Knee Osteoarthritis: This surgery may prevent the need for total knee replacement
There are many treatment options for knee osteoarthritis, depending on the severity of the condition. But when all other treatment options failed or when the joint damage is beyond repair, your doctor may suggest total knee replacement.
Knee osteoarthritis (OA), also known as degenerative joint disease, is a condition in which the knee's articular cartilage the flexible, slippery material that protects bones against impacting each other degenerates or wears away. While osteoarthritis of the knee is more common in older adults, it can be found in young people too. Knee osteoarthritis in young adults can result from a previous injury or infection to the knee, or even from being overweight or obese, which puts extra pressure on the joints. For some individuals, hereditary may play a role.
There are many treatment options for knee osteoarthritis, depending on the severity of the condition. But when all other treatment options failed or when the joint damage is beyond repair, your doctor may suggest total knee replacement (TKR) to reduce your pain and improve your ability to move. This involves removing all or damaged parts of the knee joint and replacing them with an artificial joint. Often total knee replacement is performed on older patients with end-stage osteoarthritis and limited mobility.
A new study published in CMAJ (Canadian Medical Association Journal) suggested that an underused type of knee surgery can help younger osteoarthritis patients prevent or delay the need for total knee replacement. The surgery, named high tibial osteotomy, is usually recommended in the earlier stages of knee osteoarthritis.
It is a surgical procedure that realigns the knee joint to repair damage to articular cartilage inflicted by osteoarthritis and malalignment. It involves wedging open the upper portion of the tibia (shin bone in your knee) to reconfigure the knee joint so that the weightbearing is taken off from the damaged or worn tissue and shifted away to the healthier tissue.
The benefits of high tibial osteotomy typically fade after 8 to 10 years, and therefore this type of surgery is generally considered a way to delay knee replacement. Also, this procedure is commonly targeted at younger patients with knee pain resulting from instability and malalignment.
When done in conjunction with other joint preservation procedures, high tibial osteotomy may help cartilage repair tissue to grow without putting excessive pressure on the joints.
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According to study co-author Trevor Birmingham from the Western University in Canada, high tibial osteotomy is "like performing a front-end alignment on your car to stop asymmetric wear on your tires and increase their longevity."
It may benefit patients with later-stage osteoarthritis too
The new study included 556 patients who got high tibial osteotomy. Majority of these patients (95 per cent) did not need a total knee replacement within 5 years, while 79 per cent did not get a total knee replacement within 10 years, the researchers said.
Surprisingly, high tibial osteotomy showed considerable success in reducing the need for total knee replacement even in patients who are usually not considered ideal candidates for such surgery, like women and patients with later-stage disease. In the study, about 70 per cent of such patients did not get a knee replacement within 10 years.
However, the researchers noted that high tibial osteotomy is particularly suitable for people who are younger, have less severe joint damage and who may be more physically active. These are the patients who mainly contribute to the burden of knee osteoarthritis, they added.