Bone & joint open · 2025
What is the clinical and cost-effectiveness of surgery with Medial Opening wedge high TIbial Osteotomy compared with Non-surgical treatment (MOTION) in the management of osteoarthritis of the knee in patients younger than 60 years? : a protocol for a multicentre, randomized controlled trial.
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Amin Anish K, Locherty Rachel, Agarwal Nikhil, Rickman Hannah, Metcalfe Andrew, Blyth Mark John Graham, Scott Chloe E H, Clement Nick D, Miller Martine, Dobbie Fiona, Stoddart Andrew, Hamilton David F, Ralston Stuart H, Lewis Steff, Duckworth Andrew D
Аннотация
AIMS: For patients aged < 60 years with symptomatic medial compartment knee osteoarthritis (OA), there is uncertainty regarding the most effective management (surgical or non-surgical). Surgical realignment with a high tibial osteotomy (HTO) can relieve pain and improve function, while also potentially avoiding or delaying a knee arthroplasty. However, HTO has never been compared with non-surgical treatment in this patient group. MOTION (Medial Opening wedge high TIbial Osteotomy compared with Non-surgical treatment) aims to determine the relative clinical effectiveness and cost-effectiveness of HTO compared with non-surgical management for patients aged < 60 years with medial compartment knee OA.
METHODS: MOTION is a pragmatic, multicentre, prospective randomized open blinded endpoint (PROBE) parallel group-controlled superiority trial. A total of 224 patients (112 per arm) will be recruited from approximately 20 UK sites. Patients aged < 60 years with moderate to severe symptomatic knee OA localized to the medial compartment, in whom surgical intervention is indicated, are eligible. The intervention is surgery with medial opening wedge HTO followed by standard postoperative rehabilitation, compared with a non-surgical intervention in the form of personalized knee therapy (PKT) focused on a structured, progressive, and tailored exercise programme of rehabilitation. Participants will be randomly assigned to one of the two treatment arms in a 1:1 ratio. The primary outcome is the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 24 months post randomization. Secondary outcomes include the Oxford Knee Score (OKS), Forgotten Joint Score (FJS), EuroQol five-dimension questionnaire (EQ-5D), Sleep Problem Scale, return to work, need for secondary surgical intervention, and adverse events at 12 and 24 months. Health economic evaluation will determine the cost-effectiveness of the interventions. MOTION is funded by the National Institute for Health and Care Research (Ref: NIHR129820).
DISCUSSION: MOTION aims to determine whether HTO is a superior option to non-surgical management (PKT) for patients aged < 60 years with medial compartment knee OA with regard to both the clinical benefit for patients and cost-effectiveness for the NHS.
METHODS: MOTION is a pragmatic, multicentre, prospective randomized open blinded endpoint (PROBE) parallel group-controlled superiority trial. A total of 224 patients (112 per arm) will be recruited from approximately 20 UK sites. Patients aged < 60 years with moderate to severe symptomatic knee OA localized to the medial compartment, in whom surgical intervention is indicated, are eligible. The intervention is surgery with medial opening wedge HTO followed by standard postoperative rehabilitation, compared with a non-surgical intervention in the form of personalized knee therapy (PKT) focused on a structured, progressive, and tailored exercise programme of rehabilitation. Participants will be randomly assigned to one of the two treatment arms in a 1:1 ratio. The primary outcome is the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 24 months post randomization. Secondary outcomes include the Oxford Knee Score (OKS), Forgotten Joint Score (FJS), EuroQol five-dimension questionnaire (EQ-5D), Sleep Problem Scale, return to work, need for secondary surgical intervention, and adverse events at 12 and 24 months. Health economic evaluation will determine the cost-effectiveness of the interventions. MOTION is funded by the National Institute for Health and Care Research (Ref: NIHR129820).
DISCUSSION: MOTION aims to determine whether HTO is a superior option to non-surgical management (PKT) for patients aged < 60 years with medial compartment knee OA with regard to both the clinical benefit for patients and cost-effectiveness for the NHS.