1
|
Petersen W, Al Mustafa H, Häner M, Braun K. [Modified pendulum osteotomy to correct severe tibial varus deformity]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024:10.1007/s00064-024-00854-w. [PMID: 39150497 DOI: 10.1007/s00064-024-00854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE Correction of a severe tibial varus deformity near the knee joint with only a slight influence on leg length and patella height. INDICATIONS Medial osteoarthritis and/or cartilage damage with a severe varus deformity > 10° with a medial proximal tibial angle (MPTA) < 80°. CONTRAINDICATIONS Femoral varus deformity with lateral distal femoral angle > 91°, severe lateral cartilage damage, lateral osteoarthritis, lateral meniscus loss. SURGICAL TECHNIQUE Skin incision of approx. 8-10 cm between the tibial tuberosity and the head of the fibula. Exploration of the peroneal nerve. Detachment of the extensors. Insertion of an obliquely ascending guidewire ending approximately 10 mm below the medial articular surface. Insertion of a second guidewire. This aims at the middle of the first wire (hemi wedge). Check the wire position under fluoroscopy. Osteotomy with an oscillating saw under cooling. Removal of the wedge and closure of the osteotomy. Percutaneous needling of the medial collateral ligament with a cannula to carefully lengthen the ligament. Check the correction result with a metal rod. Osteosynthesis with lateral angle-stable plate. POSTOPERATIVE MANAGEMENT Partial weight-bearing with 10 kg for 6 weeks postoperatively, free range of motion. RESULTS Reports from the literature show that good clinical results can be achieved with this procedure for severe tibial varus deformities. Postoperative leg length discrepancies are less common with this procedure than with laterally closing osteotomy.
Collapse
Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland.
| | - Hasan Al Mustafa
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
| | - Martin Häner
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
| | - Karl Braun
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
| |
Collapse
|
2
|
Callan KT, Smith E, Karasavvidis T, Wang D. Comparison of Trends and Complications of Unicompartmental Knee Arthroplasty Versus Periarticular Knee Osteotomy Among ABOS Part II Oral Examination Candidates. Orthop J Sports Med 2024; 12:23259671241257818. [PMID: 39100213 PMCID: PMC11295226 DOI: 10.1177/23259671241257818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/01/2024] [Indexed: 08/06/2024] Open
Abstract
Background While unicompartmental knee arthroplasty (UKA) and osteotomy procedures are commonly used to treat knee osteoarthritis, the differences in complication profiles between procedures are still poorly understood. Purpose/Hypothesis The purpose of this study was to assess the trends and complication rates of UKA and periarticular knee osteotomy for knee osteoarthritis among newly trained surgeons by using the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination Case List database. It was hypothesized that more adult reconstruction fellowship-trained surgeons would perform UKA, while more sports medicine fellowship-trained surgeons would perform osteotomy, and that both procedures would have low rates of complications. Study Design Cross-sectional study; Level of evidence, 3. Methods The ABOS database was queried for patients who underwent UKA, high tibial osteotomy, and distal femoral osteotomy procedures in examination years 2011 to 2021. Patient characteristics, surgeon fellowship training history, surgeon-reported postoperative complications, and readmission and reoperation rates were recorded. Comparisons between the UKA and osteotomy groups were performed using independent t tests and chi-square tests. Results There were 2524 patients in the UKA group and 270 patients in the osteotomy group. The majority of newly trained surgeons performing UKA (70.5%) had fellowship training in adult reconstruction, while the majority of those performing osteotomy (57.8%) had fellowship training in sports medicine (P < .001). The incidence of UKA and osteotomy increased during the study period (18.8 UKAs and 1.8 osteotomies performed per 10,000 cases in 2011 vs 39.5 UKAs and 4.2 osteotomies performed per 10,000 cases in 2021). Rates were significantly higher for osteotomy compared with UKA regarding anesthetic complications (2.2% vs 0.6%; P = .015), surgical complications (23.7% vs 7.3%; P < .001), reoperation (5.2% vs 1.9%; P = .002), and infection (6.7% vs 1.4%; P < .001). There were no significant differences in rates of medical complication, readmission, deep vein thrombosis, pulmonary embolism, or stiffness/arthrofibrosis. Conclusion Among newly trained surgeons taking the ABOS Part II Oral Examination, the incidence of UKA and periarticular knee osteotomy increased over the past decade. Compared with UKA, complication rates were higher after osteotomy, with an overall surgical complication rate of 23.7%.
Collapse
Affiliation(s)
- Kylie T. Callan
- Department of Orthopaedic Surgery, University of California–Irvine Health, Orange, California, USA
| | - Eric Smith
- Department of Orthopaedic Surgery, University of California–Irvine Health, Orange, California, USA
| | - Theofilos Karasavvidis
- Department of Orthopaedic Surgery, University of California–Irvine Health, Orange, California, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California–Irvine Health, Orange, California, USA
| |
Collapse
|
3
|
Wyatt FW, Al-Dadah O. Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis: A comparison of clinical and radiological outcomes. World J Orthop 2024; 15:444-456. [PMID: 38835690 PMCID: PMC11145972 DOI: 10.5312/wjo.v15.i5.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/05/2024] [Accepted: 04/12/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are well-established operative interventions in the treatment of knee osteoarthritis. However, which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate. Simultaneously, there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes, preoperatively and following HTO or UKA. AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis: Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this. METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA (n = 23) and HTO (n = 19) to treat medial compartment knee osteoarthritis. Patient-reported outcome measures (PROMs) were collected to evaluate clinical outcome. These included two disease-specific (Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score) and two generic (EQ-5D-5L, Short Form-12) PROMs. The radiographic parameters of knee alignment assessed were the: Hip-knee-ankle angle, mechanical axis deviation and angle of Mikulicz line. RESULTS Statistical analyses demonstrated significant (P < 0.001), preoperative to postoperative, improvements in the PROM scores of both groups. There were, however, no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group. Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively (P < 0.05). Postoperatively, two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters (hip-knee-ankle angle, mechanical axis deviation) within the HTO group; yet no such associations were observed within the UKA group. CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis. Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively; however, a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.
Collapse
Affiliation(s)
- Frederick William Wyatt
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, United Kingdom
| | - Oday Al-Dadah
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, United Kingdom
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Shields NE34 0PL, United Kingdom
| |
Collapse
|
4
|
Li J, Zhao F, Dong W, Yu X, Zhu C, Liu S, Jia G, Liu G. Medial open-wedge high tibial osteotomy for the treatment of degenerative varus knee osteoarthritis in geriatric patients: a retrospective study. Sci Rep 2023; 13:16848. [PMID: 37803059 PMCID: PMC10558429 DOI: 10.1038/s41598-023-44051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023] Open
Abstract
HTO has proven to be a cost-effective surgical procedure in the treatment of KOA, but few investigations have studied radiological changes and clinical effectiveness of OWHTO in geriatric patients. 76 patients were recruited in this retrospective study. According to the age, patients were divided into two groups (≤ 60, Group "Young"; > 60, Group "Geriatric"). Demographic data, radiological imaging and postoperative complications were analyzed. Kellgren-Lawrence grade (K-L), weight-bearing line ratio (WBLR); posterior tibial slope angle (PTS); American knee score (AKS); Western Ontario and McMaster Universities Arthritis Index (WOMAC) and visual analog scale (VAS) were introduced to estimate the clinical outcome of OWHTO. There were 18 male and 58 female patients in the present study with a mean age of 58.5 ± 9.2 years (ranges from 40 to 82 years); the average age was 51.4 ± 4.1 years and 67.3 ± 4.9 years for group Y and G respectively, 44.7% and 31.5% patients were older than 60 and 65 years. BMI for the 76 patients was 26.6 ± 3.2 kg/m2, and geriatric patients were more likely accompanied by one or more comorbidities (70.6 vs. 45.2%). There were 34 and 42 patients in group Geriatric and group Young respectively, and no significant difference of MPTA, WBLR, PTS and WOMAC, VAS, AKS and ROM between the two group (P > 0.05) were found. After more than a two-year follow-up period, postoperative WBLR, AKS, WOMAC and VAS were much more desired than preoperative, and no significant difference of these variables between the young and geriatric group (P > 0.05), however, elderly patients were more likely to suffer from a longer bone union time. OWHTO can avoid geriatric patients from undergoing secondary knee surgery in the short term, however the survival rate of OWHTO in geriatric patients should be ultimately clarified by different studies.
Collapse
Affiliation(s)
- Jia Li
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, People's Republic of China
| | - Feng Zhao
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, People's Republic of China
| | - Wei Dong
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, People's Republic of China
| | - Xiaoguang Yu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, People's Republic of China
| | - Chaohua Zhu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, People's Republic of China
| | - Sen Liu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, People's Republic of China
| | - Guoxing Jia
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, People's Republic of China
| | - Guobin Liu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, 050031, Hebei, People's Republic of China.
| |
Collapse
|
5
|
Okimura S, Suzuki T, Matsumura T, Ikeda Y, Shiwaku K, Teramoto A, Yamashita T. Patient-reported outcome measures after mobile-bearing unicompartmental knee arthroplasty were better than medial opening-wedge high tibial osteotomy in early elderly patients with severe osteoarthritis. Arch Orthop Trauma Surg 2023; 143:6339-6344. [PMID: 37103607 DOI: 10.1007/s00402-023-04888-w] [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: 12/25/2022] [Accepted: 04/10/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Many countries are faced with aging populations. However, few studies have directly compared the clinical outcomes of medial opening-wedge high tibial osteotomy (OWHTO) and mobile-bearing unicompartmental knee arthroplasty (MB-UKA) in early elderly patients. Thus, we aimed to investigate the clinical outcomes after OWHTO and MB-UKA in early elderly patients with similar demographics and osteoarthritis (OA) severity. METHODS Three hundred and fifteen OWHTO and 142 MB-UKA were performed for medial compartment OA by a single surgeon between August 2009 and April 2020. Among them, patients aged 65-74 years with more than two years of follow-up were enrolled. The patient-reported outcome measures (PROMs), including visual analog scale (VAS) score and Japanese Knee Osteoarthritis Measure (JKOM) score, were compared between both procedures preoperatively and at the last follow-up. The PROMs were compared between the groups by Kellgren-Lawrence (K-L) OA grades. RESULTS Seventy-three OWHTO and 37 MB-UKA patients were enrolled. No significant differences were found in the distribution of age, gender, follow-up period, body mass index, and Tegner activity scale between the two procedures. The postoperative PROMs in patients with K-L grade 4 were better after MB-UKA than OWHTO at the mean follow-up of 5 years. No significant difference was found in PROMs in patients with K-L grades 2 and 3. CONCLUSION ThePROMs after MB-UKA were superior to that after OWHTO in early elderly patients with severe OA. In particular, pain relief was better after MB-UKA than OWHTO with severe OA. Meanwhile, no significant difference in PROMs was found with moderate OA patients. LEVEL OF EVIDENCE Level IVprospective cohort study.
Collapse
Affiliation(s)
- Shinichiro Okimura
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, North-7, West-27-1-3, Chuo-ku, Sapporo, Hokkaido, 060-0007, Japan.
| | - Takashi Matsumura
- Department of Orthopaedic Surgery, Obihiro Kyokai Hospital, East-5, South-9-2, Obihiro, Hokkaido, 080-0805, Japan
| | - Yasutoshi Ikeda
- Department of Orthopaedic Surgery, Saiseikai Otaru Hospital, Chikko 10-1, Otaru, Hokkaido, 047-0008, Japan
| | - Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| |
Collapse
|
6
|
Huang Y, Ge H, Peng B, Feng W, Zhang H, Zeng Y. Comparison of joint awareness after total knee arthroplasty, medial unicompartmental knee arthroplasty, and high tibial osteotomy: a retrospective study. BMC Musculoskelet Disord 2023; 24:673. [PMID: 37620829 PMCID: PMC10463784 DOI: 10.1186/s12891-023-06779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION This study aimed to compare the Forgotten Joint Score-12(FJS) outcomes and the minimum clinically important difference (MCID) of the FJS after high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA) with short-term follow-up (at least 2 years). Another objective of the study is to investigate the factors influencing FJS. It is hypothesized that there are differences in FJS outcomes among the three procedures. METHODS Patients who underwent HTO, UKA, and TKA from January 2016 to December 2020 and were followed up for a minimum of 2 years were included in the study. The FJS were analyses from a cohort of people who submitted data to two years. The preoperative and postoperative clinical outcomes were compared and evaluated the patient-related factor. The FJS scores were predicted using multiple linear regression analysis. Additionally, Patient's Joint Perception (PJP) questions were used as anchors to determine the achievement of the forgotten joint, and FJS MCID were calculated using the receiver operating characteristic curve (ROC). RESULTS Three hundred eighty-nine patients were included in the final study, and there were 111 patients in HTO groups,128patients in UKA groups, and 150 patients in TKA groups. The mean follow-up was 47.0 months. There was a significant difference in the total FJS, between the HTO, UKA, and TKA groups (FJS:59.38 ± 7.25, 66.69 ± 7.44 and 56.90 ± 6.85, p < 0.001. We found the MCID of the FJS of HTO, UKA, and TKA were 63.54, 69.79, and 61.45, respectively. In multiple linear regression, younger age, and higher FS were significant predictors of better FJS. CONCLUSION Medial UKA demonstrated lower patient awareness in comparison to HTO and TKA, as assessed by the FJS. Younger age and higher FS were identified as significant predictors of improved FJS, providing valuable guidance for surgical decision-making.
