Investigation of exercise, nutrition, and high tibial osteotomy interventions for patients with medial dominant knee osteoarthritis
Purpose: To evaluate the effectiveness of two distinct interventions in improving outcomes for patients with knee osteoarthritis (OA) and varus alignment: 1) a 12-week minimally supervised therapeutic exercise program with nutrition recommendations, 2) and high tibial osteotomy (HTO). Methods: This dissertation involved four studies. Participants were recruited as part of two separate ongoing prospective cohort studies evaluating clinical, biomechanical, and physiological outcomes following a) a 12-week exercise and nutrition program (studies 1-2) or b) HTO (studies 3-4) for knee OA. For studies 1 & 2, we evaluated change in physiological measures (body composition, muscle strength, gait biomechanics), patient-reported measures (pain, function, quality of life, perceived exertion) and performance-based measures, and explored associations among variables. For studies 3 & 4, we evaluated responder criteria at 2 years after HTO, the rate of conversion from HTO to total knee replacement (TKR), and changes in patient-reported outcomes and gait biomechanics at 2, 5 and 10 years after HTO. We also evaluated associations between demographics and biomechanics with various clinical outcomes (i.e., responder criteria, TKR, clinically important improvements in patient-reported outcomes). Results: For the exercise and nutrition program, patients worked harder while experiencing decreases in exercise-induced pain. Patients also experienced substantial improvements in physiological measures (body composition, muscle strength, gait speed), and patient-reported and performance-based outcomes. While physiological measures were associated with patient-reported and performance-based outcomes, magnitudes of association were small. Following HTO, 78% of patients were responders to surgery at 2 years. There were also 5% of patients who went on to a TKR at 5 years, and 20% at 10 years after HTO. Substantial improvements in pain and function, and reductions in knee joint moments (i.e., >40%) were also maintained up to 10 years post-HTO. Changes in gait biomechanics were associated future TKR and meaningful improvements in pain and function. Conclusions: We showed a therapeutic exercise and nutrition program similar to everyday physical therapy practice can be effective in improving various patient outcomes. We also showed HTO leads to substantial long-term improvements and may delay the need for TKR, suggesting HTO may provide an opportunity for secondary prevention of OA.
knee osteoarthritis, exercise, nutrition, high tibial osteotomy, varus alignment, knee joint moments
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