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Contact the study team using the details below to take part. If there are no contact details below please ask your doctor in the first instance.

Contact Information:

Mr Anish Amin
+44 (0)131 242 6881
Anish.K.Amin@ed.ac.uk


Miss Rachel Penman
+44 (0)131 651 9970
r.penman@ed.ac.uk


More information about this study, what is involved and how to take part can be found on the study website.

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Be Part of Research - Trial Details - A randomised study to compare the outcomes after realignment knee surgery versus non-surgical treatment with bespoke knee physiotherapy, for patients under 60 years of age with osteoarthritis of the knee
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A randomised study to compare the outcomes after realignment knee surgery versus non-surgical treatment with bespoke knee physiotherapy, for patients under 60 years of age with osteoarthritis of the knee

Not Recruiting

Open to: All Genders

Age: Adult

Edinburgh Coventry Salisbury Birmingham Glasgow Aberdeen Kirkcaldy Sunderland Hamilton Oxford Kingston upon Thames London Warrington Maidstone Colchester Prescot London London Camberley,

Medical Conditions

Medial compartment knee osteoarthritis

This information is provided directly by researchers, and we recognise that it isn't always easy to understand. We are working with researchers to improve the accessibility of this information. In some summaries, you may come across links to external websites. These websites will have more information to help you better understand the study.


Osteoarthritis (OA) is the leading cause of disability worldwide and most commonly affects the knee joint causing issues with mobility, quality of life, and ability to work. Treatment options include non-surgical management and surgery may also be considered. Knee replacement is successful in patients over 60 years but less so if under 60 as the implant wears out sooner, therefore alternative options are sought to delay knee replacement surgery as long as possible. High tibial osteotomy (HTO), is a surgical procedure where the bone is cut just below the knee joint and a small wedge is opened, to shift the person’s weight away from the damaged part of the knee to a healthy part of the knee. This can decrease pain, improve function and delay or avoid the need for knee replacement. Personalised knee therapy (PKT) is a physiotherapist-delivered non-surgical focussed intervention consisting of a programme of exercise alongside exercise enabling pain relief (external braces if required) which aims to improve muscle control in the lower limb and knee joint, to shift weight away from the ‘worn’ part of the knee, help reduce pain and avoid the need for further surgery. In this study, the team want to find out if HTO is better at delaying or avoiding knee replacement surgery than PKT alone in patients under 60 years old by comparing these two interventions.

Start dates may differ between countries and research sites. The research team are responsible for keeping the information up-to-date.  

The recruitment start and end dates are as follows:

01 Feb 2023 01 Apr 2025

Patients will be enrolled at around 20 NHS hospitals in the UK to determine the clinical (pain relief, improvement in function, quality of life, return to work) and cost-effectiveness of both treatments at 24 months. A mixed method process evaluation in a subset of staff and patients will explore trial eligibility; recruitment and retention; acceptability of intervention implementation including trial processes and collection of routine monitoring data; patient experience of taking part and the contextual factors that influence this.

For participants randomised to the surgical group:
1. They will be placed on a routine NHS waiting list to have the HTO surgery
2. They will have their surgery at their local hospital and follow the local process for having the surgery and recovering from the operation. After their operation, they will receive standard postoperative rehabilitation from their hospital

For participants randomised to the non-surgical group:
1. They will be referred to the local NHS Physiotherapy department at the hospital and receive the specialised PKT physiotherapy programme of rehabilitation for knee OA
2. PKT will be delivered at their local NHS physiotherapy department over six sessions within a period of 3-4 months

Participants in both arms of the study will get the same questionnaires at 12 and 24 months post-randomisation (either via post or email) to assess whether these treatments have worked.