Collapse
Affiliation(s)
- Yiwei Huang
- The First Clinical of Medical School, Guangzhou University of Chinese Medicine, NO.12 Jichang Road, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Hao Ge
- The First Clinical of Medical School, Guangzhou University of Chinese Medicine, NO.12 Jichang Road, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Bo Peng
- The First Clinical of Medical School, Guangzhou University of Chinese Medicine, NO.12 Jichang Road, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Wenjun Feng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.16 Jichang Road, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Haitao Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725, Wanping South Road, Shanghai, 200032, China.
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, NO.16 Jichang Road, District Baiyun, Guangzhou, 510405, Guangdong, China.
| |
Collapse
|
7
|
Neubauer M, Reinberger EM, Dammerer D, Moser LB, Neugebauer J, Gottsauner-Wolf F, Nehrer S. Unicompartmental Knee Arthroplasty Provides Superior Clinical and Radiological Outcomes Compared to High Tibial Osteotomy at a Follow-Up of 5-8 Years. J Clin Med 2023; 12:5387. [PMID: 37629429 PMCID: PMC10455152 DOI: 10.3390/jcm12165387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Knee Osteoarthritis (OA) is a debilitating disease. Initially, the medial compartments are affected in most cases. For this pathology, joint preservation is preferable. Two surgical procedures aim to meet this goal: high-tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA). The aim was to compare clinical and radiological outcomes of HTO versus UKA in patients with unicompartmental, medial OA. METHOD Retrospective case series. A total of 86 (61 UKA, 25 HTO) patients that received either treatment at a single, specialized center were assessed pre-operatively and at a single follow-up examination at 77.13 months (±8.170). The Knee Society Score (KSS), range of motion (ROM), SF36 questionnaire and the Tegner score were used. The Kellgren-Lawrence score was assessed pre- and post-surgically. Survivorship with the endpoint "revision" was assessed. RESULTS The UKA group showed significantly better improvements in KSS scores for pain (p < 0.006) and function (p < 0.001). OA progression (p < 0.02) and survivorship (p < 0.018) differed, significantly favoring UKA. ROM, SF36 and Tegner score did not differ significantly. CONCLUSIONS The presented mid-to long-term data suggest that UKA provides superior results in selected outcomes. Nevertheless, significant differences in the demographics of treatments indicate the challenge of comparing these two treatments.
Collapse
Affiliation(s)
- Markus Neubauer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Eva-Maria Reinberger
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Dietmar Dammerer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Lukas B. Moser
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Johannes Neugebauer
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Florian Gottsauner-Wolf
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Stefan Nehrer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| |
Collapse
|
8
|
Ge H, Huang Y, Yan H, Zeng Y, Zeng J. What is the difference in proprioception between single condylar arthroplasty and high tibial osteotomy? a comparative study on both knees of the same patient. J Orthop Surg Res 2023; 18:486. [PMID: 37415243 DOI: 10.1186/s13018-023-03965-5] [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: 05/08/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE This study aims to investigate the efficacy and outcomes of different surgical procedures, namely unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO), for the treatment of bilateral medial compartment knee osteoarthritis in the same patient. The joint awareness and function of these two surgical methods were evaluated. METHODS A total of 15 patients with bilateral medial compartment knee osteoarthritis who underwent either UKA or HTO between 2012 and 2020 were included in the study. Patient data, including age, gender, body mass index and length of hospital stay, were collected. Pre- and post-operative measurements were conducted, including tibiofemoral angle, tibial plateau posterior inclination angle, proximal tibial medial angle, distance from mechanical axis to knee joint center, hip-knee-ankle angle, pre- and post-operative knee joint scores, knee joint range of motion, and FIS-12 scores at 3, 6, 12, and 24 months postoperatively. The latest follow-up was used for evaluating the outcomes of osteoarthritis treatment. Normality of continuous variables was assessed using the Shapiro-Wilk test. Between-group comparisons were performed using the paired sample t-test or Wilcoxon rank-sum test. Repeated measures analysis of variance was utilized to analyze FJS-12 measurements at different time points, and the correlation between FJS-12 and postoperative clinical results was examined using Pearson's correlation coefficient. Statistical significance was set at P < 0.05. RESULTS Significant differences were observed in FJS between the UKA and HTO groups at 3 and 6 months postoperatively, but no significant difference was found at 1 and 2 years postoperatively. FJS in the UKA group demonstrated a significant increase from 3 to 6 months postoperatively, but no significant difference was observed from 6 to 24 months postoperatively. In contrast, FJS in the HTO group showed a significant increase from 3 to 24 months postoperatively. CONCLUSIONS Patients who underwent UKA exhibited superior joint awareness compared to those who underwent HTO during the early postoperative period. Furthermore, the rate of joint awareness in UKA patients was faster than in HTO patients.
Collapse
Affiliation(s)
- Hao Ge
- Guangzhou University of Chinese Medicine, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yiwei Huang
- Guangzhou University of Chinese Medicine, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Hongsong Yan
- Guangzhou University of Chinese Medicine, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District 22 Baiyun, Guangzhou, 510405, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District 22 Baiyun, Guangzhou, 510405, Guangdong, China.
- Baiyun Hospital, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Longqi Road 2#, Renhe Town, Baiyun, Guangzhou, 510405, Guangdong, China.
| |
Collapse
|
9
|
Serbin PA, Do DH, Hinkle A, Wukich D, Huo M, Sambandam S. Comparative Analysis of Unicompartmental Total Knee Arthroplasty and High Tibial Osteotomy: Time to Total Knee Arthroplasty and Other Outcome Measures. Arthroplast Today 2023; 20:101107. [PMID: 37069946 PMCID: PMC10104836 DOI: 10.1016/j.artd.2023.101107] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/22/2022] [Accepted: 01/14/2023] [Indexed: 04/19/2023] Open
Abstract
Background There is no consensus on whether unicompartmental arthroplasty (UKA) or high tibial osteotomy (HTO) is superior for unicompartmental arthritis. While there are studies comparing revision and complication rates, none matched a large number of patients undergoing HTO and UKA in the United States and compared these outcomes. We investigated TKA conversion rate and the complications following HTO or UKA. Methods This retrospective study queried the PearlDiver database of all patients undergoing UKA and HTO using CPT codes between January 2011 and January 2020. We compared propensity-matched populations based on age, gender, Charlson comorbidity index, and Elixhauser comorbidity index to compare odds of complications, TKA conversion, and drug use between UKA and HTO groups. Two-independent sample t-test for unequal variances and test of significance were performed. Results We found 32,583 UKA patients and 816 HTO patients. Each matched group had 535 patients. One-year complication showed higher risk of pneumonia, hematoma, infection, and mechanical complications among HTO patients. UKA patients used narcotics on average of 10.3 days compared to 9.1 days among HTO patients (P < .01). UKA conversion rates were 4.1%, 5.4%, 7.7%, and 9.2% at 1-, 2-, 5-, and 10-year intervals, respectively. HTO conversion rates were less than 2% at 1- and 2-year intervals, 3.4% at 5-year, and 4.5% at 10-year intervals. This difference was statistically significant at 5- and 10-year intervals (P < .01). Conclusions Using large matched cohorts, HTO may be converted to TKA later than UKA in short- to mid-term follow-up, and HTO patients used opioids for shorter duration.
Collapse
Affiliation(s)
- Philip A. Serbin
- Corresponding author. Department of Orthopaedic Surgery, UT Southwestern, 1801 Inwood Drive, Dallas, TX 75390, USA. Tel.: +1 423 839 6961.
| | | | | | | | | | | |
Collapse
|
10
|
Impact of Proximal Tibial Varus Anatomy on Survivorship After Medial Unicondylar Knee Arthroplasty. J Arthroplasty 2023:S0883-5403(22)01133-0. [PMID: 36603744 DOI: 10.1016/j.arth.2022.12.043] [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: 02/18/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Precise indications for medial unicondylar knee arthroplasty (UKA) continue to be defined. It is unclear if patients who have proximal tibia vara should be considered candidates for UKA. The purpose of this study was to evaluate the impact of proximal tibial varus alignment on outcomes after UKA. METHODS A retrospective review identified 2,416 patients (3,029 knees) who underwent mobile-bearing medial UKA with 2-year minimum follow-up or revision. Preoperative radiographs were evaluated, and medial proximal tibial angle (mPTA) was measured. Patients were grouped into two groups as follows: mPTA <80 degrees and mPTA ≥80 degrees. Analyses were performed on the impact of mPTA on clinical outcomes, all-cause revisions, and tibial failures. RESULTS At a mean follow-up of 5 years (range, 0.5 years to 12.8 years), there was not a statistically significant difference in clinical outcomes nor increased risk for all-cause revision or tibial failure in patients who had an mPTA <80°. Mean mPTA in patients who had tibial failures was 82.5° and not significantly different than those who did not have a tibial failure (82.9°) (P = .289). Tibial failure rate in knees with an mPTA <80° was 2.2% and not significantly different than knees with an mPTA ≥80° at 1.4% (P = .211). The all-cause revision rate in knees with an mPTA <80° was 5.8% and was not significantly different than knees with an mPTA ≥80° at 4.9% (P = .492). CONCLUSION Patients who have tibia vara are not at increased risk for tibial related or all-cause failure in medial UKA. This data may allow surgeons to increase their indications for medial UKA.
Collapse
|
11
|
Fu Q, Yan S, Hou X, He Z, Lu Q, Yuan W, Hu H. Distal tibial tubercle-high tibial osteotomy with assistance of modifiable spreader in the treatment of varus knee osteoarthritis: A retrospective observational study. Medicine (Baltimore) 2022; 101:e32604. [PMID: 36596069 PMCID: PMC9803415 DOI: 10.1097/md.0000000000032604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
As one of the knee preservation surgical approaches, good clinical outcomes of high tibial osteotomy were reported. Aims of this study were to analyze the clinical outcome and pre- and postoperative radiographical parameter and knee functional score between distal tibial tubercle high tibial osteotomy (DTTHTO) and open wedge- high tibial osteotomy (OWHTO) in patients with varus knee osteoarthritis after more than 1 year following-up. A total of 194 consecutive patients in our joint center from March 2016 to October 2021 were enrolled, according to the surgical method, patients were divided into DDTHTO and OWHTO groups. Radiographic parameters of Kellgren-Lawrence grading, hip-knee-ankle angle, weight bearing line ratio and medial tibial plateau angle, knee functional score of American knee society (AKS) score, western Ontario and McMaster universities arthritis index (WOMAC) score, visual analogue score (VAS) were introduced to evaluate clinical outcome for patients who received DDTHTO and OWHTO. There were 103 knees and 89 knees in the OWHTO and DTTHTO group, respectively. Mean weight bearing line ratio for OWHTO and DTTHTO were 25.1 ± 11.7 and 25.2 ± 12.0% respectively, medial tibial plateau angle and hip-knee-ankle angle angle demonstrated that all patients in the present study inherited a varus angle ranges from 3.4° to 9.5°. Preoperative AKS, WOMAC and VAS were 68.4 ± 5.7 versus 69.0 ± 5.9, 109.3 ± 15.0 versus 107.7 ± 14.0 and 6.8 ± 1.0 versus 6.9 ± 0.8, and there was no significant difference between 2 groups (P > .05). Mean postoperative AKS and WOMAC score for patients in both OWHTO and DTTHTO group were significantly improved, moreover, postoperative VAS of DTTHTO patients was lower than that in OWHTO group (P < .05). When comparing the operation time, intraoperative blood loss and bone union time, DHHTO group shows a superiority in these variables over patients in OWHTO (121 ± 29.6 vs 145.7 ± 35.2 minutes, 115.0 ± 20.8 vs 103.3 ± 17.3 mL, 13.7 ± 4.1 vs 12.0 ± 2.8 weeks; P < .005) and incidence of complication was lower for DTTHTO group. DTTHTO in patients with varus knee osteoarthritis has good clinical outcomes, and it can achieve a better postoperative alignment. Operation time and surgical trauma were also less in patients who underwent DTTHTO.
