Ann Intern Med

Surgical realignment improves outcomes in medial knee OA

July 30, 2025

Study details: This single-center, open-label, assessor-blinded randomized trial (NCT020003976) with a parallel preference arm enrolled 145 adults with varus alignment and symptomatic medial compartment knee osteoarthritis. Participants were randomized to nonsurgical management (supervised exercise, nutrition counseling, analgesics) with or without medial opening wedge high tibial osteotomy (HTO). Primary outcome: 2-year change in medial tibiofemoral cartilage thickness on 3T MRI (a 6.3% loss was considered the minimal clinically important difference [MCID]). Secondary outcomes: change in total Knee Injury and Osteoarthritis Outcome Score (KOOS; MCID, 10 points).

Results: At 2 years, the HTO group had a mean cartilage thickness loss of 2% (−0.07 mm) vs. 9% (−0.25 mm) in controls, for a between-group difference of 0.18 mm (95% confidence interval [CI], 0.18–0.19 mm). KOOS improved by 24.95 points in the HTO group vs. 9.06 in controls (mean difference, 15.89 points; 95% CI, 8.94–22.84). These benefits were consistent in the preference arm.

Clinical impact: Medial opening wedge HTO significantly slows structural progression and yields clinically meaningful improvements in pain and function for patients with medial compartment knee osteoarthritis and varus alignment, supporting its use as a joint-preserving intervention in appropriately selected patients.

Source:

Birmingham TB, et al. (2025, July 29). Ann Intern Med. High Tibial Osteotomy for Medial Compartment Knee Osteoarthritis : A Randomized Trial With Parallel Preference Arm. https://pubmed.ncbi.nlm.nih.gov/40720836/