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Sim JA, Jeun J, Lee BH. Offloading effect in the unoperated contralateral knee after unilateral medial open wedge high tibial osteotomy: A SPECT/CT analysis. Knee 2024; 51:58-64. [PMID: 39236638 DOI: 10.1016/j.knee.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND An open wedge high tibial osteotomy (OWHTO) may lead to gait alteration, which change the contact loading in the contralateral knee, while clear evidence about the impact on contralateral knee still lacks. The purpose of the current study was to evaluate the change in scintigraphic uptake using SPECT-CT in the medial compartment of the contralateral knee following OWHTO. METHODS Contralateral radiographic measurements were performed for patients with medial osteoarthritis and varus malalignment of >5° treated with OWHTO in this retrospective analysis. The medial compartmental changes according to SPECT/CT analysis before and 1-year after OWHTO were evaluated on the contralateral side. RESULTS The study comprised 72 patients. The mean preoperative mechanical femorotibial angle was a mean varus of 7.6° (range, 5.1° - 13.0°), corrected to a mean valgus of 2.5° (range, 1.9° - -8.5°) postoperatively. The average grading of the scintigraphic uptakes in the medial compartment of the contralateral knee was significantly decreased 1 year postoperatively than after the surgery (from 2.8 ± 0.4 to 2.1 ± 0.6, p < 0.001). Measurable differences in varus alignment on radiographs of the contralateral limb were identified. The preoperative mechanical axis value decreased from 8.0° ± 2.4° to 6.7° ± 2.6° at the 3-month postoperative visit (p = 0.011). The overall decrease in varus alignment remained at the 2-year final postoperative follow-up. CONCLUSION Alignment correction by OWHTO results in reducing scintigraphy uptakes in medial compartment and improvement in mechanical alignment of the contralateral knee. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Jae Ang Sim
- Department of Orthopaedic Surgery, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Jigang Jeun
- Department of Orthopaedic Surgery, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Byung Hoon Lee
- Department of Orthopaedic Surgery, Gachon University College of Medicine, Incheon, Republic of Korea.
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Wen PY, Sun H, Li J, Fu C, Chen P, Yu J, Chen W, Zhang Y. Is single-stage bilateral medial opening wedge high tibial osteotomy advisable? BMC Musculoskelet Disord 2024; 25:497. [PMID: 38926688 PMCID: PMC11201859 DOI: 10.1186/s12891-024-07501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 05/06/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To validate the safety and clinical results of single-stage bilateral versus unilateral medial opening wedge high tibial osteotomy (HTO). METHODS A propensity-matched cohort study was performed from March 2020 to March 2021 in our medical center. Data were prospectively collected. Including 34 patients who underwent single-stage bilateral medial opening HTO(SSBHTO), and 68 cases in the unilateral group. Propensity-matched ration was 2:1 based on age, sex, and body mass index using R software. Comparisons of the length of hospital stay, operative time, blood loss, postoperative adverse events, 90-day readmission rate, conversion to TKA rate, self-reported VAS and WOMAC scores were made to investigate the safety and clinical results of bilateral HTO. RESULTS The mean length of hospital stay was 7.36 ± 2.23 days for SSBHTO and 7 days (IQR, 3 days; range, 4 to 23 days) for the unilateral group (P = 0.219). The mean operative time was 144 ± 47 min for bilateral HTO and 105(37.5) mins for a unilateral OWHTO (P < 0.001). The mean blood loss was 150(100) ml for SSBHTO and 100(50) ml for unilateral OWHTO (P < 0.001). There were no significant difference of the adverse events and 90-day readmission rate between two groups. No failed HTO or conversion to knee arthroplasty were observed at the end of follow-up. VAS, pain, stiffness, and functional scores of the WOMAC scale were essentially comparable of two groups one year after surgery (P > 0.05). CONCLUSIONS A single-stage bilateral medial opening wedge high tibial osteotomy is advisable for patients with knee osteoarthritis. Patients benefit from avoiding secondary anesthesia, postoperative complications, and substantial cost savings. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Peizhi Yu Wen
- Orthopaedic Research Institute, Shijiazhuang, Hebei Province, People's Republic of China
| | - Huilian Sun
- The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Shijiazhuang, 050004, People's Republic of China
| | - Jiaqi Li
- Orthopaedic Research Institute, Shijiazhuang, Hebei Province, People's Republic of China
| | - Chunxu Fu
- Orthopaedic Research Institute, Shijiazhuang, Hebei Province, People's Republic of China
| | - Pengzhao Chen
- Orthopaedic Research Institute, Shijiazhuang, Hebei Province, People's Republic of China
| | - Jiahao Yu
- Orthopaedic Research Institute, Shijiazhuang, Hebei Province, People's Republic of China
| | - Wei Chen
- Trauma Emergency Center, Shijiazhuang, People's Republic of China
- Department of Orthopedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- Orthopaedic Research Institute, Shijiazhuang, Hebei Province, People's Republic of China.
- Trauma Emergency Center, Shijiazhuang, People's Republic of China.
- Department of Orthopedic Surgery, NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People's Republic of China.
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, People's Republic of China.
