2017 ISAKOS Biennial Congress ePoster #1505

 

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

Mark van Outeren, MD, Rotterdam NETHERLANDS
Erwin Waarsing, PhD, Rotterdam NETHERLANDS
Max Reijman, PhD, Benthuizen NETHERLANDS
Reinoud W. Brouwer, MD PhD, Groningen NETHERLANDS
Jan Verhaar, MD, PhD, Prof., Rotterdam NETHERLANDS
Sita Bierma-Zeinstra, MD, Rotterdam NETHERLANDS

Erasmus MC, Rotterdam, NETHERLANDS

FDA Status Not Applicable

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.