ORIGINAL ARTICLE PUBLISHED IN ANN INT MED: HTO MODIFIES SYMTOMS AND STRUCTURE, DEMONSTRATED BY CARTILAGE MORPHOMETRY

Double Ace:  A new original study published in Annals of Internal Medicine, a prestigious and influential medical journal that shapes medical practice by its high-impact publications, has highlighted the dual benefit of high tibial osteotomy (HTO) on structure & pain in knee osteoarthritis

Birmingham TB, Primeau CA, Moyer RF, Bryant DM, Ma J, Leitch KM, Wirth W, Degen R, Getgood AM, Litchfield RB, Willits KR, Eckstein F, Giffin JR. High Tibial Osteotomy for Medial Compartment Knee Osteoarthritis : A Randomized Trial With Parallel Preference Arm.
Ann Intern Med. 2025 Sep;178(9):1238-1248.     https://pubmed.ncbi.nlm.nih.gov/40720836/

This clinical trial demonstrates efficacy on both structural and symptomatic endpoints in knee osteoarthritis patients treated. HTO is a surgical procedure to correct varus (bow-legged) knee malalignment, with the aim to achieve more balanced joint loading.

What is unique is that the study included a randomized arm (HTO+ non-surgical care vs. non-surgical care alone) and a preference arm, where patients chose their treatment group. The trial combined quantitative analysis of cartilage thickness by MRI (primary endpoint) at years 1 & 2, performed by Chondrometrics, with symptom assessment by the total KOOS patient-reported-outcome.

Why it matters?  While symptom improvement is key in osteoarthritis therapy, long-term, sustainable benefit critically depends on protecting joint structure. The trial demonstrated that biomechanical intervention via HTO leads to improvement in both cartilage and symptoms, with pain relief and beneficial effects on joint structure observed in parallel.

Two-year medial femorotibial cartilage loss was substantially less with HTO (−0.07 mm) than in non-operated controls (−0.25 mm; Fig.). The difference (0.18 mm [95%CI: 0.18, 0.19mm]) was similar in the preference arm. Further, HTO patients reported clinically meaningful relief of +25/100 KOOS points vs. +9 in controls (Fig.). The treatment effect (16; 95%CI: 9, 23) was greater than the minimally clinically important difference (MCID), and that in both the randomized and preference arms.

Hence, this dual signal of structure and symptom improvement is extremely encouraging, informing future clinical trials on osteoarthritis therapies (incl. DMOADs). It supports the role of imaging as sensitive biomarker and potential surrogate endpoint, unleashing its potential in clinical research.

At Chondrmetrics we are proud to have supported this study with our medical device class IIa (CE approved) platform, an ISO 13485-certified QM system, and our team of image analysis experts.

The study has been generously funded by the:
• Canadian Institutes of Health Research | Instituts de recherche en santé du Canada
• Bernard and Norton Wolf Family Foundation
• Arthritis Society Canada