison of 30 brace patient with 83 HTO patients, and of 28 usual care patients with 71 HTO patients. Pain at 1 year after HTO (VAS 3.8) was lower than after valgus bracing (VAS 5.0) with a mean difference of -1.1 (95% CI -2.2; -0.1). Function showed a nonsignificant mean difference of 2.1 [95% CI -3.1; 7.3]. Comparing HTO to usual care a difference was seen in pain (-1.7 [95% CI -2.8; -0.6]) and function (6.6 [95% CI 0.2; 13.1]), in favor of the HTO.

CONCLUSIONS:

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.

KEYWORDS:

Bracing; HTO; OA; Propensity score matching

PMID:
28903017
DOI:
10.1016/j.joca.2017.09.003
[Indexed for MEDLINE]
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