Collapse
Affiliation(s)
- Qiang Fu
- Department of Orthopedic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, P.R. China
| | - Shijie Yan
- Department of Orthopedic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, P.R. China
| | - Xizhi Hou
- Department of Orthopedic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, P.R. China
| | - Zeyang He
- Department of Orthopedic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, P.R. China
- * Correspondence: Zeyang He, Department of Orthopedic Surgery, The Third Hospital of Shijiazhuang, No. 15 South Tiyu Street, Shijiazhuang 050011, Hebei Province, P.R. China (e-mail: )
| | - Quanxiu Lu
- Department of Orthopedic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, P.R. China
| | - Weijie Yuan
- Department of Orthopedic Surgery, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, P.R. China
| | - Hongliang Hu
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| |
Collapse
|
12
|
Bierke S, Häner M, Bentzin M, Park HU, Petersen W. The use of tranexamic acid reduces blood loss in osteotomy at knee level: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:4104-4114. [PMID: 35344058 DOI: 10.1007/s00167-022-06938-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Aim of this systematic review was to evaluate the literature regarding the effect of tranexamic acid (TXA) on the outcome after knee osteotomy. METHODS A systematic literature search was carried out in various databases on studies on the use of tranexamic acid in osteotomies around the knee. Primary outcome criterion was the hemoglobin (drop). Secondary outcome criteria were total blood loss, drainage volume, adverse effects such as thromboembolic events, blood transfusions, wound complications and clinical scores. A meta-analysis was performed for quantitative measures. The present study was registered prospectively ( www.crd.york.ac.uk/PROSPERO ; no.: CRD42021229624). RESULTS Seven studies with 584 patients (TXA group: 282 patients, non TXA group: 302 patients) Hemoglobin decrease (1.54 g/dl vs. 2.28 g/dl), blood loss (394.49 ml vs. 595.54 ml) and drainage volume (266.5 ml vs. 359.05 ml) were significantly less in the TXA group compared to the non TXA group. No thromboembolic event was noted in any study. In the non TXA group four blood transfusions were given. Eleven wound complications occurred in the non TXA group in comparison to two wound complications in the TXA group. CONCLUSIONS The results of the present study show that the application of TXA reduces hemoglobin drop, blood loss and drainage volume. These effects could be responsible for the lesser rate of side effects after administration of TXA during knee osteotomy.
Collapse
Affiliation(s)
- Sebastian Bierke
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Strasse 27-31, 14193, Berlin, Germany
| | - Martin Häner
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Strasse 27-31, 14193, Berlin, Germany
| | - Mats Bentzin
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Strasse 27-31, 14193, Berlin, Germany
| | - Hi Un Park
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Strasse 27-31, 14193, Berlin, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Strasse 27-31, 14193, Berlin, Germany.
| |
Collapse
|
13
|
Yadav AK, Parihar M, Mariani I, Giorgino R, Mangiavini L, Ursino N, D'Ambrosi R. High tibial osteotomy with an external fixator or unicompartmental knee arthroplasty for varus knee in young patients? J Orthop 2022; 34:254-259. [PMID: 36148179 PMCID: PMC9486030 DOI: 10.1016/j.jor.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study compares the functional results and survivorship of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with an external fixator for medial compartment osteoarthritis (OA) of the knee. Methods Two cohorts of patients aged less than 60 years who had undergone either a cemented medial mobile-bearing UKA or an HTO with an external fixator were included in the study. The first cohort included patients undergoing a series of 197 consecutive medial UKA procedures (UKA group). The second cohort consisted of 60 consecutive patients undergoing HTO with an external fixator (HTO group). Each patient was assessed based on the Oxford Knee Score (OKS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Subjective International Knee Documentation Committee (IKDC) score/questionnaire. A clinical evaluation was conducted on the day of the surgery (T0) and at the follow-up visit (T1) (minimum follow-up time was 60 months). Complications and failures resulting from the surgery were recorded for each patient. Results Only the age of the patients at the pre-operative time differed significantly between the two groups, with the HTO group being significantly younger (47.7 ± 8.0 versus 55.8 ± 2.2).After the final follow-up visit, all scores improved in both groups (p < 0.05).IKDC and Oxford scores were higher for the UKA group (p < 0.05). In the HTO group, three complications occurred (5%), including two superficial infections and one deep infection. On the other hand, the UKA group reported four complications (2%): three aseptic mobilisations and one infection requiring revision surgery. There was no difference in the complication rate between the two groups (p = 0.208). Conclusions In young patients (<60 years) with an isolated medial knee OA, both HTO and UKA led to good to excellent clinical results with a low rate of complications at mid-term follow-up; both surgical procedures may be considered in this patient population. Level of evidence Level III.
Collapse
Affiliation(s)
- Amit Kumar Yadav
- Sir HN Reliance Foundation Hospital and Research Center, Mumbai, India
| | - Mangal Parihar
- Mangal Ananad Hospital, Swastik Park Chembur East, Mumbai, Maharashtra, India
| | - Ilaria Mariani
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Riccardo Giorgino
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | - Laura Mangiavini
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| | | | - Riccardo D'Ambrosi
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
| |
Collapse
|
14
|
Ping H, Wen J, Liu Y, Li H, Wang X, Kong X, Chai W. Unicompartmental knee arthroplasty is associated with lower pain levels but inferior range of motion, compared with high tibial osteotomy: a systematic overview of meta-analyses. J Orthop Surg Res 2022; 17:425. [PMID: 36153554 PMCID: PMC9509560 DOI: 10.1186/s13018-022-03319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to overview the findings of reported meta-analyses on unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 (PRISMA 2020) guidelines were followed. Two independent reviewers conducted a literature search of PubMed, Embase, the Web of Science, and the Cochrane Database of Systematic Reviews for meta-analyses comparing UKA and HTO that were published prior to September 2021. Literature screening, data extraction, and article quality appraisal were performed according to the study protocol registered online at PROSPERO (CRD42021279152). Results A total of 10 meta-analyses were identified, and different studies reported different results. Five of the seven meta-analyses showed that the proportion of subjects with excellent or good functional results was higher for UKA than for HTO. All three meta-analyses showed that UKA was associated with lower pain levels, and all six of the studies that included an analysis of range of motion (ROM) reported that UKA was inferior to HTO. Four of the eight meta-analyses found that total complication rates were lower for UKA. Only 3 of the 10 meta-analyses found that UKA had lower revision rates. Moreover, in the subgroup analysis, the revision and complication rates of UKA were similar to those of opening-wedge HTO but much lower than those of closing-wedge HTO. Conclusions Compared to HTO, UKA was associated with lower pain levels but inferior postoperative ROM. The results were inconclusive regarding whether UKA yielded better knee function scores and lower revision or complication rates than HTO. Accurate identification of indications and appropriate patient selection are essential for treating individuals with OA. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03319-7.
Collapse
|
15
|
Petersen W, Bentzin M, Bierke S, Park HU, Häner M. Use of tranexamic acid in medial open wedge high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:2287-2293. [PMID: 34698931 DOI: 10.1007/s00402-021-04219-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Aim of this study was to evaluate the effect of tranexamic acid (TXA) on the outcome after medial open wedge osteotomy. MATERIAL AND METHODS A prospective non-randomized comparative study with 52 patients has been performed. In both treatment groups, the same surgical technique for the medial open wedge HTO was used. In group 1 (N: 26) the patients received 1 g TXA i.v. preoperatively, in group 2 (N: 26) no TXA was given. Primary outcome measure was the decrease in hemoglobin concentration. Secondary outcome criteria were postoperative pain, intraarticular effusion (measured by ultrasound), range of motion (ROM) at discharge, peri- and postoperative complications and the KOOS PS (pre- and postoperatively at 1 year follow up). RESULTS Hemoglobin decrease was significantly less in the TXA group compared to the non TXA group. Postoperative pain and intraarticular effusion was also significantly lower and ROM at discharge was higher in the TXA group. There was no group difference in peri- and postoperative complications and the pre- and postoperatively KOOS PS. CONCLUSIONS The results of the present study show the systemic application of 1 g TXA reduces hemoglobin drop and postoperative morbidity (pain, intraarticular effusion, and ROM) after tibial open wedge HTO.
Collapse
Affiliation(s)
- Wolf Petersen
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany.
| | - Mats Bentzin
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany
| | - Sebastian Bierke
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany
| | - Hi Un Park
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany
| | - Martin Häner
- Klinik Für Orthopädie Und Unfallchirurgie, Martin Luther Hospital, Caspar-Theyß-Straße 27-31, Grunewald, 14193, Berlin, Germany
| |
Collapse
|
16
|
Unicompartmental vs. total knee replacement in patients with failed high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:2051-2056. [PMID: 34351470 DOI: 10.1007/s00402-021-04093-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The influence of a previous high tibial osteotomy (HTO) on the outcome and survival of a knee arthroplasty is a debated issue. The purpose of this study is to compare subjective, radiographic, and functional outcomes of unicompartmental knee replacement (UKR) and total knee replacement (TKR) after failed open wedge HTO. METHODS 26 post-HTO UKRs (group A) with an average follow-up of 7.8 years (range 2-13), and 33 post-HTO TKRs (group B) with an average follow-up of 11.2 years (range 4-16) operated between 2001 and 2017, were retrospectively reviewed. Assessment included Knee Society Score (KSS), University of California at Los Angeles Activity Score (UCLA), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Standard knee X-rays, and long-standing X-rays were performed pre-operatively and at follow-up to evaluate prosthesis survival, coronal alignment, and patellar height. RESULTS Improvements regarding KSS, UCLA and WOMAC scores were noted at follow-up in both groups compared to pre-operatory status (p < 0.001). No statistically significant differences in clinical and functional postoperative scores were reported between groups (p = n.s.) at follow-up. Group B presented a more neutral mean mechanical axis of 0.5° compared to 2.7° in Group A (p < 0.001). CONCLUSIONS Performing UKR after previous failed HTO is a safe and effective procedure which leads to clinical, radiological and functional outcomes comparable to TKR after HTO.
Collapse
|
17
|
Huang L, Xu Y, Wei L, Yuan G, Chen W, Gao S, Liu W, Tan Z, Zhao J. Unicompartmental knee arthroplasty is superior to high tibial osteotomy for the treatment of medial unicompartmental osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29576. [PMID: 35905249 PMCID: PMC9333480 DOI: 10.1097/md.0000000000029576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are widely used for the treatment of medial unicompartmental knee osteoarthritis (OA). However, the best approach remains controversial. This study aimed to present a systematic review and a meta-analysis to directly compare the clinical outcomes between HTO and UKA. We hypothesized that the clinical outcomes after UKA and HTO would be similar. METHODS Electronic databases (Web of Science, PubMed, Embase, CENTRAL, and Biosis Preview) were searched for related studies published before November 30, 2021. Retrospective and prospective studies that directly compared the postoperative outcomes between UKA and HTO were included. Odds ratio (ORs) and 95% confidence interval (CIs) for complications, revision to total knee arthroplasty (TKA), and weighted mean difference (MD) and 95% CIs in range of motion (ROM), pain, walking speed and function score were evaluated. Two reviewers independently assessed the quality of the studies. Subgroup and sensitivity analyses were performed to explore the heterogeneity. RESULTS Twenty-three retrospective and 6 prospective studies were included. A total of 3004 patients (3084 knees) were evaluated for comparison. Complications (OR, 4.88, 95% CI: 2.92-6.86) were significantly greater in the HTO group than in the UKA group. Postoperative function scores including Lysholm score (MD, -2.78, 95% CI: -5.37 to -0.18) and Hospital for Special Surgery (HSS) score (MD, -2.80, 95% CI: -5.39 to -0.20) were significantly lower in the HTO group than the UKA group. The postoperative ROM was similar between HTO and mobile-bearing UKA (MD, -3.78, 95% CI: -15.78 to 8.22). However, no significant differences were observed between the HTO and UKA group in terms of postoperative pain, walking speed, and revision to TKA. CONCLUSIONS UKA is superior to HTO in minimizing complications and enhancing postoperative function scores. Mobile-bearing UKA has a similar ROM compared with HTO. Both HTO and UKA provide satisfactory clinical outcomes in terms of walking speed, relieving pain, and revision to TKA. UKA appears to be more suitable for the elderly, and both mobile-bearing UKA and HTO are viable surgical options for younger active individuals.