- Engineering Research Center of Orthaepedic, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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Higuchi T, Koseki H, Yonekura A, Imai C, Tomonaga I, Sunagawa S, Matsumura U, Osaki M. Comparison of short-term clinical outcomes between open-wedge high tibial osteotomy and tibial condylar valgus osteotomy. BMC Musculoskelet Disord 2024; 25:98. [PMID: 38281004 PMCID: PMC10821256 DOI: 10.1186/s12891-024-07205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND This study aimed to compare radiological features and short-term clinical outcomes between open-wedge high tibial osteotomy (OWHTO) and tibial condylar valgus osteotomy (TCVO), to provide information facilitating decision-making regarding those two procedures. METHODS Twenty-seven cases involving 30 knees that had undergone OWHTO (HTO group) and eighteen cases involving 19 knees that had undergone TCVO (TCVO group) for medial compartment knee osteoarthritis (OA) were retrospectively evaluated. Patient characteristics, severity of knee OA, lower limb alignment, joint congruity and instability were measured from standing full-length leg and knee radiographs obtained before and 1 year after surgery. Range of motion in the knee joint was measured and Knee Injury and Osteoarthritis Outcome Score (KOOS) was obtained to evaluate clinical results preoperatively and 1 year postoperatively. RESULTS Mean age was significantly higher in the TCVO group than in the HTO group. Radiological features in the TCVO group included greater frequencies of advanced knee OA, varus lower limb malalignment, higher joint line convergence angle, and varus-valgus joint instability compared to the HTO group before surgery. However, alignment of the lower limb and joint instability improved to comparable levels after surgery in both groups. Maximum flexion angles were significantly lower in the TCVO group than in the HTO group both pre- and postoperatively. Mean values in all KOOS subscales recovered similarly after surgery in both groups, although postoperative scores on three subscales (Symptom, Pain, and ADL) were lower in the TCVO group (Symptom: HTO, 79.0; TCVO, 67.5; Pain: HTO, 80.5; TCVO, 71.1; ADL: HTO, 86.9; TCVO, 78.0). CONCLUSIONS Both osteotomy procedures improved short-term clinical outcomes postoperatively. TCVO appears preferable in cases of advanced knee OA with incongruity and high varus-valgus joint instability. An appropriate choice of osteotomy procedure is important to obtain favorable clinical outcomes.
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Affiliation(s)
- Takashi Higuchi
- Department of Physical Therapy, Osaka University of Human Sciences, Settsu, Japan
| | - Hironobu Koseki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan.
- Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chieko Imai
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Iku Tomonaga
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinya Sunagawa
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Umi Matsumura
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Yoon KH, Song SJ, Hwang SH, Jung CH, Park CH. Use of Grafts on an Open Gap Is Advantageous for Preventing Correction Loss in 1-Week Staged Bilateral Open-Wedge High Tibial Osteotomies. J Knee Surg 2024; 37:49-55. [PMID: 36270324 DOI: 10.1055/a-1965-5631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
One-week staged bilateral open-wedge high tibial osteotomies (OWHTOs) can be a safe procedure, with the added advantage of fast functional recovery, cost saving, and reduced hospital stay. However, there can be concerns about correction loss after 1-week staged OWHTOs because high loading is inevitably applied to osteotomy sites during postoperative weight bearing. Although leaving the osteotomy site with no grafts is possible in OWHTOs, the use of grafts can provide additional stability to the osteotomy site and prevent correction loss. We compared the amount and incidence of correction loss between 1-week staged bilateral OWHTOs with and without allogenic bone grafts. Seventy-five patients who underwent 1-week staged bilateral OWHTOs with a locking spacer plate (Nowmedipia, Seoul, Korea) by a single surgeon were retrospectively reviewed. Allogenic cancellous bone grafts were applied in 53 patients (group G; 106 knees, operated consecutively between 2012 and 2017) but not in 22 patients (group N; 44 knees, operated consecutively between 2017 and 2019). Demographics were similar between the groups. Radiographically, the mechanical axis (MA), medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) were evaluated preoperatively and within 1 year postoperatively. Unstable hinge fracture was investigated using computed tomography in all cases. The incidence of correction loss (MPTA loss ≥ 3 degrees) was determined. There were no significant differences in the MA, MPTA, and PTS between the groups preoperatively and 2 weeks postoperatively. The incidence of unstable hinge fractures did not differ. The losses in MA, MPTA, and PTS during the first postoperative year were significantly greater in group N than in group G (MA, -5.5 vs. -2.3 degrees; MPTA, -3.0 vs. 0 degrees; PTS, -2.0 vs. -0.7 degrees; p < 0.05 on all parameters). The correction loss incidence was 6.6% (7/106) and 31.8% (14/44) in groups G and N, respectively (p < 0.001). Appropriate treatment is necessary to prevent correction loss in 1-week staged bilateral OWHTOs. Grafting, which provides additional stability to the osteotomy site, is a recommended method. Level of evidence is IV.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Hyun Hwang
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hyun Jung
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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Kang Y, Kim J, Sim JA, Moon M, Park JC, Cho SH, Lee BH. Stress Effect in the Knee Joint Based on the Fibular Osteotomy Level and Varus Deformity: A Finite Element Analysis Study. Bioengineering (Basel) 2023; 10:1003. [PMID: 37760105 PMCID: PMC10650311 DOI: 10.3390/bioengineering10091003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023] Open
Abstract
Proximal fibular osteotomy (PFO) was found to relieve pain and improve knee function in patients with medial compartment knee osteoarthritis (OA). Therapy redistributes the load applied from the inside to the outside and alleviates the load applied on the inside through fibula osteotomy. Therefore, the clinical effect of fibular osteotomy using the finite element (FE) method was evaluated to calculate the exact change in stress inside a knee joint with varus deformity. Using CT and MRI images of a patient's lower extremities, 3D models of the bone, cartilage, meniscus, and ligaments were constructed. The varus angle, representing the inward angulation of the knee, was increased by applying a force ratio in the medial and lateral directions. The results showed that performing proximal fibular osteotomy led to a significant reduction in stress in the medial direction of the meniscus and cartilage. The stress reduction in the lateral direction was relatively minor. In conclusion, the study demonstrated that proximal fibular osteotomy effectively relieves stress and redistributes the load in the knee joints of patients with medial compartment knee osteoarthritis. The findings emphasize the importance of considering force distribution and the position of fibular osteotomy to achieve optimal clinical outcomes.
