Osteotomy for treating knee osteoarthritis

Brouwer RW., van Raaij TM, Bierma-Zeinstra SMA, Verhagen AP, Jakma TT.S.C., Verhaar JAN

Summary

Osteotomy for treating knee osteoarthritis

This summary of a Cochrane review presents what we know from research about the effect of an osteotomy for osteoarthritis of the knee. The review shows that:

In people with osteoarthritis of the inside of the knee,
- an osteotomy can improve pain and function
- it is not known which techniques are better and which should be used
- some osteotomy techniques may lead to more complications
- it is not known whether an osteotomy (valgus high tibial osteotomy) is better than no surgery at all
But there is not enough evidence to be certain of these results.

What is osteoarthritis of the knee and what is an osteotomy?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling and can change the alignment of joints.

There are three main types of surgery for osteoarthritis of the knee: a total knee replacement (arthroplasty), partial knee replacement (minimally invasive), and an osteotomy. An osteotomy is surgery in which the bones are cut and reshaped. An osteotomy changes the position of the knee so that the bones bear on an area of the knee that is not diseased. By 'unloading' the bear to a better part of the knee, it is thought that an osteotomy may decrease pain, improve function, slow damage in the knee, and possibly delay the need for partial or total knee replacement surgery.

What are the effects of an osteotomy?
The studies included in this review did not compare an osteotomy to no surgery at all. All of the studies tested a 'valgus high tibial osteotomy' (HTO) for osteoarthritis on the inside of the knee.

All studies showed that people had less pain and improved function in the knee 2 months to 7½ years after any type of HTO.

Some of the studies compared HTO to HTO with another procedure such as using a tourniquet, abrasion and overcorrection. Some compared HTO to HTO plus electromagnetic stimulation, and a plaster cast to a hinged-cast brace after surgery. Improvements in pain and function may not be any different between these different techniques. But there is not enough evidence to be certain.

Some studies also compared HTO to a partial knee replacement, the benefits may not be different between these surgeries. But there is not enough evidence to be certain.

When comparing HTO techniques with each other, some techniques may lead to complications, such as pin-track infections or more revisions when a total knee replacement is done in the future. But there is not enough evidence to be certain.