Collapse
Affiliation(s)
- Linke Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Yinglong Xu
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- Department of Orthopaedics, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Linhua Wei
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- The Affiliated Nanning Infectious Disease Hospital of Guangxi Medical University, The Fourth People’s Hospital of Nanning, Nanning, GuangxiChina
| | - Guangzhi Yuan
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Weiwei Chen
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, GuangxiChina
| | - Shiyao Gao
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Wei Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Zhen Tan
- Department of Orthopaedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
| | - Jinmin Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, GuangxiChina
- * Correspondence: Jinmin Zhao MD, Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi, China (e-mail: )
| |
Collapse
|
18
|
Seth I, Bulloch G, Seth N, Gibson D, Rastogi A, Lower K, Rodwell A, Bruce W. High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty for Unicompartmental Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Indian J Orthop 2022; 56:973-982. [PMID: 35669023 PMCID: PMC9123137 DOI: 10.1007/s43465-022-00620-9] [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: 09/23/2021] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
Purpose High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are commonly performed procedures for the treatment of compartmental knee osteoarthritis; however, the optimal procedure remains controversial. We conducted this systematic review and meta-analysis to compare the functional outcomes and assess complications and revision rates between the two techniques. Methods We searched electronic databases for relevant studies comparing HTO versus UKA for unicompartmental knee osteoarthritis. Continuous data as visual analogue scale (VAS), range of motion, and free walking speed were pooled as mean differences (MDs). Dichotomous data as functional knee outcomes, complications, and revision were pooled as odds ratios (ORs), with 95% confidence interval (CI), using R software for windows. Results Twenty-five studies involving 8185 patients were included. Meta-analysis showed that HTO was associated with higher risk of complications (OR = 2.47, 95% CI [1.52, 4.04]), poorer functional results (excellent/good) (OR = 0.32, 95% CI [0.21, 0.49]), and greater range of motion (MD = 7.05, 95% CI [2.41, 11.68]) compared to UKA. No significant differences were found between the compared groups in terms of VAS (MD = 0.14, 95% CI [- 0.08, 0.36]), revision rates (OR = 1.30, 95% CI [0.65, 2.60]), and free walking speed (MD = - 0.05, 95% CI [- 0.11, 0.00]). Conclusion This study showed that UKA achieved fewer complications, better functional outcomes, and less range of motion compared to HTO. No significant differences were detected between HTO and UKA in terms of VAS and revision rate. Treatment options should be personalized to each patient considering factors such as their age, activities of daily living, their body mass index, and severity of osteoarthritis. Level of evidence II. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00620-9.
Collapse
Affiliation(s)
- Ishith Seth
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
- Department of Surgery, Bendigo Base Hospital, 100 Barnard Street, Bendigo, VIC 3550 Australia
| | - Gabriella Bulloch
- grid.1623.60000 0004 0432 511XDepartment of Orthopaedic Surgery, The Alfred Hospital, Melbourne, VIC 3004 Australia
| | - Nimish Seth
- grid.1008.90000 0001 2179 088XFaculty of Science, Medicine and Health, University of Melbourne, Melbourne, VIC 3010 Australia
| | - Damien Gibson
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Anish Rastogi
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Kirk Lower
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Aaron Rodwell
- grid.417154.20000 0000 9781 7439Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW 2500 Australia
| | - Warwick Bruce
- grid.414685.a0000 0004 0392 3935Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW 2139 Australia
| |
Collapse
|
19
|
Comparison of joint awareness after medial unicompartmental knee arthroplasty and high tibial osteotomy: a retrospective multicenter study. Arch Orthop Trauma Surg 2022; 142:1133-1140. [PMID: 34269892 DOI: 10.1007/s00402-021-03994-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are established treatments for medial compartment osteoarthritis (OA) or osteonecrosis (ON) of the knee joint, and the predominance of either procedure is inconclusive. We compared the awareness of the knee after UKA and HTO using the Forgotten joint score-12 (FJS). MATERIALS AND METHODS This was a retrospective, multicenter study. Ninety-six knees of 90 patients who received UKA or HTO and were followed-up for at least 1 year were analyzed. Postoperative FJS was compared between the two groups and evaluated for the effect of patient-related factors and clinical outcomes. Multiple linear regression analysis was performed to predict FJS. RESULTS There was no significant difference in the FJS between the UKA and HTO groups (p = 0.24). FJS did not correlate with any of the patient-related factors. There was a correlation between the FJS and each item of the Knee Injury and Osteoarthritis Outcome Scores (KOOS) and Lysholm Knee Scoring Scale (LKS). In multiple linear regression analysis, lower BMI, the diagnosis of OA Kellgren-Lawrence (KL) grade ≥ 3, and ON were significant predictors of better FJS. In both groups, FJS was correlated with each item of the KOOS and LKS. Internal consistency in terms of Cronbach's alpha was excellent. CONCLUSIONS There was no significant difference in FJS between patients who underwent UKA and HTO. Lower BMI, the diagnosis of OA KL grade ≥ 3, and ON were significant predictors of better FJS.
Collapse
|
20
|
Lee SH, Kim HR, Seo HY, Seon JK. A comparative study of 21,194 UKAs and 49,270 HTOs for the risk of unanticipated events in mid-age patients from the national claims data in South Korea. BMC Musculoskelet Disord 2022; 23:127. [PMID: 35135508 PMCID: PMC8827168 DOI: 10.1186/s12891-022-05080-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, over the past 20 years, results of comparisons of long-term survival rates and outcomes have remained controversial. Furthermore, in patients at the boundary age, from 50 to 70 years, considering age as a treatment indication, selecting a surgical method is difficult. Therefore, we aimed to investigate conversion rates to total knee arthroplasty (TKA) and perioperative adverse outcomes between the two surgical methods in mid-age patients. Methods We extracted data from the Korean National Health Insurance claims database. A total of 70,464 patients aged between 50 and 70 years, considered as mid-age patients were included in the final study population. We used a multivariable Cox proportional hazard regression model, adjusting for potential confounders such as age, sex, insurance type, region of residence, hospital type, comorbidities, and the Charlson comorbidity Index (CCI). Results Of the 70,464 patients, 21,194 were treated with UKA and 49,270 were treated with HTO. HTO showed a higher risk of revision than UKA at five, and 10 years and during the whole observation period. The incidence of deep vein thromboembolism, and surgical site infection was significantly higher in UKA than in HTO. Conclusions It is important to choose an appropriate surgical method considering that UKA has better results in terms of long-term survival rates but may have a higher incidence of various complications.
Collapse
Affiliation(s)
- Sun-Ho Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Hae-Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul, Republic of Korea
| | - Hyoung-Yeon Seo
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Jong-Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea.
| |
Collapse
|
21
|
Lee SH, Seo HY, Kim HR, Song EK, Seon JK. Older age increases the risk of revision and perioperative complications after high tibial osteotomy for unicompartmental knee osteoarthritis. Sci Rep 2021; 11:24340. [PMID: 34934052 PMCID: PMC8692610 DOI: 10.1038/s41598-021-03259-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022] Open
Abstract
Among various patient risk factors affecting survival after high tibial osteotomy (HTO), the ideal age limit for HTO is unclear. This study was performed to evaluate the effect of age on survival rate and complications after HTO for medial unicompartmental osteoarthritis. Among of 61,145 HTO patients from Korean National Health Insurance database, 41,112 patients underwent the procedure before the age of 60 years (Group A), 13,895 patients between the age of 60 and 65 years (Group B), and 6138 patients after the age of 65 years (Group C). We compared the survival rate in person-years among the three groups from the date of primary surgery until subsequent total knee arthroplasty. Perioperative complications were also recorded. The adjusted hazard ratio (HR) were calculated using the multivariable Cox proportional hazard regression model, adjusting for the potential confounders: age, sex, type of medical insurance, region of residence, hospital type, comorbidities, and Charlson comorbidity index score. The total number of HTO increased 6.5-fold, especially in patients aged > 65 years (by 8.2-fold) from 2008 to 2018. The overall revision rate was 4.2% in Group A, 6.4% in Group B, and 7.3% in Group C. The 5- and 10-year revision rate was significantly lower in Group A (p < 0.001), but no difference between Groups B and C. After adjusting for potential confounders, multivariable regression analysis revealed that revision rate was significantly lower in Group A than Group B (HR: 0.57; p < 0.0001), but no difference between Groups B and C. The incidence of complications was also significantly lower in Group A than in other groups. The inferior survival rate and more perioperative complications after HTO was found in old patients (aged ≥ 60 years) than in young patients. Therefore, the patient age is one of the predicting factors for a high risk of failure after HTO.
Collapse
Affiliation(s)
- Sun-Ho Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Hyoung-Yeon Seo
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Hae-Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul, Republic of Korea
| | - Eun-Kyoo Song
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Jong-Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea.
| |
Collapse
|
22
|
Risk of Revision and Adverse Outcomes Following Partial Knee Replacement and High Tibial Osteotomy for Unicompartmental Knee Osteoarthritis: A Nationwide Cohort Study. Indian J Orthop 2021; 55:1101-1110. [PMID: 34824709 PMCID: PMC8586119 DOI: 10.1007/s43465-021-00517-z] [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: 05/19/2021] [Accepted: 09/05/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate comparative study for potential associations of adverse outcomes as well as survival rates after high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA). METHODS We reviewed the Korean National Health Insurance claims database from January 1, 2007 to May 31, 2019. A total of 90,705 patients aged 30-90 years who were newly treated for HTO or UKA were identified considering their eligibility. We performed four rounds of propensity score matching to reduce imbalance of baseline characteristics, especially disparities among different age groups. Multivariable logistic regression models were used to compare the risk of revision and various unwanted medical problems between HTO and UKA treatment groups after propensity score matching. RESULTS 23,563 matched patients were assigned to each group on the basis of propensity score. HTO showed higher risk of revision than UKA at 5 years, 10 years and the whole observed period (hazard ratio: 1.21, 95% CI 1.10-1.34). Deep vein thromboembolism (0.27, 0.21-0.35), and surgical site infection (0.37, 0.30-0.44) were less likely for HTOs than UKAs. Postoperative admission to intensive care unit was significantly lower with HTO (odds ratio: 0.40, 0.29-0.54) while rehospitalization within 30 days (1.27, 1.16-1.38) and 90 days (1.24, 1.18-1.30) were higher than UKA. CONCLUSION When choosing the surgical method for unicompartmental knee OA, not only the survival rate, but also the risk of other adverse outcomes should be considered. In particular, attention should be paid to the risk of developing deep vein thromboembolism and surgical site infection. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00517-z.
Collapse
|
23
|
Itoh M, Itou J, Kuwashima U, Okazaki K. Good Validity and High Internal Consistency of the Forgotten Joint Score-12 in Patients After Medial Opening Wedge High Tibial Osteotomy. J Arthroplasty 2021; 36:2691-2697. [PMID: 33812712 DOI: 10.1016/j.arth.2021.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Forgotten Joint Score-12 (FJS-12) was originally developed to assess awareness of an artificial joint. Medial opening wedge high tibial osteotomy (MOWHTO), an alternative surgical method of knee replacement, is a joint-preservation surgery; therefore, joint awareness should be used to evaluate its clinical results. However, FJS-12 has not been validated as a tool to evaluate the postoperative results of MOWHTO. This study aimed to validate FJS-12 in MOWHTO. METHODS Patients with bilateral knee surgery, previous knee surgery, flexion contracture >15°, varus alignment >20°, and patients without plate removal surgery were excluded. Finally, 71 knees of 71 patients were analyzed, with a mean follow-up of 34.5 months. The FJS-12 score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained, and the floor and ceiling effect of each score was investigated. Cronbach's α was calculated to determine the internal consistency of FJS-12. Spearman's correlation coefficients between FJS-12 and KOOS were calculated to assess convergent validity. RESULTS There were ceiling effects in 3 KOOS subscales (symptoms [25.4%], pain [15.5%], and activities of daily living [25.4%]) but not in FJS-12 (8.5%). No floor effect was noted in any patient-reported outcome measures. The total Cronbach's α was 0.9457 in FJS-12. FJS-12 showed moderate-to-strong positive correlations with all KOOS subscales (r = 0.64-0.72). CONCLUSION FJS-12 showed a lower ceiling effect than KOOS and high internal consistency and convergent validity in patients following MOWHTO. With its low ceiling effect, FJS-12 was found to be useful for evaluating patients following MOWHTO.
Collapse
Affiliation(s)
- Masafumi Itoh
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Junya Itou
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Umito Kuwashima
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
24
|
Jin QH, Lee WG, Song EK, Jin C, Seon JK. Comparison of Long-Term Survival Analysis Between Open-Wedge High Tibial Osteotomy and Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:1562-1567.e1. [PMID: 33261999 DOI: 10.1016/j.arth.2020.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To compare unicompartmental knee arthroplasty (UKA) and open-wedge high tibial osteotomy (OWHTO) in a long-term follow-up propensity score matching analysis. METHODS Patients who underwent UKA or OWHTO for unilateral medial unicompartmental osteoarthritis (OA) between 2004 and 2010 were included. The ROM, HSS score, KS score, WOMAC score, forgotten joint score, OA progression in patellofemoral and lateral compartments, and survivorship were compared within ten years of follow-up between 67 UKA and 67 OWHTO patients after propensity score matching for age, gender, body mass index, range of motion, and osteoarthritis (OA) grade. RESULTS At the last follow-up, there were no significant differences between the two groups in clinical outcomes, but the WOMAC score showed better results after UKA (13.1 in UKA vs 18.9 in OWHTO, P = .011). The OA progression also showed no significant difference between the two groups. After a 10-year follow-up, the survival rate was higher in UKA patients (96.2%) than in OWHTO patients (87.7%), with no statistical difference (P = .06). CONCLUSION UKA showed better clinical outcomes and OA progressions than OWHTO. The survival rate presented a superiority of 8.5% for the UKA group in the 10-year follow-up, without significant difference.