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Affiliation(s)
- Yeokyung Kang
- Central Research & Development Center, Corentec Company Co., Ltd., 33-2, Banpo-daero 20-gil, Seocho-gu, Seoul 06649, Republic of Korea; (Y.K.); (J.K.)
| | - Jungsung Kim
- Central Research & Development Center, Corentec Company Co., Ltd., 33-2, Banpo-daero 20-gil, Seocho-gu, Seoul 06649, Republic of Korea; (Y.K.); (J.K.)
| | - Jae Ang Sim
- Department of Orthopedic Surgery, Gachon University College of Medicine, Namdong-gu, Incheon 21565, Republic of Korea; (J.A.S.); (S.H.C.)
| | - Myeong Moon
- Medical School, Gachon University College of Medicine, Namdong-gu, Incheon 21565, Republic of Korea;
| | - Jong-Chul Park
- Cellbiocontrol Laboratory, Department of Medical Engineering, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Sung Ha Cho
- Department of Orthopedic Surgery, Gachon University College of Medicine, Namdong-gu, Incheon 21565, Republic of Korea; (J.A.S.); (S.H.C.)
| | - Byung Hoon Lee
- Department of Orthopedic Surgery, Gachon University College of Medicine, Namdong-gu, Incheon 21565, Republic of Korea; (J.A.S.); (S.H.C.)
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Kim Y, Kubota M, Sato T, Tanabe H, Ohno R, Ishijima M. Hip abduction angle after open-wedge high tibial osteotomy is associated with the timed up & go test and recurrence of varus alignment. Sci Rep 2023; 13:7047. [PMID: 37120621 PMCID: PMC10148799 DOI: 10.1038/s41598-023-33481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 04/13/2023] [Indexed: 05/01/2023] Open
Abstract
The aim of this study is to investigate the association between the hip abduction angle (HAA) and lower limb alignment as well as the clinical assessments in open-wedge high tibial osteotomy (OWHTO) patients. A total of 90 patients who underwent OWHTO were included. The demographic characteristics and clinical assessments (the Visual Analogue Scale for activities of daily living, the Japanese knee osteoarthritis measure, the Knee injury and Osteoarthritis Outcome Score, the Knee Society score, the Timed Up & Go (TUG) test, the single standing (SLS) test and muscle strength) were recorded. The patients were divided into two groups according to the HAA at 1 month after operation: the HAA (-) group (HAA < 0°) and the HAA (+) group (HAA ≥ 0°). Clinical scores except for the SLS test and radiographic parameters except for the posterior tibia slope (PTS), lateral distal femoral angle (LDFA) and lateral distal tibial angle (LDTA) were significantly improved at 2 years postoperatively. Regarding the two groups, scores on the TUG test in the HAA (-) group were significantly lower than those in the HAA (+) group (p = 0.011). The hip-knee-ankle angle (HKA), weight bearing line (WBLR) and knee joint line obliquity (KJLO) in the HAA (-) group were significantly higher than those in the HAA (+) group (p < 0.001, 0.001 and p = 0.025). In contrast, the LDFA in the HAA (-) group were significantly lower than those in the HAA (+) group (p < 0.001). The TUG test and the LDFA were weakly positively correlated with the HAA (r = 0.34, 0.42, p < 0.001 and 0.001). In contrast, the HKA, WBLR and KJLO had a weak negative correlation with the HAA (r = - 0.43, - 0.38 and - 0.37, p < 0.001, 0.001 and 0.001). This study showed the postoperative HAA was significantly associated with the TUG test and the HKA, WBLR, LDFA, and KJLO. A higher postoperative HAA might induce varus recurrence and poor outcomes of the gait parameter.
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Affiliation(s)
- Youngji Kim
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan
- Department of Orthopaedic Surgery and Sports Medicine, Faculty of Medicine, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan
| | - Mitsuaki Kubota
- Department of Orthopaedic Surgery and Sports Medicine, Faculty of Medicine, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan.
