Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
Osteoarthritis Cartilage. 2017 Dec;25(12):1988-1993. doi: 10.1016/j.joca.2017.09.003. Epub 2017 Sep 10.
No randomized controlled trial (RCT) has compared the high tibial osteotomy (HTO) with non-surgical treatment in patients with medial knee osteoarthritis (OA) and varus malalignment. The aim was to compare the effectiveness of an unloader brace treatment or a usual care program to the HTO regarding pain severity and knee function.
Surgical treatment (HTO) to two non-surgical options was compared by combining the data of two RCTs. One RCT (n = 117) compared an unloader brace to usual care treatment; the other RCT (n = 92) compared closing to opening wedge HTO. One-to-many propensity score matching was used to equalize patient characteristics. We compared clinical outcome at 1 year follow-up (VAS pain (0-10) and knee function (HSS, 0-100)) with mixed model analysis.
Propensity score matching resulted in a comparison of 30 brace patient with 83 HTO patients, and of 28 usual care patients with 71 HTO patients. Pain at 1 year after HTO (VAS 3.8) was lower than after valgus bracing (VAS 5.0) with a mean difference of -1.1 (95% CI -2.2; -0.1). Function showed a nonsignificant mean difference of 2.1 [95% CI -3.1; 7.3]. Comparing HTO to usual care a difference was seen in pain (-1.7 [95% CI -2.8; -0.6]) and function (6.6 [95% CI 0.2; 13.1]), in favor of the HTO.
Our data suggest that HTO was more effective in pain reduction compared to both non-surgical treatments. Function improved only when HTO was compared to usual care treatment. These small differences question the benefits of surgical treatment over the brace treatment.
尚无随机对照试验（RCT）比较内侧膝关节骨关节炎（OA）和内翻畸形患者的胫骨高位截骨术（HTO）与非手术治疗。目的是比较使用减荷支具治疗或常规护理方案与 HTO 治疗在疼痛严重程度和膝关节功能方面的有效性。
通过合并两项 RCT 的数据，将手术治疗（HTO）与两种非手术选择进行比较。一项 RCT（n=117）比较了减荷支具与常规护理治疗；另一项 RCT（n=92）比较了闭合楔形与开放楔形 HTO。采用一对一多项倾向评分匹配来均衡患者特征。我们使用混合模型分析比较了 1 年随访时的临床结果（VAS 疼痛（0-10）和膝关节功能（HSS，0-100））。
倾向评分匹配后，将 30 名支具患者与 83 名 HTO 患者进行了比较，将 28 名常规护理患者与 71 名 HTO 患者进行了比较。HTO 治疗后 1 年的疼痛（VAS 3.8）低于内翻支具治疗后的疼痛（VAS 5.0），平均差值为-1.1（95%CI-2.2；-0.1）。功能显示出无统计学意义的平均差值为 2.1 [95%CI-3.1；7.3]。与常规护理相比，HTO 在疼痛（-1.7 [95%CI-2.8；-0.6]）和功能（6.6 [95%CI 0.2；13.1]）方面存在差异，HTO 更有优势。
我们的数据表明，与两种非手术治疗相比，HTO 能更有效地减轻疼痛。只有当 HTO 与常规护理治疗相比时，功能才会改善。这些微小的差异使得手术治疗比支具治疗的获益受到质疑。