Collapse
Affiliation(s)
- Quan He Jin
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea
| | - Won-Gyun Lee
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea
| | - Eun-Kyoo Song
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea
| | - Cheng Jin
- Department of Orthopaedic Surgery, Zhoushan Hospital, Lincheng New District, Zhoushan Zhejiang, China
| | - Jong-Keun Seon
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, South Korea
| |
Collapse
|
25
|
Wang F, Xue H, Ma T, Wen T, Yang T, Xue L, Tu Y. Short-term effectiveness of medial unicompartmental knee arthroplasty in young patients aged less than or equal to 60 years. J Orthop Surg (Hong Kong) 2021; 28:2309499020945118. [PMID: 33034241 DOI: 10.1177/2309499020945118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The treatment for young patients with advanced knee arthritis by Oxford unicompartmental knee arthroplasty (Oxford-UKA) is still controversial. A relative few studies were published about Asian patients. We evaluated midterm results of Oxford-UKA in young patients aged less than or equal to 60 years. METHODS Between December 2009 and December 2018, 95 patients (109 knees) (mean age 57.48 years; range: 33-60 years) were included. The mean follow-up period was 3.0 years (range: 1.0-9.5 years). The functional outcomes and pain score of the knee before and after surgery were examined. RESULTS To the last follow-up, no patient died, six patients (nine knees) were lost and one patient underwent total knee revision in case of unexplained postoperative pain. The patients demonstrated significant improvement in range of knee motion (103.65 vs. 115.96, p < 0.05), Oxford Knee Score (40.0 vs. 14.4, p < 0.05), Hospital for Special Surgery Score (56.0 vs. 85.7, p < 0.05), and Visual Analogue Score (VAS) (5.23 vs. 1.08, p < 0.05) before and after surgery. CONCLUSION Our midterm results showed that the Oxford-UKA was a reliable and effective treatment option for young patients aged less than or equal to 60 years with anterior medial osteoarthritis. The knee pain can be effectively relieved and excellent functional activities of the knee joint can be obtained after surgery.
Collapse
Affiliation(s)
- Fangxing Wang
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Huaming Xue
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Tong Ma
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Tao Wen
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Tao Yang
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Long Xue
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| | - Yihui Tu
- Department of Joint Surgery, 74683Yangpu Hospital Affiliated to Tongji University, Shanghai, China
| |
Collapse
|
26
|
Matsumoto K, Ogawa H, Yoshioka H, Akiyama H. Differences in patient-reported outcomes between medial opening-wedge high tibial osteotomy and total knee arthroplasty. J Orthop Surg (Hong Kong) 2020; 28:2309499019895636. [PMID: 31916479 DOI: 10.1177/2309499019895636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To compare patient subjective satisfaction between medial opening-wedge high tibial osteotomy (HTO) and total knee arthroplasty (TKA). METHODS This study enrolled 110 knees, including comprising 49 knees in the HTO group, and 61 knees in the TKA group. We assessed the overall satisfaction using a three-point questionnaire. The satisfaction questionnaire included three questions: (1) How satisfied are you with the results of your knee surgery? (2) How satisfied are you with your most recent knee surgery for reducing your pain? and (3) How satisfied are you with your most recent knee surgery for improving your ability to perform functions? Furthermore, we assessed knee pain and function by using the Knee Society Function Score (KSS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) systems. RESULTS Overall, 93.8% of patients from the HTO group and 95.1% from the TKA group indicated subjective satisfaction (very satisfied and satisfied) with their surgeries. For pain relief, the HTO group showed significantly better outcomes for overall satisfaction (p = 0.04 in walking on a flat surface and p = 0.02 in going upstairs or downstairs). For restored function, the HTO group scored significantly better on ascending stairs than the TKA group (p = 0.007). Functional outcomes using the KSS scoring system did not show significant differences between the two groups. The KOOS pain score was significantly higher in the TKA group (89.9 ± 6.4) than in the HTO group (80.3 ± 12.5). CONCLUSION HTO and TKA have comparable outcomes with respect to overall patient satisfaction. LEVEL OF EVIDENCE Level III, therapeutic case series.
Collapse
Affiliation(s)
- Kazu Matsumoto
- Department of Orthopedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroyasu Ogawa
- Department of Orthopedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroki Yoshioka
- Department of Orthopedic Surgery, Yamauchi Hospital, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| |
Collapse
|
27
|
Bouguennec N, Mergenthaler G, Gicquel T, Briand C, Nadau E, Pailhé R, Hanouz JL, Fayard JM, Rochcongar G. Medium-term survival and clinical and radiological results in high tibial osteotomy: Factors for failure and comparison with unicompartmental arthroplasty. Orthop Traumatol Surg Res 2020; 106:S223-S230. [PMID: 32863169 DOI: 10.1016/j.otsr.2020.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are two surgical solutions for isolated medial tibiofemoral osteoarthritis. Results depend on preoperative criteria and patient selection, but also on postoperative factors: implant positioning, limb alignment. Factors for HTO survival need identifying to reduce risk of failure requiring total knee arthroplasty (TKA). HYPOTHESIS Age, gender, weight, osteoarthritis grade, degree of correction, type of osteotomy, technique and intraoperative complications impact HTO survival. MATERIAL AND METHOD As part of a symposium of the French Society of Arthroscopy (SFA), a multicenter retrospective study compared 2 series. The HTO series comprised 488 patients: 153 female (31.4%); mean age, 55.1 years; mean weight, 83.1kg; mean body-mass index (BMI), 28.6. The UKA series comprised 284 patients: 172 female (60.6%); mean age, 64.1 years; mean weight, 75.3kg; mean BMI, 27.6. The main endpoint was comparative survival at 5, 8 and 10 years; secondary endpoints comprised pre- and post-operative hip-knee-ankle (HKA) angle, mechanical femoral angle (mFA) and mechanical tibial angle (mTA), surgical technique, satisfaction, time to and level of return to work, WOMAC and Tegner scores and complications rates. The significance threshold was set at p<0.05; 95% confidence intervals were calculated. RESULTS Age>54 years, male gender, BMI>25, medial tibiofemoral wear severity Ahlback ≥3, ≥0.9° varus joint component, HKA correction<8°, postoperative HKA<180° and hinge fracture were significantly associated with poorer survival. There was no impact of type of osteotomy, navigation assistance or postoperative HKA 183-186°. Ten-year survival was 74.3% for HTO and 71% for UKA (non-significant); however, survival curves crossed at 6 years. CONCLUSION HTO showed survival and functional results comparable to those of UKA in selected patients when target limb alignment correction was achieved. The present study determined selection criteria. A predictive score for results of either procedure would facilitate decision-making. LEVEL OF EVIDENCE IV, retrospective cohort study.
Collapse
Affiliation(s)
- Nicolas Bouguennec
- Clinique du Sport de Bordeaux-Mérignac, 2, rue Georges Nègrevergne, 33700 Merignac, France.
| | - Guillaume Mergenthaler
- Département de Chirurgie Orthopédique et Traumatologique, Unité Inserm COMETE, UMR U1075, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - Thomas Gicquel
- Clinique Mutualiste de la Porte de L'Orient, 3, rue Robert de La Croix, 56100 Lorient, France
| | - Cyril Briand
- Service de Chirurgie Orthopédique, Traumatologique et Réparatrice, CHU de Rennes, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - Elodie Nadau
- Service de Chirurgie Orthopédique, Traumatologique, CHU Amiens Picardie, 80054 Amiens cedex 1, France
| | - Régis Pailhé
- Service de Chirurgie de l'Arthrose et du Sport, Urgences Traumatiques des Membres, Hôpital Sud - CHU de Grenoble, Laboratoire TIMC-GMCAO UMR 5525 UGA/CNRS, 38000 Grenoble, France
| | - Jean Luc Hanouz
- Service d'Anesthésie Réanimation, CHU de Caen, 14033 Caen cedex, France
| | - Jean Marie Fayard
- Centre Orthopédique Santy-Hopital Privé Jean Mermoz-Ramsay Générale de Santé, 69008 Lyon, France
| | - Goulven Rochcongar
- Département de Chirurgie Orthopédique et Traumatologique, Unité Inserm COMETE, UMR U1075, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | -
- 15, rue Ampère, 92500 Rueil Malmaison, France
| |
Collapse
|
28
|
Migliorini F, Driessen A, Oliva F, Maffulli GD, Tingart M, Maffulli N. Better outcomes and reduced failures for arthroplasty over osteotomy for advanced compartmental knee osteoarthritis in patients older than 50 years. J Orthop Surg Res 2020; 15:545. [PMID: 33213483 PMCID: PMC7678158 DOI: 10.1186/s13018-020-02079-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/10/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Both compartmental knee arthroplasty (CKA) and open-wedge high tibial osteotomy (HTO) may be used to treat patients older than 50 years of age with advanced compartmental osteoarthritis (OA) secondary to leg axis deformities. A meta-analysis was conducted to clarify the role of open-wedge HTO versus CKA for patients older than 50 years with advanced compartmental knee OA. The present investigation aimed to analyse the clinical outcomes, implant failure and survivorship. METHODS This meta-analysis was performed in accordance with the PRISMA guidelines. In September 2020, the main online databases were accessed. All clinical trials comparing the outcomes of open-wedge HTO versus CKA for compartmental knee OA were considered. Data analysis was performed through the Review Manager Software 5.3 (the Nordic Cochrane Collaboration, Copenhagen). Implant survivorship was analysed with a Kaplan-Meier (KM) curve that was performed using the STATA/MP software (StataCorp, College Station, TX). RESULTS Data from 618 (HTO, 307; CKA, 311) patients were collected. Good baseline comparability among patient age, BMI and gender was detected. The Tegner Activity Scale was higher in the CKA group (P = 0.04), as were the Lysholm score (P = 0.001), the International Knee Documentation Committee (P = 0.0001) and the Knee injury and Osteoarthritis Outcome Score (P = 0.05). At a mean follow-up of 5 years, revisions were less in the CKA cohort (OR, 2.27; P = 0.004). The Kaplan-Meier curve evidenced longer implant survivorship in favour of the CKA group (P = 0.01). CONCLUSION In patients older than 50 years of age with compartmental knee OA secondary to frontal axis leg deformities, CKA performed better than open-wedge HTO.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Arne Driessen
- Department of Orthopaedic Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | | | - Markus Tingart
- Department of Orthopaedic Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.,Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England, UK
| |
Collapse
|
29
|
Pongcharoen B, Timjang J. The outcomes of mobile bearing unicompartmental knee arthroplasty and total knee arthroplasty on anteromedial osteoarthritis of the knee in the same patient. Arch Orthop Trauma Surg 2020; 140:1783-1790. [PMID: 32710343 DOI: 10.1007/s00402-020-03527-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/14/2020] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Compared to total knee arthroplasty (TKA), mobile-bearing unicompartmental knee arthroplasty (UKA) is associated with better outcomes, such as an earlier recovery, less postoperative pain, lower morbidity and mortality, and a greater "feel" of a normal knee. However, no study has reported the clinical outcomes in patients with the same stage of osteoarthritis of the knee. The purpose of this study was to determine the clinical outcomes, including the Joint Forgotten Score (JFS), Oxford Knee Score (OKS), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Kujala score after UKA on one knee and TKA on the opposite knee in the same patient. MATERIALS AND METHODS We retrospectively reviewed 32 patients with anteromedial OA who underwent mobile-bearing UKA in one knee and TKA in the other knee from 2009 to 2017. The JFS, OKS, KSS, KOOS, and Kujala scores were recorded and compared between the groups. Patients' preferences between UKA and TKA and satisfaction were also recorded. RESULTS The JFS and KOOS in the UKA group were significantly (p = 0.01, 0.01) higher than those in the TKA group: 97.01 ± 3.26 (89.58-100) vs. 94.92 ± 3.34 (87.80-100) and 91.16 ± 2.67 (85.25-96) vs. 89.24 ± 2.67 (84.50-94.71), respectively. The OKS, KSS, and Kujala scores were not different between the two groups (p = 0.82, 0.95, and 0.31, respectively) and neither was patient preference (p = 0.41) or satisfaction (p = 0.42). The mean follow-up was 48.36 months (range 24.00-96.00 months), during which there were no postoperative complications. CONCLUSION UKA was associated with a better JFS and KOOS but was otherwise comparable to TKA and may be preferable.