| | - Taisuke Sato
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan
- Department of Orthopaedic Surgery and Sports Medicine, Faculty of Medicine, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan
| | - Hiroki Tanabe
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan
- Department of Orthopaedic Surgery and Sports Medicine, Faculty of Medicine, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan
| | - Ryuichi Ohno
- Department of Orthopaedic Surgery, Koshigaya Municipal Hospital, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan
- Department of Orthopaedic Surgery and Sports Medicine, Faculty of Medicine, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery and Sports Medicine, Faculty of Medicine, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyoku, Tokyo, 113-8431, Japan
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Uçan V, Aliyev O, Demirkiran CB, Yildiz F, Elmali N, Uzer G. Comparison of the Functional and Radiological Outcomes of Single- and Two-Stage Bilateral Open Wedge High Tibial Osteotomy. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:51-56. [PMID: 34781390 DOI: 10.1055/a-1611-0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This study compared the functional and radiological outcomes and complications of single- (SS) and two-stage (TS) bilateral high tibial osteotomy (HTO). METHODS From 2014 to 2018, 48 patients underwent bilateral HTO surgery for osteoarthritis. The outcomes of SS in 28 knees and TS in 32 knees were compared using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS) as functional outcomes, and the medial proximal tibial (MPTA), hip-knee-ankle (HKA), tibial slope (TSA) angles, and mechanical axis deviation (MAD) as radiological outcomes. We also evaluated the estimated blood loss (EBL). RESULTS No significant differences in the pre- and postoperative mean OKS and KOOS were found between the groups. There was a significant difference between the groups in the last postoperative HKA angle (- 0.9 ± 3.9 and 1.8 ± 4.3°, respectively). In SS and TS, the respective total mean surgical time was 108 ± 28 and 143 ± 36 min (p < 0.001). The mean calculated EBL was 612 ± 267 and 544 ± 357 mL, respectively, (p = 0.5), and the mean length of stay (LOS) was 2.2 ± 0.83 and 3.5 ± 1.0 days, respectively, (p = 0.01). CONCLUSION SS bilateral HTO is a safe reasonable option for certain patients with bilateral knee osteoarthritis because it involves a single hospitalization, one-time exposure to anesthesia risks, accelerated rehabilitation, earlier return to expected life status, reduced total hospital stay, and a likely decrease in total cost.
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Affiliation(s)
- Vahdet Uçan
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | - Orkhan Aliyev
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | | | - Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | - Nurzat Elmali
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakıf University, Fatih, Turkey
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Association of the joint line orientation angle of the contralateral limb with the alignment change of the unilateral and bilateral opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2022; 31:1593-1602. [PMID: 35994078 DOI: 10.1007/s00167-022-07123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE This study aimed to evaluate and compare unilateral and bilateral open-wedge high tibial osteotomy (OWHTO) using mid-term serial assessment of clinical and radiological outcomes, especially focussing on coronal lower extremity alignment. METHODS Serial radiological assessments were performed in 40 patients (80 knees) with bilateral OWHTO and 49 patients (49 knees) with unilateral OWHTO. Both groups were further divided into four subgroups to compare each limb (unilateral involved and non-involved limbs and bilateral primarily and secondarily treated limbs). Radiological and clinical outcomes were evaluated and compared among the four groups. For the alignment change assessment, the pelvic tilt angle (PTA), weight-bearing line ratio (WBLR), joint line orientation angle (JLOA), medial proximal tibia angle (MPTA), joint line convergence angle (JLCA), distal tibia articular angle (DTAA), and talar inclination (TI) were measured pre- and postoperatively at 3, 6, and 12 months and annually thereafter. Student's t-test, one-way repeated-measures analysis of variance, and correlation analysis were used to compare the groups. RESULTS Patients in the unilateral and bilateral OWHTO groups had similar postoperative radiological and clinical outcomes. Each unilaterally involved limb and primarily treated bilaterally involved limb were negatively affected by the contralateral limb with respect to increased JLOA during the postoperative period (unilateral OWHTO group: r = -0.350, p = 0.023; bilateral OWHTO group: r = -0.520, p = 0.005). The correction change of the ankle parameters in the secondarily treated limb showed greater varus alignment than the primarily treated limb after bilateral OWHTO (DTAA (0.1 ± 3.0 vs. -0.5 ± 3.8°, p = 0.014) and TI (0.9 ± 3.2° vs. -0.3 ± 2.9, p = 0.001)). CONCLUSION Unilateral and bilateral OWHTOs shared similar postoperative radiological and clinical outcomes. Alignment changes of the unilateral OWHTO and the primarily treated limb of the bilateral OWHTO were associated with the JLOA of the contralateral limb. LEVEL OF EVIDENCE Cohort study; Level III.
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Tawy G, Shahbaz H, McNicholas M, Biant L. The Relationships between Coronal Plane Alignments and Patient-Reported Outcomes Following High Tibial Osteotomy: A Systematic Review. Cartilage 2021; 13:132S-146S. [PMID: 33884908 PMCID: PMC8808848 DOI: 10.1177/19476035211007903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This systematic review aimed to determine whether coronal angular corrections correlate with patient reported outcomes following valgus-producing high tibial osteotomy (HTO). DESIGN Ovid MEDLINE, Embase, and Web of Science were systematically searched. Studies that reported hip-knee-ankle angles (HKA) or femorotibial angles (FTA), and the Oxford Knee Score (OKS), visual analogue scale (VAS) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), or EQ-5D before and after valgus-producing HTO were eligible. Correlation analyses were performed where appropriate to investigate the relationships between variables. PROSPERO ID: CRD42019135467. RESULTS This study included 39 articles including 50 cohorts. VAS was reported in 22 studies, OKS in 9, KOOS in 12 and EQ-5D in 2. The HKA angle was corrected from 7.1° ± 1.7° varus to 2.3° ± 1.7° valgus at final follow-up. The FTA changed from 3.0° ± 2.0° varus to 7.7° ± 1.3° valgus. Outcome scores improved with clinical and statistical significance postoperatively. Spearman correlations for nonparametric data revealed greater changes in knee alignment were moderately associated with larger improvements in VAS scores (r = 0.50). Furthermore, those who experienced greater changes in alignment showed larger improvements in the KOOS Activity and Quality of Life domains (r = 0.72 and r = 0.51, respectively). CONCLUSION On average, patients did not achieve the "ideal correction" of 3° to 6° valgus postoperatively. Nevertheless, statistical and clinical improvements in patient-reported outcome measure scores were consistently reported. This suggests that the "ideal correction" may be more flexible than 3° to 6°.
