CORRInsights®: Lateral-compartment Osteophytes are not Associated With Lateral-compartment Cartilage Degeneration in Arthritic Varus Knees

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Patients with medial compartment osteoarthrosis who opt for surgical treatment often choose between (1) TKA, (2) unicompartmental knee arthroplasty (UKA), and (3) osteotomy. There is a commonly held belief among knee surgeons that knee radiographs which reveal the presence of osteophytes in the lateral compartment or in the patella-femoral compartment, reflect arthritic change within those compartments, and therefore, constitute an almost absolute indication for TKA and a contraindication for either UKA or osteotomy. This notion (what I call the “osteophyte myth”) has resulted in subjecting many patients to a TKA who might well have been better served with UKA or osteotomy.
The biology and science of osteophyte formation is complex. It is likely that osteophytes develop as a result of a loss of joint homeostasis. This osteophytic response affects the entire joint not just regions adjacent to arthrosis [3].
The current study by Waldstein and colleagues helps discredit the osteophyte myth. In a series of patients undergoing TKA for medial compartment varus knee arthrosis, the authors search for the presence of degenerative articular cartilage in the lateral compartment of those patients with lateral joint osteophytes. Their search is not trivial. The study questions are stated clearly: Do lateral osteophytes correlate with lateral compartment biomechanical evidence of degeneration of lateral articular cartilage? Answer: No. Do lateral osteophytes correlate with histological evidence of degeneration of lateral articular cartilage? Answer No. This important and well-designed paper helps dispel the myth that osteophytes indicate adjacent degenerative cartilage.
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