Collapse
Affiliation(s)
- Boonchana Pongcharoen
- Department of Orthopaedic Surgery, Thammasat University, 95 Moo 8, Paholyotin Road, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand.
| | - Jitisak Timjang
- Department of Orthopaedic Surgery, Thammasat University, 95 Moo 8, Paholyotin Road, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand
| |
Collapse
|
30
|
Petersen W, Bierke S, Häner M. Kniegelenknahe Osteotomie bei unikompartimenteller Gonarthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00378-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
31
|
Kunze KN, Beletsky A, Hannon CP, LaPrade RF, Yanke AB, Cole BJ, Forsythe B, Chahla J. Return to Work and Sport After Proximal Tibial Osteotomy and the Effects of Opening Versus Closing Wedge Techniques on Adverse Outcomes: A Systematic Review and Meta-analysis. Am J Sports Med 2020; 48:2295-2304. [PMID: 31774691 DOI: 10.1177/0363546519881638] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although many studies have reported successful functional outcomes after proximal tibial osteotomy (PTO), a paucity of literature has sought to quantify outcomes and current rates of return to sport (RTS) and return to work (RTW) after PTO. PURPOSE To (1) determine current rates of RTS and RTW after PTO and (2) quantify the incidence of complications and conversion to total knee arthroplasty (TKA) after PTO for all patients as well as those undergoing opening and closing wedge PTO. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), EMBASE (2008-2019), and MEDLINE (2008-2019) databases were queried. Data pertaining to article information, patient demographics, surgical techniques, rates of complication and conversion to TKA, patient-reported outcome scores, RTS, and RTW were extracted. Data were synthesized, and a random effects meta-analysis of proportions using continuity correction methods was performed to determine the proportion of patients receiving opening and closing wedge PTO who experienced adverse events. RESULTS The review and meta-analysis included 33 studies involving 1914 patients who underwent PTO with a weighted mean ± SD age of 50.3 ± 9.9 years and body mass index of 26.9 ± 2.3 kg/m2. The pooled RTS and RTW rates were 75.7% (range, 55%-100%) in 814 patients and 80.8% (range, 41%-100%) in 505 patients, respectively. The pooled TKA rate was 12.5% (range, 0%-35.7%) at a mean of 70.6 months and the pooled complication rate was 11.1% (range, 0%-28.6%). The overall random pooled summary estimate of the proportion of patients who underwent opening wedge PTO and subsequently converted to TKA was 2.0% (95% CI, 1.0%-4.0%; I2 = 63.65) at a mean of 43.4 ± 31.9 months and who experienced a complication was 6.0% (95% CI, 3.0%-9.0%; I2 = 87.10%). For closing wedge PTO, the proportion of patients who converted to TKA was 5.0% (95% CI, 1.0%-9.0%; I2 = 93.1%) and experienced a complication was 2.0% (95% CI, 1.0%-3.0%; I2 = 90.0%). Only 53.8% of studies that referenced RTS provided postoperative RTS rates, and 80% of studies that referenced RTW provided RTW rates. Only 1 study defined RTS criteria, no studies defined RTW criteria, and 31 different outcome measures were reported across all studies. CONCLUSION Patients undergoing PTO for osteoarthritis, cartilage defects, and symptomatic malalignment of the knee experience high rates of RTS and RTW. These patients also experience low rates of complications and conversion to TKA, regardless of opening or closing wedge technique. Significant heterogeneity exists with regard to criteria used to define RTS and RTW and patient-reported outcome measures used to assess clinical and functional improvements after PTO.
Collapse
Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander Beletsky
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Adam B Yanke
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
32
|
Is iliac autogenous graft augmentation in medial open wedge high tibial osteotomies superior to no augmentation in terms of bone healing? Jt Dis Relat Surg 2020; 31:360-366. [PMID: 32584738 PMCID: PMC7489180 DOI: 10.5606/ehc.2020.73408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/08/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aims to investigate if iliac autogenous graft augmentation in medial open wedge high tibial osteotomies (OWHTOs) is superior to no augmentation in terms of bone healing. PATIENTS AND METHODS Twenty-five patients (14 males, 11 females; mean age 40.9±4.0 years; range, 33 to 48 years) with medial compartmental osteoarthritis of knee joint who underwent high tibial osteotomy with medial open wedge between January 2016 and December 2018 were included in this retrospective study. Twelve of the operated knees were the right knee. Graft was used in 13 patients (52%). Data including age, gender, body mass index (BMI), direction, follow-up period, union, Lysholm and International Knee Documentation Committee (IKDC) scores, pre- and postoperative femoral tibial angles (FTAs) and posterior tibial slopes were evaluated. RESULTS The mean BMI was 26.4±1.9 (range, 22.0 to 30.0). Only 48% of the patients were smoking. The mean follow-up period was 28.6±5.3 months (range, 24 to 38 months). No statistically significant difference was found between the grafted and non-grafted groups in terms of age, BMI, follow-up time, gender, side and smoking status (p>0.05) There was no statistically significant difference between two groups in terms of pre- and postoperative Lysholm scores, pre- and postoperative IKDC scores, or pre- and postoperative FTA values (p>0.050). CONCLUSION Iliac autogenous graft augmentation in medial OWHTO has no effect on union but shortens the union time. Preoperative high varus degree adversely affects union. Therefore, routine use of iliac crest autograft is not recommended.
Collapse
|
33
|
Liebensteiner M, Köglberger P, Ruzicka A, Giesinger JM, Oberaigner W, Krismer M. Unicondylar vs. total knee arthroplasty in medial osteoarthritis: a retrospective analysis of registry data and functional outcome. Arch Orthop Trauma Surg 2020; 140:545-549. [PMID: 32100107 DOI: 10.1007/s00402-020-03377-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE It was the aim of our study to compare the functional outcome (WOMAC score, range of motion) achieved with unicondylar knee arthroplasty (UKA) and total knee arthroplasty (TKA). It was hypothesized that UKA and TKA would differ with regard to the WOMAC function scale (hypothesis 1) and the WOMAC total scale (hypothesis 2). It was assumed that the groups would differ with respect to changes in range of motion (ROM) over time (hypothesis 3). METHODS A retrospective comparative study was conducted to analyze data available from the federal state's Arthroplasty Registry (WOMAC score) and from clinical routine (ROM). Patients who underwent UKA or TKA between 2008 and 2015 were considered. ANOVAs for repeated measurements were applied, adjusted for age, to test hypotheses 1-3. RESULTS The UKA group was comprised of 112 patients (age 65, BMI 29). The TKA group included 330 cases (age 69, BMI 29). Regarding hypothesis 1, the amount of improvement in WOMAC function was not influenced by the surgical group (no significant group*time interactions, p = 0.608). Similarly, for hypothesis 2, the amount of improvement in the WOMAC total score was not influenced by the surgical group (no significant group*time interactions, p = 0.392). Regarding hypothesis 3, we found no significant group*time interaction for the ROM data (p = 0.731). CONCLUSIONS On the basis of our findings, it is concluded that whether knee osteoarthritis is treated with either medial UKA or TKA has no influence on the WOMAC total score or any of the WOMAC subscales. It has no effect on early or late ROM gain.
Collapse
Affiliation(s)
| | - Paul Köglberger
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Ruzicka
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria.
| | - Johannes M Giesinger
- Innsbruck Institute of Patient-Centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - Wilhelm Oberaigner
- Institut für Klinische Epidemiologie, Tirol Kliniken, Innsbruck, Austria
- UMIT Private University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Martin Krismer
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
34
|
Herbst M, Kuwashima U, Ahrend MD, Gueorguiev BG, Schröter S, Ihle C. Health-Related Quality of Life - an Underestimated Factor to Evaluate the Treatment Success after Open Wedge HTO Surgery: Prospective 6-Years Follow-Up. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:288-297. [PMID: 32106329 DOI: 10.1055/a-1098-8894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The subjective health related quality of life in patients with degenerative joint diseases is an important variable to evaluate the treatment outcome. In this study, mid-term results of open wedge HTO were analysed and compared to the subjective quality of life (SF 36) of the general population. Furthermore, the relationships of preoperative assessed subscales of the health-related quality of life (SF 36) and the conversion to knee arthroplasty were analysed. METHODS The cohort consisted of 120 patients who were prospectively followed-up after open wedge HTO. At five follow-up points of time, patients were examined and asked about their subjective, health-related quality of life using the SF 36 score. RESULTS 104 patients were included and evaluated until the last follow-up (mean: 81.2 ± 11.3 months after open wedge HTO; follow-up rate: 86.7%). Six years after open wedge HTO, similar values in several psychologic subscales of the SF 36 (BP, GH, V, MH) and the mental health component summary score (MCS) compared to the general population were found. The physical health component summary score (PCS) showed a significant improvement relative to the preoperative values. Nine out of 104 patients (8.7%) received a knee arthroplasty (50.1 ± 25.0 months). Low preoperative values of the subscales "physical functioning" (PF) and "bodily pain" (BP) were identified as risk factors in terms of conversion to a total knee arthroplasty. CONCLUSIONS Patients with medial unicompartimental knee osteoarthrosis treated with open wedge HTO showed very good results. The health-related quality of life was nearly as high as in the general population. Patients with preoperative low physical function and high pain values have a higher risk to have a conversion to knee arthroplasty. Surgeons should be aware of these factors if an open wedge HTO is considered.
Collapse
Affiliation(s)
- Moritz Herbst
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - Umito Kuwashima
- Joint Surgery Center, Yokosuka City Hospital, Yokosuka, Japan
| | - Marc-Daniel Ahrend
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | | | - Steffen Schröter
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| | - Christoph Ihle
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
| |
Collapse
|
35
|
Early experience of lateral hinge fracture during medial opening-wedge high tibial osteotomy: incidence and clinical outcomes. Arch Orthop Trauma Surg 2020; 140:161-169. [PMID: 31273455 DOI: 10.1007/s00402-019-03237-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 02/09/2023]
Abstract
PURPOSE Lateral hinge fracture (LHF) during a medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be the main cause of instability, further displacement, loss of correction, malunion, and nonunion. The purposes of this study were to evaluate whether the incidence of LHFs during MOWHTOs has decreased as the number of cases performed over time has increased, and whether the radiographic and clinical outcomes of patients with LHFs were worse than those of patients without LHFs. MATERIALS AND METHODS During the period of July 2013 to January 2017, 132 MOWHTOs were performed by a single surgeon using a locking plate (TomoFix®, DePuySynthes, Solothurn, Switzerland) for the treatment of medial compartment osteoarthritis, with LHFs postoperatively detected in 32 knees (24.2%). To evaluate trends in the incidence of LHFs occurring during MOWHTOs over time, all 132 cases were divided chronologically into four groups of 33 cases and compared. The time for bony union and loss of correction were compared between the LHF group and the non-LHF group using an osteotomy filling index, hip-knee-ankle (HKA) angles, medial proximal tibial angles (MPTA), weight-bearing line (WBL) ratios, and posterior tibial slope (PTS) angles on radiographs. Clinical outcomes were also compared using the Knee Society Scores (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores 1 year post-surgery. RESULTS The incidence of LHFs in each group of 33 cases did not decrease over time (21.2%, 27.3%, 24.2%, and 24.2%, respectively, p = 0.954). The time to union was significantly different between the non-LHF group (5.0 months) and the LHF group (7.3 months) (p < 0.001). However, there were no immediate or 1-year postoperative differences in the HKA angles, MPTAs, WBL ratios, or PTS angles between the non-LHF and LHF groups (all p > 0.05). The KSS and WOMAC scores were significantly improved in both groups (all p < 0.001) 1 year post-surgery, without any differences between the groups (p = 0.997 and p = 0.122, respectively). CONCLUSIONS LHFs during MOWHTO procedures occurred consistently, with a similar incidence over time. Although patients with LHFs required more time to bony union, they showed similarly favorable radiographic and clinical results as the patients without LHFs 1 year after surgery.