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Affiliation(s)
- Gwenllian Tawy
- Division of Cell Matrix Biology &
Regenerative Medicine, School of Biological Sciences, The University of Manchester,
Manchester, UK,Gwenllian Tawy, Division of Cell Matrix
Biology & Regenerative Medicine, School of Biological Sciences, The
University of Manchester, 1.541 Stopford Building, Oxford Road, Manchester, M13
9PG, UK.
| | - Hamza Shahbaz
- Division of Medical Education, School
of Medical Sciences, The University of Manchester, Manchester, UK
| | - Michael McNicholas
- Division of Cell Matrix Biology &
Regenerative Medicine, School of Biological Sciences, The University of Manchester,
Manchester, UK,Department of Orthopaedics, Aintree
University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool,
UK
| | - Leela Biant
- Division of Cell Matrix Biology &
Regenerative Medicine, School of Biological Sciences, The University of Manchester,
Manchester, UK,Manchester Orthopaedic Centre, Trafford
General Hospital, Manchester University NHS Foundation Trust, Manchester, UK,Centre for Health Sciences Research,
University of Salford, Manchester, UK
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Ogawa H, Matsumoto K, Sengoku M, Yoshioka H, Yamamoto K, Shimokawa T, Ohnishi K, Akiyama H. Clinical course and outcomes of simultaneous-versus staged-bilateral medial opening wedge high tibial osteotomy. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 23:13-17. [PMID: 33344173 PMCID: PMC7725662 DOI: 10.1016/j.asmart.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/12/2020] [Accepted: 11/26/2020] [Indexed: 11/08/2022]
Abstract
Background Difference in the clinical course and outcomes between simultaneous- and staged-bilateral medial opening wedge high tibial osteotomies (OWHTOs) over time was unknown. The study hypothesis was that patients who underwent simultaneous-bilateral OWHTO (SMBO) have a more rapid improvement in knee function than those who underwent staged-bilateral OWHTO (STBO) due to difference in the change of lower limb alignment between SMBO and STBO. Methods The records of 56 knees in 28 patients who underwent either SMBO (n = 28) or STBO (n = 28) were retrospectively analysed. The time course data of weight-bearing line percentage (%WBL), joint line convergence angle (JLCA), and Knee Society Score were compared between the two procedures. Results Hospitalisation for SMBO was longer than that for STBO by 1 week. No significant difference was observed in %WBL between the two procedures. The JLCA was significantly lower with SMBO than with the first-stage surgery of STBO (P < 0.05), but it became equivalent in both groups at the last follow-up. The knee scores in both SMBO and the first-stage surgery of STBO significantly improved in approximately 1 year. The function scores in the first-stage surgery of STBO did not significantly improve until the completion of the second-stage surgery whereas those in SMBO significantly improved 1 year after surgery and become stable. The function score 1 year after surgery was significantly higher in SMBO than in the first-stage surgery of STBO (p < 0.001). Conclusions Although both SMBO and STBO achieved the desired therapeutic results, SMBO led to earlier functional improvement and decreased JLCA compared with STBO.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan.,Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu, 501-1194, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu, 501-1194, Japan
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
| | - Hiroki Yoshioka
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu, 501-1194, Japan
| | - Kyosuke Yamamoto
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
| | - Tetsuya Shimokawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
| | - Kazuichiro Ohnishi
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu, 501-1194, Japan
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Yapici F, Aykut US, Coskun M, Arslan MC, Merder-Coskun D, Kocabiyik A, Ulu E, Bayhan AI, Kaygusuz MA. Complications, Additional Surgery, and Joint Survival Analysis After Medial Open-Wedge High Tibial Osteotomy. Orthopedics 2020; 43:303-314. [PMID: 32931590 DOI: 10.3928/01477447-20200819-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/11/2019] [Indexed: 02/03/2023]
Abstract
The reported incidence of complications following medial open-wedge high tibial osteotomy (MOWHTO) varies. The authors sought to assess the complications, additional surgeries, and joint survival following MOWHTO in patients with isolated medial compartment arthrosis during a mean follow-up of 10 years. This retrospective study involved patients implanted with spacer plates, angle adjustable plates, or inverse L-type plates with wedges between 2000 and 2010. A total of 504 knees from 441 patients were examined. Mean age of the study population was 52.6±7.0 years, with 56 (11.1%) knees from men and 448 (88.9%) from women. The 10-year Kaplan-Meier joint survival rate was 94.8%. Overall complication rate for MOWHTO was 63.7%, with complications in 20.3% of treated knees requiring additional surgery. In this population, although the overall complication rate and the need for additional surgery were high, the need for additional surgery resulting from serious complications was low (2.6%). The high joint survival rate and low rate of additional surgery for serious complications indicate that MOWHTO can be safely applied in patients with isolated medial gonarthrosis. [Orthopedics. 2020;43(5):303-314.].
