This alternative surgery may prevent total knee replacement

An underused type of knee surgery in younger patients shows considerable success in reducing the need for total knee replacement, a new study suggests.

The surgery, named high tibial osteotomy, is a knee surgery aimed at younger patients in the earlier stages of knee osteoarthritis, according to the study published in CMAJ (Canadian Medical Association Journal).

“One of its goals is to prevent or delay the need for knee replacement,” said coauthor Trevor Birmingham from the Western University in Canada.

“In some ways, it's like performing a front-end alignment on your car to stop asymmetric wear on your tires and increase their longevity,” Birmingham added.

Knee osteoarthritis is a common cause of pain and disability and puts tremendous burden on health care systems. Total knee replacement is frequently performed on older patients with end-stage disease and limited mobility.

Of the patients in this study getting high tibial osteotomy (643 knees in 556 patients), 95 per cent did not need a total knee replacement within 5 years, and 79 per cent did not get a total knee replacement within 10 years.

Even in patients traditionally not considered ideal candidates for high tibial osteotomy (e.g., women and patients with later-stage disease), about 70 per cent did not get a knee replacement within 10 years.

The procedure is particularly suitable for people who are younger, have less severe joint damage and who may be more physically active.

“Those patients especially contribute to the burden of knee osteoarthritis,” the researchers said.

“There is a treatment gap between exhausting non-operative treatments and appropriateness for joint replacement, resulting in many years of pain, lost productivity and associated costs,” they added.