Collapse
|
36
|
Kennedy JA, Molloy J, Mohammad HR, Mellon SJ, Dodd CAF, Murray DW. Mid- to long-term function and implant survival of ACL reconstruction and medial Oxford UKR. Knee 2019; 26:897-904. [PMID: 31174980 DOI: 10.1016/j.knee.2019.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/15/2019] [Accepted: 05/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to describe mid- to long-term outcomes of anterior cruciate ligament (ACL) reconstruction with simultaneous or staged medial unicompartmental knee replacement (UKR), and compare outcomes between (1) young patients aged younger than 55 at surgery and those older, (2) those with long-term follow-up greater than 10 years, (3) cemented and cementless UKR, and (4) compare outcomes to those with an intact ACL. PATIENTS AND METHODS We identified knees with staged or simultaneous ACL reconstruction and medial UKR from a prospectively followed designer UKR cohort, and describe mean Oxford Knee Score (OKS), mean Tegner activity score and Kaplan-Meier survival estimates. We matched these knees to ACL-intact knees. RESULTS Seventy-six consecutive UKR with staged or simultaneous ACL reconstruction were identified with mean six-year follow-up (range 1-15). There was significant improvement in OKS and Tegner score with surgery. At most recent follow-up, OKS was 41.0 (range 11 to 48), and Tegner score 3.6 (0 to 8). There were three revisions occurring at a mean of five years post-operatively. The five-, 10- and 15-year survival estimates were 97% (95% confidence interval [CI] 93-100), 92% (83-100), and 92% (83-100). There was no difference in functional scores or implant survival in young patients, those with long-term follow-up (>10 years), those with cementless fixation, or when compared to ACL intact knees. CONCLUSION These results demonstrate excellent mid- to long-term function and survival of selected patients who have undergone ACL reconstruction and medial UKR. Their outcome was similar to those with intact ACLs.
Collapse
Affiliation(s)
- J A Kennedy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom.
| | - J Molloy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - H R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - S J Mellon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - C A F Dodd
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - D W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom; Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom
| |
Collapse
|
37
|
Cheng X, Liu F, Xiong F, Huang Y, Paulus AC. Radiographic changes and clinical outcomes after open and closed wedge high tibial osteotomy: a systematic review and meta-analysis. J Orthop Surg Res 2019; 14:179. [PMID: 31200743 PMCID: PMC6570851 DOI: 10.1186/s13018-019-1222-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 06/04/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The purpose of this meta-analysis is to examine changes in radiological variables and clinical outcomes between open and closed wedge high tibial osteotomy (OWHTO and CWHTO, respectively), which have ongoing controversial issues in numerous quantitative clinical studies. METHODS PubMed, Embase, and the Cochrane Library were systematically searched for suitable controlled trials between Jan 1, 1999, and Feb 2, 2018. The inclusion criteria included studies written in English, studies with a level of evidence of I-IV, and studies presenting comparisons between OWHTO and CWHTO. The main clinical and radiographic results were extracted and pooled using Stata 12.0. RESULTS After searching for and screening trials, 28 trials involving 2840 knees were eligible for the meta-analysis. After OWHTO or CWHTO, clinical scores, including the American Knee Society Score, Hospital for Special Surgery Knee Score, Lysholm score, and Visual Analog Scale pain score, improved (p < 0.05), but the range of motion was unchanged (p > 0.05). The anatomical femorotibial angle (SMD 0.04, 95% CI - 0.66 to 0.74) and hip-knee-ankle angle (SMD 0.11, 95% CI - 0.11 to 0.33) data suggested that the OWHTO and CWHTO groups were similar in function of correction. Posterior tibial slope increased (SMD - 0.71, 95% CI - 1.04 to - 0.37) after OWHTO but decreased (SMD 0.72, 95% CI 0.35 to 1.08) after CWHTO. OWHTO decreased patellar height (p < 0.05), while patellar height did not change significantly after CWHTO (p > 0.05). CONCLUSION This meta-analysis indicates that compared with CWHTO, OWHTO increases the posterior slope, decreases the patellar height, and provides a similar accuracy of correction; however, CWHTO leads to a decreased posterior slope and an unchanged patellar height. Therefore, programs should be personalized and customized for the specific situation of each patient.
Collapse
Affiliation(s)
- Xiangyun Cheng
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Fanxiao Liu
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Fei Xiong
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Yijiang Huang
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
| | - Alexander Christoph Paulus
- 0000 0004 0477 2585grid.411095.8Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistrasse 23, 81377 Munich, Germany
| |
Collapse
|
38
|
Song SJ, Bae DK, Kim KI, Park CH. Long-term survival is similar between closed-wedge high tibial osteotomy and unicompartmental knee arthroplasty in patients with similar demographics. Knee Surg Sports Traumatol Arthrosc 2019; 27:1310-1319. [PMID: 30719541 DOI: 10.1007/s00167-019-05390-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/30/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Long-term clinical and radiographic results and survival rates were compared between closed-wedge high tibial osteotomy (HTOs) and fixed-bearing unicompartmental knee arthroplasty (UKA) in patients with similar demographics. METHODS Sixty HTOs and 50 UKAs completed between 1992 and 1998 were retrospectively reviewed. There were no significant differences in pre-operative demographics. The mean follow-up period was 10.7 ± 5.7 years for HTO and 12.0 ± 7.1 years for UKA (n.s.). The Knee Society knee and function scores, WOMAC, and range of motion (ROM) were investigated. The mechanical axis and femorotibial angle were evaluated. Kaplan-Meier survival analysis was performed (failure: revision to TKA) and the failure modes were investigated. RESULTS Most of the clinical and radiographic results were not different at the last follow-up, except ROM; ROM was 135.3° ± 12.3° in HTO and 126.8° ± 13.3° in UKA (p = 0.005). The 5-, 10-, 15-, and 20-year survival rates were 100%, 91.0%, 63.4%, and 48.3% for closed-wedge HTO, respectively, and 90.5%, 87.1%, 70.8%, and 66.4% for UKA (n.s.). The survival rate was higher than that for UKA until 12 years post-operatively but was higher in UKAs thereafter, following a remarkable decrease in HTO. The most common failure mode was degenerative osteoarthritic progression of medial compartment in HTO and femoral component loosening in UKA. CONCLUSIONS Long-term survival did not differ significantly between closed-wedge HTO and fixed-bearing UKA in patients with similar pre-operative demographics and knee conditions. The difference in post-operative ROM and failure mode should be considered when selecting a procedure. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, South Korea
| | - Kang Il Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-872, South Korea.
| |
Collapse
|
39
|
Koh IJ, Kim MS, Sohn S, Song KY, Choi NY, Jung H, In Y. Predictive factors for satisfaction after contemporary unicompartmental knee arthroplasty and high tibial osteotomy in isolated medial femorotibial osteoarthritis. Orthop Traumatol Surg Res 2019; 105:77-83. [PMID: 30509622 DOI: 10.1016/j.otsr.2018.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/28/2018] [Accepted: 11/13/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are viable treatment options for early osteoarthritis (OA). Although a substantial proportion of the patient selection criteria for HTO and UKA are now shared, the factors related to satisfaction following each procedure remain unclear. HYPOTHESIS We hypothesized that patient factors associated with satisfaction following contemporary HTO and UKA would be different. MATERIAL AND METHODS We retrospectively reviewed the records of consecutively enrolled medial opening-wedge HTOs (n=123) and Oxford mobile-bearing UKAs (n=118) with satisfactory postoperative alignment. Preoperative demographics, physical activity levels, varus deformity status, and degree of OA were recorded. Postoperative radiographs, frequency of combined procedures and patient-reported outcomes (PROs) including pain, Western Ontario and McMaster Universities Osteoarthritis Index score, and patient satisfaction were assessed. RESULTS Severe OA (p<0.01) was associated with an increased risk of dissatisfaction following HTO, whereas young age (p<0.01) and severe varus deformity (p=0.045) were related to dissatisfaction after UKA. In addition, patient satisfaction following UKA was higher than that following HTO in individuals with highly physically demanding activity. All UKA PROs were superior to those of the HTO group, except pain level. CONCLUSION Despite the shared patient selection criteria for contemporary HTO and UKA, severe OA was associated with dissatisfaction following HTO, whereas young age and varus deformity were associated with dissatisfaction following UKA. Age, varus deformity and OA severity should be considered when deciding whether to perform HTO or UKA. TYPE OF STUDY AND LEVEL OF PROOF Retrospective cohort study, Level III.
Collapse
Affiliation(s)
- In Jun Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, 02559 Seoul, Republic of Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea
| | - Sueen Sohn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea
| | - Kwang Yun Song
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea
| | - Nam Yong Choi
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea
| | - Hoyoung Jung
- Department of Orthopaedic Surgery, St. Paul's Hospital, 02559 Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea.
| |
Collapse
|
40
|
Mobile-bearing unicompartmental knee arthroplasty in old-aged patients demonstrates superior short-term clinical outcomes to open-wedge high tibial osteotomy in middle-aged patients with advanced isolated medial osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2018; 42:2357-2363. [DOI: 10.1007/s00264-018-3880-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/06/2018] [Indexed: 12/31/2022]
|
41
|
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.
Collapse
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.
| |
Collapse
|
42
|
Unicompartmental Knee Arthroplasty vs High Tibial Osteotomy for Knee Osteoarthritis: A Systematic Review and Meta-Analysis. J Arthroplasty 2018; 33:952-959. [PMID: 29203354 DOI: 10.1016/j.arth.2017.10.025] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/07/2017] [Accepted: 10/10/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prior studies have compared unicompartmental knee arthroplasty (UKA) with high tibial osteotomy (HTO) suggesting that both procedures had good clinical outcomes. However, which treatment is more beneficial for unicompartmental knee osteoarthritis is still a controversy. The purpose of our study is to obtain postoperative outcomes of revision rate, complications, function results, range of motion (ROM), and pain between the 2 procedures. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and study protocol was published online at PROSPERO under registration number CRD42016049316. We searched the databases MEDLINE, EMBASE, Cochrane Library, and Web of Science up to May 2017. Articles that directly compared postoperative outcomes of UKA to HTO were included. RESULTS A total of 10 comparative studies were included in our meta-analysis. UKA patients showed less revision rate, less complications, and less postoperative pain than HTO patients; however, HTO patients obtained more ROM. No significant difference was observed between the group accruing to the knee function scores and excellent/good surgical results. CONCLUSION UKA offers a safe and efficient alternative to osteoarthritis reduced postoperative pain, less postoperative complication, and revision. The 2 surgical techniques showed satisfactory function results for the patients; however, the HTO group achieved superior ROM compared to the UKA group. HTO may be suitable for patients with high activity requirements. Treatment options should be carefully considered for each patient in accordance with their age, body mass index, grade of osteoarthritis, and patients' activity levels.
Collapse
|
43
|
Han SB, Kyung HS, Seo IW, Shin YS. Better clinical outcomes after unicompartmental knee arthroplasty when comparing with high tibial osteotomy. Medicine (Baltimore) 2017; 96:e9268. [PMID: 29390376 PMCID: PMC5815788 DOI: 10.1097/md.0000000000009268] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, it is unclear whether HTO or UKA leads to better clinical outcomes and lower complication rates. This meta-analysis compared the clinical outcomes and complications of HTO and UKA in patients with medial knee OA. METHODS All studies comparing the functional outcome, postoperative pain, revision rate to total knee arthroplasty (TKA), postoperative complications, postoperative velocity, and postoperative range of motion (ROM) as assessed with various measurement tools in patients with medial knee OA treated with HTO or UKA were included. RESULTS Sixteen studies were included in the meta-analysis. The proportion of patients who underwent revision to TKA (OR 1.56, 95% CI: 0.61-3.98; P = .35) did not differ significantly between HTO and UKA. In contrast, functional outcome (OR 0.47, 95% CI: 0.24 to 0.95; P = .04), postoperative pain (OR 0.28, 95% CI: 0.12 to 0.62; P = .002), postoperative complications (OR 2.48, 95% CI: 1.26 to 4.90; P = .009), postoperative velocity (95% CI: -0.11 to -0.00; P = .03), and postoperative ROM (95% CI: 2.02 to 15.23; P = .01) were significantly different between the 2 groups. CONCLUSIONS There were no significant differences in the revision rate to TKA between HTO and UKA. However, results from subgroup analyses suggested that opening-wedge HTO resulted in a lower revision rate to TKA than did UKA, whereas closing-wedge HTO resulted in a higher revision rate to TKA than did UKA. In addition, UKA resulted in significantly better functional outcomes and postoperative velocity, along with less postoperative pain, fewer postoperative complications, and lower postoperative ROM. Based on the findings of current meta-analysis, UKA appears to be as efficacious and safe as HTO in the treatment of medial knee OA.