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Lorbergs AL, Birmingham TB, Primeau CA, Atkinson HF, Marriott KA, Giffin JR. Improved Methods to Measure Outcomes After High Tibial Osteotomy. Clin Sports Med 2019; 38:317-329. [PMID: 31079765 DOI: 10.1016/j.csm.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Observational studies suggest high tibial osteotomy produces substantial improvements in knee loading and stability that can limit the progression of joint damage; decrease pain; improve function and quality of life; and delay the need for knee replacement surgery. It can be cost-effective in knee osteoarthritis. However, systematic reviews and clinical practice guidelines are unable to provide strong recommendations, because limited high-level evidence supports its therapeutic value versus other treatments. We describe findings suggesting it can improve outcomes important to knee joint structure and function, patient quality of life, and health care systems. Future clinical trials are warranted and required.
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Affiliation(s)
- Amanda L Lorbergs
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Rd, London, Ontario N6G 1H1, Canada.
| | - Codie A Primeau
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Rd, London, Ontario N6G 1H1, Canada
| | - Hayden F Atkinson
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Rd, London, Ontario N6G 1H1, Canada
| | - Kendal A Marriott
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Rd, London, Ontario N6G 1H1, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Ontario, St. Joseph's Healthcare London, 268 Grosvenor St, London, Ontario N6A 4V2, Canada.
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Kim JH, Kim HJ, Celik H, Kim JH, Lee DH. Change in adduction moment following medial open wedge high tibial osteotomy: a meta-analysis. BMC Musculoskelet Disord 2019; 20:102. [PMID: 30841871 PMCID: PMC6402090 DOI: 10.1186/s12891-019-2472-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/21/2019] [Indexed: 11/12/2022] Open
Abstract
Background This meta-analysis was designed to quantify adduction moment loss, to evaluate the relationship between changes in mechanical axis alignment and adduction moment, and to assess whether sagittal plane moment is altered after medial open wedge high tibial osteotomy (HTO). Methods Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, all studies reporting preoperative and postoperative peak knee adduction moment or change in peak knee adduction moment from before to after surgery in patients who underwent medial open wedge HTO were included. Results Nine studies were included in the meta-analysis. The pooled mean difference in adduction moment from before to after medial open wedge HTO was 1.44% Nm/body weight (BW)xheight (HT) (95% confidence interval [CI]: 1.33 to 1.55% Nm/BWxHT; P < 0.001; I2 = 4%). However, flexion (0.18% Nm/BWxHT, 95% CI: -0.50 to 0.86% Nm/BWxHT; P = 0.61; I2 = 79%) and extension (0.15% Nm/BWxHT, 95% CI, − 0.37 to 0.68% Nm/BWxHT; P = 0.56; I2 = 46%) moments did not differ significantly from before to after surgery. Alignment correction amount and postoperative final valgus alignment were not significantly associated with difference in adduction moment from before to after surgery. Conclusion Knee adduction moment after medial open wedge HTO decreased to 60% of the preoperative level. However, this adduction moment decrement was not affected by the magnitude of alignment correction. In addition, there was no change in sagittal plane knee moment, including flexion and extension moments, from before to after medial open wedge HTO. Level of Evidence: Meta-analysis (Level II).
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Preventive medicine, Korea University College of Medicine, Seoul, South Korea
| | - Haluk Celik
- Department of Orthopaedic Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Joo-Hwan Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Badie F, Katouzian HR, Rostami M. Dynamic analysis of varus knee using a subject-specific multibody model of the knee before and after osteotomy. Med Eng Phys 2019; 66:18-25. [PMID: 30773339 DOI: 10.1016/j.medengphy.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 01/27/2019] [Accepted: 02/01/2019] [Indexed: 11/15/2022]
Abstract
Varus misalignment of the hip-knee-ankle angle causes greater loads on the medial compartment of the knee and increases the risk of developing knee osteoarthritis. High tibial osteotomy is a surgical method where the load-bearing axis is shifted laterally. The purpose of this study is to define a subject-specific three-dimensional multibody model of the knee to investigate the effect of osteotomy on cartilages and menisci during the stance phase of gait. It is assumed that osteotomy transfers load-bearing to the lateral parts of the knee. Magnetic resonance images of a patient with varus alignment were used to generate the geometries of the bones, cartilages, and menisci. Then, an experimental approach was used to determine the parameters for the stiffness matrices and compliant contact models of the tibio-menisco-femoral articulations with the use of finite element solutions. As indicated by the research findings, the contact force at the medial cartilage decreased as the load-bearing axis was transferred to the lateral parts. This subject-specific noninvasive analysis of contact force can be considered as a preoperative assessment tool for the surgeon. to predict the effects of high tibial osteotomy and the shifting of the load-bearing axis to the soft tissues of the knee.
