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Purpose: This narrative review describes experiences at the Fowler Kennedy Sport Medicine Clinic (FKSMC) with high tibial osteotomy (HTO) for patients with varus gonarthrosis, with particular focus on research published from the unit that has guided practice.Methods: The goals of surgery are to improve alignment of the weight bearing axis of the lower limb to lessen the load on the medial tibiofemoral compartment and thereby decrease these important risk factors for disease progression. The overall aims are to improve knee function and delay or even prevent the eventual need for arthroplasty. To achieve these aims, a medial opening wedge osteotomy is utilised, deliberately avoiding an over correction of the lower limb, but tailoring the angle of correction to an individual patient's characteristics. With such an approach, patients with a broad range of characteristics (including age, BMI and lateral compartment involvement) can benefit from the procedure. In addition, the HTO can be used with concomitant procedures to address specific presentations, such as large deformities and instability.Results: The results suggest that correction to a slight valgus alignment produces approximately 50% reduction in medial compartment loads during gait with large, clinically important improvements in patient-reported outcomes at 2-years postoperatively. In patients with substantial bilateral varus deformity, unilateral surgery can lead to increased dynamic knee joint loads on the nonoperative limb after surgery. This means that such patients require the close monitoring of both limbs and consideration of a staged, bilateral procedure if necessary. In patients requiring bilateral surgery, similar results after bilateral HTO to those after unilateral surgery have been reported. For patients requiring large corrections, the need for a concomitant tibial tubercle osteotomy to reduce the potential for iatrogenic patella infera is considered. Finally, HTO procedures can also be used in patients with instability, either to alter both sagittal and coronal alignment to correct instability in complex ligament deficiencies or to undertake simultaneous HTO and ACL reconstruction.Conclusions: HTO is being used both alone and in conjunction with concomitant procedures with good clinical results. While continued investigation into patient selection and outcomes are required, current research indicates that HTO offers at least a partial solution for the patient with varus gonarthrosis to prolong the life of their native knee joint.Level Of Evidence: V. [ABSTRACT FROM AUTHOR]

Objective: To evaluate trajectories of knee pain and perceived exertion during a neuromuscular exercise (NEMEX) program for patients with knee osteoarthritis (OA). Methods: Fifty-two participants with knee OA underwent a 12-week NEMEX program. At baseline, patients received instructions for a NEMEX program, consisting of 12 visits with a physiotherapist plus home exercises. We assessed the Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) pre and post program and measured knee pain (pre, post, max) and the overall rating of perceived exertion (RPE) at each exercise visit. We calculated change in pain (PC; pre to post) and acute pain flare up (PF; pre to max level) for each visit. We evaluated mean changes (with 95%CI) for the ICOAP from pre- to post-program. We performed linear regression to investigate pain trajectory over time, using the group mean of PC for each exercise visit as the outcome and time as the predictor. The analysis was repeated for PF and RPE. Results: Fifty patients (96%) completed the program. Decreases in intermittent [12.2 (95%CI 5.1, 19.3)], constant [14.1 (95%CI 8.0, 20.1)] and total pain [13.2 (95%CI 7.3, 19.1)] over the 12-week program indicated substantial improvements. PC and PF levels decreased over time by 0.07 (95%CI 0.01, 0.12) and 0.07 (95%CI 0.02, 0.12) per exercise visit, respectively. RPE increased over time by 0.24 (95%CI 0.12, 0.34) per exercise visit. Time (i.e. increasing number of exercise sessions) explained 36% of the change in PC level, 42% of the change in PF level and 73% of the change in RPE. Conclusion: Exercise-induced pain decreased while perceived exertion while exercising increased during a 12-week NEMEX program for patients with knee OA. Clinical implications: Patients with knee OA and their therapists should expect that exercise-induced knee pain during a neuromuscular exercise program will decrease progressively over time, enabling gradual increases in exertion and perhaps intensity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of knee aspiration and intraarticular corticosteroid injection on gait biomechanics and strength in patients with knee osteoarthritis (OA) and active inflammation. Methods: Fifteen patients with knee OA, synovitis and effusion were tested before and 3 weeks after receiving a knee aspiration and triamcinolone injection. All patients' ultrasound (US) exam revealed signs of inflammation that aligned with symptoms. A standard of care knee aspiration and injection was performed under US guidance. Three-dimensional quantitative gait analysis included peak knee angles and moments during walking. Muscular strength testing included isokinetic knee flexion and extension torque at 90 deg/s. Ultrasound, gait and strength tests were completed by the same examiner to reduce variability. Paired t-tests were used to assess changes. Results: Pre minus post mean changes (95% CI) were: peak knee varus angle -0.11 deg (-1.97, 1.76), first peak knee adduction moment (KAM) 0.01 %BW*ht (-0.33, 0.35), second peak KAM -0.05 %BW*ht (-0.49, 0.39), peak knee flexion excursion angle -2.5 deg (-4.50, -0.59), peak knee flexion moment -0.57 %BW*ht (-1.06, -0.68), peak knee extension moment -0.06 %BW*ht (-0.64, 0.52), peak quadriceps strength -6.14 Nm (-16.92, 4.65) and peak hamstring strength -5.59 Nm (-11.14, -0.03). Conclusion: Preliminary results suggest patients undergoing aspiration and injection for knee synovitis and effusion experience increased sagittal plane angles and moments during walking and increased maximal hamstring strength. Clinical implications: Future work will categorize patients as responders and non-responders based on OARSI-OMERACT responder criteria to analyze between group differences. [ABSTRACT FROM AUTHOR]