Addition of medial opening wedge HTO to nonsurgical management reduces loss of articular cartilage
By Elana Gotkine HealthDay Reporter
FRIDAY, Aug. 1, 2025 (HealthDay News) — Medial opening wedge high tibial osteotomy (HTO) slows progression of structural joint damage in knee osteoarthritis, according to a study published online July 29 in the Annals of Internal Medicine.
Trevor B. Birmingham, Ph.D., from the London Health Sciences Centre and University of Western Ontario in Canada, and colleagues examined the efficacy of medial opening wedge HTO in a trial involving 145 adults with varus alignment and symptomatic knee osteoarthritis. Participants received either nonsurgical management followed by HTO or nonsurgical management alone (control). Eligible patients who declined to be randomized due to preference for one of the treatment groups were invited to participate in a preference arm. The primary outcome was two-year change in medial tibiofemoral articular cartilage thickness, measured via masked 3-Tesla magnetic resonance imaging; the minimal clinically important difference was a 6.3 percent loss.
Fifty-nine of 71 participants in the randomized arm and 65 of 74 in the preference arm were assessed at baseline and two years of follow-up. The researchers found that mean two-year change in medial tibiofemoral articular cartilage thickness was −0.07 and −0.25 mm in the HTO and control groups, respectively, in the randomized arm (loss of 2 and 9 percent, respectively). The change in total Knee Injury and Osteoarthritis Outcome Score was 24.95 and 9.06 points in the HTO and control groups, respectively. In the preference arm, these outcomes also favored HTO.
“These results support use of medial opening wedge HTO to slow progression of structural joint damage and improve clinical outcomes among patients with medial compartment knee osteoarthritis and varus alignment,” the authors write.
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