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Affiliation(s)
- Fateme Badie
- Biomechanics and Sport Engineering Group, Biomedical Engineering Department, Amirkabir University of Technology, Hafez Ave., Tehran, Iran.
| | - Hamid Reza Katouzian
- Biomechanics and Sport Engineering Group, Biomedical Engineering Department, Amirkabir University of Technology, Hafez Ave., Tehran, Iran.
| | - Mostafa Rostami
- Biomechanics and Sport Engineering Group, Biomedical Engineering Department, Amirkabir University of Technology, Hafez Ave., Tehran, Iran
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Morin V, Pailhé R, Duval BR, Mader R, Cognault J, Rouchy RC, Saragaglia D. Gait analysis following medial opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2018; 26:1838-1844. [PMID: 28251263 DOI: 10.1007/s00167-017-4421-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 01/03/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE High tibial osteotomy (HTO) is used to treat young and active patients with knee osteoarthritis (OA) and varus deformity. The medial compartment OA alters the patients' gait. METHODS A prospective study was carried out in 21 consecutive patients operated for HTO due to knee OA with varus deformity. There were 14 men and 7 women, with a median age of 51.9 years (38-64). Their gait was analyzed preoperatively and at 1 year postoperatively, and compared to a healthy control group. Clinical assessment (KOOS, WOMAC, Lysholm, and SF-36 scores) was also performed preoperatively and postoperatively. RESULTS Patients with medial compartment OA had altered gait relative to the control population. Their walking speed was slower, step length was shorter, and single-leg stance time was shorter, while the double-leg stance time was longer (P < 0.001). Step width was not different between the two groups preoperatively (n.s.), but it was wider in the patient group postoperatively (P = 0.003). There were no differences in the patients' gait parameters before and after the osteotomy (n.s.). However, there was an improved perception of walking so that it is no longer different from controls (n.s.). The KOOS, WOMAC, Lysholm and SF-36 scores improved after HTO. The preoperative median of 7° varus (1-11) was corrected to 3° valgus (0-6). CONCLUSION Medial compartment OA with varus deformity leads to gait modifications. HTO does not alter the time-distance parameters of gait; however, patients have improved perception of their walking ability. HTO leads to excellent results for knee function, and improves quality of life without modifying the gait pattern. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Vincent Morin
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France.
| | - Régis Pailhé
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Brice Rubens Duval
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Roch Mader
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Jérémy Cognault
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - René-Christopher Rouchy
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Dominique Saragaglia
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
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16
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Lee OS, Kwon O, Lee YS. Comparison of the outcome between unilateral and bilateral open wedge high tibial osteotomy in the bilateral varus knees. Arch Orthop Trauma Surg 2018; 138:307-316. [PMID: 29188419 DOI: 10.1007/s00402-017-2848-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Bilateral open wedge high tibial osteotomy (OWHTO) can be performed in a staged manner to enable the healing and rehabilitation of each limb separately after surgery. However, the effects of staged bilateral OWHTO on the pattern of recovery and changes over time for each limb have not been established. Additionally, there is a lack of information regarding the optimal timing for staged surgery. METHODS Twenty-two patients (44 knees) in the bilateral OWHTO group and 42 patients (42 knees) in the unilateral OWHTO group were analyzed. Clinical and radiological results were evaluated and compared between the two groups. For the alignment change assessment, the hip-knee-ankle (HKA) angle and weight-bearing line (WBL) ratio were measured preoperatively and at postoperative 6 weeks, 3 months, 6 months, and 1 year. RESULTS The correction loss of HKA angle in the bilateral OWHTO group was significantly larger than that in the unilateral OWHTO group (0.5° ± 1.4° vs 1.3° ± 2.0°, p = 0.049). The correction loss of WBL ratio was significantly greater in the patients with staged bilateral OWHTO within a 3-month interval compared to those with staged bilateral OWHTO in an interval longer than 3 months (WBL ratio; 7.5% vs 2.1%, p = 0.01). There was no significant difference in the clinical scores and range of motion at the last follow-up. CONCLUSION The smaller loss of correction in the unilateral OWHTO group occurred compared to the bilateral OWHTO group. Additionally, surgeons should keep in mind that the amount of correction loss may be greater if staged bilateral OWHTO is performed at intervals of 3 months or less.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Ohsang Kwon
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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Brisson NM, Stratford PW, Maly MR. Relative and absolute test-retest reliabilities of biomechanical risk factors for knee osteoarthritis progression: benchmarks for meaningful change. Osteoarthritis Cartilage 2018; 26:220-226. [PMID: 29128508 DOI: 10.1016/j.joca.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/24/2017] [Accepted: 11/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Biomechanical factors are important treatment targets in knee osteoarthritis. The knee adduction (KAM) and flexion (KFM) moments, quadriceps strength and power, load frequency, and body mass index (BMI) all have the potential to affect knee articular cartilage integrity by modulating forces across the joint. To identify clinically meaningful change, however, these measurements must be reliable and sensitive to change. This study estimated relative and absolute test-retest reliabilities over long periods of biomechanical risk factors for knee osteoarthritis progression. METHOD Data from a longitudinal, observational study were analyzed for knee osteoarthritis patients with data at baseline, 6-month and 24-month follow-ups. Gait kinematics and kinetics, quadriceps strength and power, daily load frequency and BMI were collected. Relative and absolute test-retest reliabilities of these measures were estimated using intraclass correlation coefficients (ICCs) and standard errors of measurement (SEMs), respectively. Minimal detectable change at the 95% confidence level (MDC95) was also calculated. RESULTS Data from 46 participants [36 women; age 61.0 (6.6) years] were included. Good-to-excellent relative reliabilities (ICC ≥ 0.80) indicated that KAM peak and impulse, quadriceps strength and power, and BMI had a strong ability to discriminate amongst participants. Absolute reliabilities were high for quadriceps strength and BMI, which demonstrated reasonable within-participant variability (SEMs ≤ 11% of the mean). The MDC95 values supported use of clinical interventions effective in reducing BMI and KAM, and increasing quadriceps strength. CONCLUSION These data are useful in interpreting findings from interventional or longitudinal investigations by determining whether observed changes are beyond measurement error and interpretable as true change.