Patients aged >18 and <60 years with old with symptomatic medial compartment knee OA who the treating orthopaedic surgeon considers a suitable candidate for medial opening wedge HTO

You can take part if:



You may not be able to take part if:


1. Aged <18 or >60 years old2. Body mass index (BMI) >403. Patients considered for HTO but who DO NOT have any knee OA including:3.1. Offloading HTO for concomitant cartilage repair (No OA)3.2. Offloading HTO solely to treat ligamentous instability (ACL/PCL)3.3. Symptomatic avascular necrosis/osteonecrosis3.4. Correction of intraarticular or extraarticular post-traumatic knee deformity4. Patients requiring double-level knee osteotomy for correction of deformity5. History of inflammatory arthropathy including rheumatoid arthritis, gout, psoriasis 6. Previous high tibial or distal femoral osteotomy in the same or contralateral knee7. Previous knee replacement (partial or total) in the same or contralateral knee8. Cognitive impairment or inability to consent.9. Inability to comply with study procedures. 10. Previous history of septic arthritis in the knee


Below are the locations for where you can take part in the trial. Please note that not all sites may be open.

  • NHS Lothian
    Waverley Gate 2-4 Waterloo Place
    Edinburgh
    EH1 3EG
  • University Hospitals Coventry and Warwickshire NHS Trust
    Walsgrave General Hospital Clifford Bridge Road
    Coventry
    CV2 2DX
  • Salisbury District Hospital
    Salisbury District Hospital Odstock Road
    Salisbury
    SP2 8BJ
  • University Hospitals Birmingham NHS Foundation Trust
    Queen Elizabeth Hospital Mindelsohn Way Edgbaston
    Birmingham
    B15 2GW
  • NHS Greater Glasgow and Clyde
    J B Russell House Gartnavel Royal Hospital 1055 Great Western Road Glasgow
    Glasgow
    G12 0XH
  • NHS Grampian
    Summerfield House 2 Eday Road
    Aberdeen
    AB15 6RE
  • NHS Fife
    Hayfield House Hayfield Road
    Kirkcaldy
    KY2 5AH
  • Sunderland Royal Hospital
    Kayll Road
    Sunderland
    SR4 7TP
  • NHS Lanarkshire
    14 Beckford Street
    Hamilton
    ML3 0TA
  • Oxford University Hospitals
    John Radcliffe Hospital Headley Way Headington
    Oxford
    OX3 9DU
  • Kingston Hospital NHS Foundation Trust
    Galsworthy Road
    Kingston upon Thames
    KT2 7QB
  • Lewisham and Greenwich NHS Trust
    University Hospital Lewisham Lewisham High Street
    London
    SE13 6LH
  • Warrington and Halton Teaching Hospitals NHS Foundation Trust
    Warrington Hospital Lovely Lane
    Warrington
    WA5 1QG
  • The Maidstone Hospital
    Hermitage Lane
    Maidstone
    ME16 9QQ
  • East Suffolk and North Essex NHS Foundation Trust
    Colchester Dist General Hospital Turner Road
    Colchester
    CO4 5JL
  • Whiston Hospital (site)
    Whiston Hospital Warrington Road
    Prescot
    L35 5DR
  • Guys and St Thomas' NHS Foundation Trust
    St Homas' Hospital Westminster Bridge
    London
    SE1 7EH
  • St George's University Hospital NHS Foundation Trust
    St George's Hospital Blackshaw Road Tooting
    London
    SW17 0QT
  • Frimley Health NHS Foundation Trust
    Portsmouth Road Frimley
    Camberley,
    GU16 7UJ

Both treatment options (non-surgical and surgical) have been proven in previous studies to improve knee pain, reduce disability and delay or avoid the need for a knee replacement altogether.
Non-surgical treatment has the obvious advantage that it does not require an operation and all the risks that go with an operation. The non-surgical treatment takes around 3-4 months to deliver and requires participants to attend at least six sessions with the physiotherapist and commit to the tailored exercise programme over this time. Participants may also be offered bracing and steroid injections. The treatment is directed at improving symptoms from osteoarthritis and does not alter the alignment of the lower leg.

Mr Anish Amin
+44 (0)131 242 6881
Anish.K.Amin@ed.ac.uk


Miss Rachel Penman
+44 (0)131 651 9970
r.penman@ed.ac.uk



More information about this study, what is involved and how to take part can be found on the study website.


The study is sponsored by University of Edinburgh; NHS Lothian and funded by National Institute for Health and Care Research.




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Read full details for Trial ID: ISRCTN99042491

Or CPMS 55238

Last updated 17 April 2025

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