High tibial osteotomy (HTO) is a limb realignment surgery which is intended for people who have medial compartment osteoarthritis (OA), but are not suitable candidates for total knee replacement due to younger age, less severe disease and greater physical demands. The aim of HTO is to correct alignment, thereby shifting load away from the more involved knee compartment and limit progression of knee OA.

On this week's episode of Joint Action, we are joined by Dr Trevor Birmingham and Dr David Parker to discuss high tibial osteotomy surgery, who it is suitable for and the risks involved.

Professor Trevor Birmingham is a physiotherapist and Canada Research Chair in Musculoskeletal Rehabilitation at the University of Western Ontario in London, Canada. He leads research on musculoskeletal health, often combining clinical outcomes with biomechanical, imaging and biological measures in cohort studies and randomized trials. He co-directs the Wolf Orthopaedic Biomechanics Lab at the Fowler Kennedy Sport Medicine Clinic and is a founding member of the Bone and Joint Institute and the Collaborative Graduate Training Program in Musculoskeletal Health Research at Western University.

Dr David Parker is an experienced orthopaedic knee specialist and co-founder of the Sydney Orthopaedic Research Institute (SORI). He is passionate about sport and is actively involved with international orthopaedic and sports medicine organisations and has extensive experience with athletes of all levels from recreational to elite. Dr Parker has authored over 100 peer-reviewed publications and many textbook chapters and has been awarded the Australian Orthopaedic Association Prize for Research.

RESOURCES

Journal articles

• Total knee replacement after high tibial osteotomy: time-to-event analysis and predictors

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This week's episode is in honour of Frank Beier, who recently passed away on July 18, 2025. Frank leaves behind a remarkable legacy through the impact he made in the field of osteoarthritis. In this previous episode (2021), he discussed the recent advances in osteoarthritis understanding with a particular emphasis on novel targets and epigenetics.

Despite the large prevalence of osteoarthritis, there is no clinically approved drug which provides a cure. Currently, drugs focus on relieving symptoms such as pain. Experiments done in the laboratory have provided insight on osteoarthritis onset and progression and will likely guide therapeutic development.

We know that osteoarthritis is a disease of the whole organ meaning that any of the tissues involved in the synovial joint can be affected. The interplay between the various cell types involved is complex and understanding the interactions between cartilage, bone and synovium may be critical to therapeutic development.

Skeletal development likely plays a very important role in predisposition to disease. Through the identification of serious pathologies such as various forms of dwarfism (what in medical terms are called chondrodysplasias) the role of transcription factors and epigenetics is increasing our understanding of disease genesis.The study of the epigenetics of OA - the mechanism by which the human genome alters it’s gene expression (without changing the primary DNA sequence) has provided valuable information on novel risk factors for the disease and are potential therapeutic targets for OA.

RESOURCES

Journal articles

• Nuclear receptors as potential drug targets in osteoarthritis
• Interplay between genetics and epigenetics in osteoarthritis
• Recent developments in emerging therapeutic targets of osteoarthritis

CONNECT WITH US

• Twitter: @ProfDavidHunter @jointactionorg
• Email: hello@jointaction.info
• Website: www.jointaction.info/podcast

If you enjoyed this episode, don't forget to subscribe to learn more about osteoarthritis from the world's leading experts! And please let us know what you thought by leaving us a review!

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On this week's episode of Joint Action discover how ultra-processed foods may be silently contributing to osteoarthritis. Dr Gabby Joseph joins us to discuss her research research linking poor diet quality to greater knee pain, poorer physical function and thinner knee cartilage.

Dr Gabby Joseph is a scientist and statistician with over 20 years of experience leading research funded by the US government at the University of California San Francisco, Her work focuses on musculoskeletal imaging, predictive modelling, and clinical study design, with a focus on applying advanced statistical and machine learning methods to improve patient outcomes

She is the co-Director of The University of California's Clinical & Translational Musculoskeletal Imaging group and passionate about making sense of complex data so that it can be used to improve real-world care.

RESOURCES

• Ultra-processed food consumption is associated with knee osteoarthritis: Data from the Osteoarthritis Initiative

CONNECT WITH US

• Twitter: @ProfDavidHunter @jointactionorg
• Instagram: @osteoarthritisresearchgroup
• Email: osteoarthritis.research@sydney.edu.au
• Website: www.jointaction.info/podcast

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