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Affiliation(s)
- N M Brisson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - P W Stratford
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - M R Maly
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
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van der Woude JAD, Wiegant K, van Heerwaarden RJ, Spruijt S, van Roermund PM, Custers RJH, Mastbergen SC, Lafeber FPJG. Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:876-886. [PMID: 27106926 PMCID: PMC5332499 DOI: 10.1007/s00167-016-4131-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/05/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Both, knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy (HTO), are knee-preserving treatments for knee osteoarthritis (OA). The efficacy of knee joint distraction compared to HTO has not been reported. METHODS Sixty-nine patients with medial knee joint OA with a varus axis deviation of <10° were randomized to either knee joint distraction (n = 23) or HTO (n = 46). Questionnaires were assessed at baseline and 3, 6, and 12 months. Joint space width (JSW) as a surrogate measure for cartilage thickness was determined on standardized semi-flexed radiographs at baseline and 1-year follow-up. RESULTS All patient-reported outcome measures (PROMS) improved significantly over 1 year (at 1 year p < 0.02) in both groups. At 1 year, the HTO group showed slightly greater improvement in 4 of the 16 PROMS (p < 0.05). The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group (p = 0.001) and 0.4 ± 0.5 mm in the HTO group (p < 0.001), with minimum JSW improvement in favour of knee joint distraction (p = 0.05). The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group, leading to a significant increase in mean JSW for knee joint distraction only (p < 0.02). CONCLUSION Cartilaginous repair activity, as indicated by JSW, and clinical outcome improvement occurred with both, knee joint distraction and HTO. These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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Affiliation(s)
- J. A. D. van der Woude
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands ,0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - K. Wiegant
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - R. J. van Heerwaarden
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - S. Spruijt
- Limb and Knee Reconstruction Unit, Department of Orthopedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands
| | - P. M. van Roermund
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - R. J. H. Custers
- 0000000090126352grid.7692.aDepartment of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - S. C. Mastbergen
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - F. P. J. G. Lafeber
- 0000000090126352grid.7692.aRheumatology and Clinical Immunology, University Medical Center Utrecht, F02.217, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Hamilton CB, Maly MR, Giffin JR, Clark JM, Speechley M, Petrella RJ, Chesworth BM. Validation of the Questionnaire to Identify Knee Symptoms (QuIKS) using Rasch analysis. Health Qual Life Outcomes 2015; 13:157. [PMID: 26416463 PMCID: PMC4587900 DOI: 10.1186/s12955-015-0358-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background The Questionnaire to Identify Knee Symptoms (QuIKS) was recently developed to promote activity by screening for experiences related to early symptoms in people with emergent chronic knee pain problems, such as osteoarthritis (OA) – like knee pain. The main purpose of the current study was to evaluate measurement properties of the QuIKS using Rasch analysis in a sample of people with knee symptoms consistent with symptomatic knee OA. Method This study used cross-sectional data. The sample was 200 subjects along the following knee health continuum: pain-free healthy knees (n = 55) from a university community, knee pain with no knee OA diagnosis (n = 111) from a university-affiliated medical clinic, and patients with surgeon-diagnosed symptomatic knee OA awaiting high tibial osteotomy (n = 34) from a sports medicine surgical clinic. The 13-item QuIKS was evaluated for its factor structure, item- and person-fit, item’s category response structure, differential item functioning by sex and obesity status, local item dependency, unidimensionality, and test precision. Subsequently, the QuIKS underwent known-groups analysis and convergent validity with the Knee injury and Osteoarthritis Outcome Score (KOOS). Results In the QuIKS, each item’s category response structure was modified. No differential item functioning was observed. Local item dependency informed the formation of four testlets. This refined QuIKS obtained summary fit to the Rasch measurement model, unidimensionality, reliability (person separation index = 0.82), and interval-level scoring. Subsequently, the Rasch-validated QuIKS (QuIKS-R) demonstrated excellent known-groups validity and good convergent validity with the KOOS (Spearman’s rho = 0.45 to 0.77). Conclusions The QuIKS-R provides interval-level quantification of knee symptoms-related experiences in people with knee symptoms consistent with symptomatic knee OA. Its scores might be useful for clinicians for promoting activity in individuals with early symptoms consistent with symptomatic knee OA. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0358-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clayon B Hamilton
- Graduate Program in Health and Rehabilitation Sciences, Western University, London, ON, Canada.
| | - Monica R Maly
- Institute for Applied Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - J Robert Giffin
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Jessica M Clark
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry; Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada.
| | - Robert J Petrella
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Bert M Chesworth
- School of Physical Therapy and Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6G1H1, Canada.
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Clinical and radiographic outcomes of medial open-wedge high tibial osteotomy with Anthony-K plate: prospective minimum five year follow-up data. INTERNATIONAL ORTHOPAEDICS 2015. [DOI: 10.1007/s00264-015-2919-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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