High Tibial Osteotomy for Medial Compartment Knee Osteoarthritis
Bibliographic record
Abstract
BACKGROUND: Medial opening wedge high tibial osteotomy (HTO) is a limb realignment surgery that aims to preserve joint structure and improve clinical outcomes by redistributing ambulatory loads on the knee among patients with knee osteoarthritis and varus alignment. OBJECTIVE: To evaluate the efficacy of medial opening wedge HTO. DESIGN: Single-center, open-label, assessor-blinded randomized trial with a parallel preference arm. (ClinicalTrials.gov: NCT02003976). SETTING: Tertiary care center. PARTICIPANTS: 145 adults with varus alignment and symptomatic knee osteoarthritis primarily involving the medial compartment. INTERVENTION: Nonsurgical management plus HTO compared with nonsurgical management alone (control), which included supervised therapeutic exercise for 3 months, nutrition counseling, and acetaminophen or nonsteroidal anti-inflammatory drugs as needed. MEASUREMENTS: The primary outcome was 2-year change in medial tibiofemoral articular cartilage thickness, measured on masked 3-Tesla magnetic resonance images, with a 6.3% loss considered the minimal clinically important difference (MCID). A key secondary outcome was change in the total Knee Injury and Osteoarthritis Outcome Score (KOOS; range, 0 to 100; MCID, 10 points). RESULTS: A total of 59 of 71 participants (83%; 30 HTO, 29 control) in the randomized arm and 65 of 74 (88%; 36 HTO, 29 control) in the preference arm were assessed at baseline and 2 years of follow-up. In the randomized arm, the mean 2-year change in medial tibiofemoral articular cartilage thickness was -0.07 mm in the HTO group (a loss of 2%) and -0.25 mm in the control group (a loss of 9%), for a mean between-group difference of 0.18 mm (95% CI, 0.18 to 0.19 mm). The change in total KOOS was 24.95 points in the HTO group and 9.06 points in the control group (mean difference, 15.89 points [CI, 8.94 to 22.84 points]). These outcomes also favored HTO in the preference arm. LIMITATION: Single-center study. CONCLUSION: 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. PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research, Arthritis Society Canada, and Bernard and Norton Wolf Family Foundation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".