Collapse
Affiliation(s)
- Seung-Beom Han
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul
| | - Hee-Soo Kyung
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu
| | - In-Wook Seo
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| |
Collapse
|
44
|
Goldhahn S, Takeuchi R, Nakamura N, Nakamura R, Sawaguchi T. Responsiveness of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Oxford Knee Score (OKS) in Japanese patients with high tibial osteotomy. J Orthop Sci 2017; 22:862-867. [PMID: 28599878 DOI: 10.1016/j.jos.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 04/10/2017] [Accepted: 05/11/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND To assess responsiveness of the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Oxford Knee Score (OKS) in patients undergoing open-wedge HTO to treat knee osteoarthritis and/or osteonecrosis. METHODS Patients completed a set of questionnaires before HTO surgery (baseline) and 1 year after surgery. The questionnaires comprised the validated Japanese versions of the KOOS, the OKS, and the SF-36v2 and a visual analogue scale (VAS) for local knee pain and general pain. The treating surgeon completed the Japanese Orthopedic Association (JOA) score for osteoarthritic knees. The study included 119 patients aged 64.7 ± 8.3, 116 were followed at 1 year. 90 patients had knee osteoarthritis (OA) solely. 28 patients suffered from both OA and osteonecrosis (ON); one patient had ON only. Responsiveness to change was assessed using the effect size (ES) between the baseline and the 1-year postoperative assessment and standardized response mean. A distribution-based approach was used to determine the minimally detectable change (MDC95) for the KOOS subscales, and the OKS. RESULTS All instruments demonstrated statistically significant changes between the preoperative assessments and one year after surgery. All changes showed an improvement in score, but the condition-specific measures revealed higher responsiveness than the generic measures. All KOOS subscales, the OKS, the local pain VAS, and the JOA score showed large ESs (ES > 1.24) and SRMs (SRM>1.04). At a 95% confidence level, the respective MDCs were 15.83, 18.94, 15.22, 18.99 and 17.23 for the KOOS-Pain, KOOS-Symptoms, KOOS-ADL, KOOS-Sport/Rec, and KOOS-QOL subscales, respectively. The MDC95 for the OKS was 8.29. CONCLUSIONS Both, the KOOS and OKS are responsive for use in Japanese-speaking patients with knee osteoarthritis and/or osteonecrosis who are undergoing HTO.
Collapse
Affiliation(s)
- Sabine Goldhahn
- AO Foundation, AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600 Duebendorf, Switzerland.
| | - Ryohei Takeuchi
- Department of Orthopaedic Surgery, Yokosuka Municipal Hospital, Yokosuka, Japan.
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan.
| | | | - Takeshi Sawaguchi
- Department of Orthopaedic Surgery & Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan.
| |
Collapse
|
45
|
Kim MS, Son JM, Koh IJ, Bahk JH, In Y. Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2017; 137:1035-1045. [PMID: 28593581 DOI: 10.1007/s00402-017-2729-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A considerable percentage of outliers with under- or over-correction continue to be reported despite precise preoperative planning and cautious intraoperative correction of lower limb alignment in medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether our novel technique for the intraoperative adjustment of alignment under valgus stress reduces the number of outliers in patients undergoing MOWHTO compared to the conventional technique, which corrects alignment according to the cable method only. MATERIALS AND METHODS One hundred seventeen consecutive knees were enrolled in this case-control study. The first 52 knees (51 patients) were corrected in accordance with preoperative plans using the Dugdale method with modification with an intraoperative cable (group 1). In the other 65 knees (60 patients), the angle was corrected using the Dugdale method and limb alignment was adjusted using the intraoperative cable technique by applying valgus stress to the knee joint (group 2). The postoperative weight bearing line ratios and mechanical axis of the lower limb were compared at postoperative one year. Each knee was evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score preoperatively and at postoperative one year. RESULTS A significant reduction in the number of outliers was seen in group 2 compared to group 1 (group 1 = 48.1%, group 2 = 9.2%, p < 0.001). Nineteen of 52 knees (36.5%) were under-corrected in group 1, whereas 6 of 65 knees (9.2%) were under-corrected in group 2 (p < 0.001). Six of 52 knees (11.6%) were over-corrected in group 1, whereas 0 of 65 knees (0.0%) were over-corrected in group 2 (p = 0.005). At one -year after operation, group 2 showed significantly lower WOMAC score than group 1 (p = 0.014). CONCLUSIONS Intraoperative adjustment of alignment under valgus stress significantly reduced the number of outliers compared to a technique that corrected alignment using the cable method in patients undergoing MOWHTO. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jong Min Son
- Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hoon Bahk
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea.
| |
Collapse
|
46
|
Domnick C, Garcia P, Raschke MJ, Glasbrenner J, Lodde G, Fink C, Herbort M. Trends and incidences of ligament-surgeries and osteotomies of the knee: an analysis of German inpatient records 2005-2013. Arch Orthop Trauma Surg 2017; 137:989-995. [PMID: 28466182 DOI: 10.1007/s00402-017-2704-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In Germany most surgical procedures of the ligaments of the knee and correcting osteotomies of the knees are performed within an inpatient setting. The purpose of this study was to analyze the available data to assess epidemiological trends and incidences in inpatient knee joint surgery. MATERIALS AND METHODS Approximately 154 million anonymized DRG inpatient records were collected by the German Federal Statistical Office between 2005 and 2013. These data were screened and analyzed for knee joint surgical ligamental procedures and osteotomies. RESULTS Anterior cruciate ligament reconstruction (ACLR) or repair had a high incidence (46 per 100,000 persons/year). In addition, the most frequent grafts included hamstring tendon (90%) and the patellar tendon (6.3%) autografts (2013). Peak age group for ACLR was 15-20 years (14.5%) for female and 20-25 years (23.6%) for male patients, while there was a second peak in the age group 45-50 years (13.8%) for female patients. Male patients had a higher risk for receiving ACLR (RR 1.96; 95% CI 1.92-2.00) and for receiving valgizing high tibial osteotomy (RR 2.43; 95% CI 2.27-2.61). Females had a higher risk for receiving varizing distal femur osteotomy (RR 1.89; 95% CI 1.58-2.26). CONCLUSION There are growing trends for joint- and activity-preserving procedure in the middle-aged patients. The knowledge of the trends and incidences related to these procedures may help to validate and discuss the results of clinical and register studies.
Collapse
Affiliation(s)
- Christoph Domnick
- Department of Trauma-, Hand- and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - Patric Garcia
- Department of Trauma-, Hand- and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - Michael J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - Johannes Glasbrenner
- Department of Trauma-, Hand- and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - Georg Lodde
- Department of Trauma-, Hand- and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany
| | - Christian Fink
- Gelenkpunkt, Zentrum für Sport-und Gelenkchirurgie, Olympiastraße 39, 6020, Innsbruck, Austria
| | - Mirco Herbort
- Department of Trauma-, Hand- and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Waldeyer Strasse 1, 48149, Muenster, Germany.
| |
Collapse
|
47
|
Kim YJ, Kim BH, Yoo SH, Kang SW, Kwack CH, Song MH. Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty in Young Asian Patients Less than 60 Years of Age: A Minimum 5-Year Follow-up. Knee Surg Relat Res 2017; 29:122-128. [PMID: 28545177 PMCID: PMC5450574 DOI: 10.5792/ksrr.16.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/09/2016] [Accepted: 12/20/2016] [Indexed: 02/02/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the efficacy of unicompartmental knee arthroplasty (UKA) in young active Asian patients by analyzing clinical outcomes, complications and survival rates. Materials and Methods Eighty-two knees were evaluated with a minimum follow-up of 5 years after Oxford phase 3 UKA in patients less than 60 years of age at the time of surgery. Their mean age was 54.7 years (range, 44 to 59 years). The mean follow-up period was 8.9 years (range, 5.3 to 12 years). Kaplan-Meier survivorship analysis was used to estimate implant survival. Results Including 3 bearing dislocations, 1 medial tibial collapse and 1 lateral osteoarthritis, the total complication rate was 6.1% (5/82). Of the 3 cases of bearing dislocation, 2 cases were resolved by replacing with a thicker bearing and 1 case was converted to total knee arthroplasty (TKA) due to repeated dislocation. The two knees with a medial tibial collapse and a lateral osteoarthritis were converted to TKA. The 10-year cumulative survival rate using Kaplan-Meier survival method was 94.7% (95% confidence interval: 88.7%-100%). Conclusions Oxford medial UKA was reliable and effective in young active Asian patients providing good clinical results and survival rate in the mid-term follow-up.
Collapse
Affiliation(s)
- Yeong-Joon Kim
- Department of Orthopaedic Surgery, Daedong General Hospital, Busan, Korea
| | - Bu-Hwan Kim
- Department of Orthopaedic Surgery, Daedong General Hospital, Busan, Korea
| | - Seong-Ho Yoo
- Department of Orthopaedic Surgery, Daedong General Hospital, Busan, Korea
| | - Suk-Woong Kang
- Department of Orthopaedic Surgery, Daedong General Hospital, Busan, Korea
| | - Chang-Hun Kwack
- Department of Orthopaedic Surgery, Daedong General Hospital, Busan, Korea
| | - Moo-Ho Song
- Department of Orthopaedic Surgery, Daedong General Hospital, Busan, Korea
| |
Collapse
|
48
|
Santoso MB, Wu L. Unicompartmental knee arthroplasty, is it superior to high tibial osteotomy in treating unicompartmental osteoarthritis? A meta-analysis and systemic review. J Orthop Surg Res 2017; 12:50. [PMID: 28351371 PMCID: PMC5371236 DOI: 10.1186/s13018-017-0552-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/17/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Debate remains whether high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA) is more beneficial for the treatment of unicompartmental knee osteoarthritis. The purpose of this study was to compare the functional results, knee scores, activity levels, and complications between the two procedures. METHODS We performed a systematic review of published literature from August 1982 through January 2017. Fifteen papers reporting three prospective randomized trials were subjected to a meta-analysis. RESULTS No significant difference between the two groups was noted with respect to free walking (velocity), knee score, deterioration of the contralateral or patellofemoral knee, or revision rate and total knee arthroplasty. However, UKA produced better outcomes compared to HTO in terms of the functional results, pain assessment, and complications, although patients who underwent HTO tended to have slightly better range of motion. CONCLUSIONS Valgus HTO provides better physical activity for younger patients whereas UKA is more suitable for older patients due to shorter rehabilitation time and faster functional recovery. Although UKA patients tended to have improved overall long-term outcomes, which may be due to accurate indications and patient selection, both treatment options yielded pleasing results. Therefore, we are unable to conclude that either method is superior.
Collapse
Affiliation(s)
- Marcel Budhi Santoso
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88th Jiefang Road, Hangzhou, 310009 Zhejiang Province People’s Republic of China
| | - Lidong Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88th Jiefang Road, Hangzhou, 310009 Zhejiang Province People’s Republic of China
| |
Collapse
|
49
|
Ogawa H, Matsumoto K, Ogawa T, Takeuchi K, Akiyama H. Preoperative varus laxity correlates with overcorrection in medial opening wedge high tibial osteotomy. Arch Orthop Trauma Surg 2016; 136:1337-42. [PMID: 27443167 DOI: 10.1007/s00402-016-2521-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Medial opening wedge high tibial osteotomy (HTO) is a realignment of the lower limb. Despite accurate preoperative planning and careful surgical techniques, many HTOs result in alignment correction errors. These alignment correction errors may be due to soft tissue laxity around the knee such as varus or valgus laxity. The purpose of this study was to examine the relationship of varus and valgus laxity of the knee and alignment correction errors, and to have a formula to predict the subsequent degree of these correction errors. MATERIALS AND METHODS Fifty knees from 41 patients undergoing opening wedge HTO for knee osteoarthritis were involved. Standing full-length anteroposterior radiographs of the lower limb and the tibia, and varus and valgus stress radiographs of the knee were used to evaluate alignment and joint laxity. Parameters were global correction (the change in the hip-knee-ankle angle), bony correction (the change in the medial proximal tibial angle), and soft tissue correction (global correction - bony correction). RESULTS The average of global correction, bony correction, and soft tissue correction were 12.8° ± 4.3°, 9.4° ± 3.2°, and 3.4° ± 2.5°, respectively. Preoperative varus laxity was moderately correlated with soft tissue correction (R = 0.58), and in which the slope of the line in the scatter plot represented 0.59, implying that soft tissue correction increases by 0.59° for every 1° of preoperative varus laxity. CONCLUSIONS Preoperative varus laxity is correlated with soft tissue correction, suggesting that more accurate alignment correction could be achieved by surgical planning taking into account preoperative varus laxity as a factor of soft tissue correction.
Collapse
Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, Gifu, 501-1194, Japan
- Department of Advanced Joint Reconstructive Surgery, Gifu University Graduate School of Medicine, Gifu, 501-1193, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, Gifu, 501-1194, Japan.
| | - Takahiro Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, Gifu, 501-1194, Japan
- Department of Orthopaedic Surgery, Kizawa Memorial Hospital, Minokamo, 505-8503, Japan
| | - Kentaro Takeuchi
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, Gifu, 501-1194, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, Gifu, 501-1194, Japan
| |
Collapse
|
50
|
Menger B, Kannenberg A, Petersen W, Zantop T, Rembitzki I, Stinus H. Effects of a novel foot-ankle orthosis in the non-operative treatment of unicompartmental knee osteoarthritis. Arch Orthop Trauma Surg 2016; 136:1281-1287. [PMID: 27393498 PMCID: PMC4990629 DOI: 10.1007/s00402-016-2500-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Unloader braces are non-surgical treatment options for patients with unicompartmental knee osteoarthritis (OA). However, many patients do not adhere to brace treatment because of complications related to discomfort and poor fit. An alternative to knee bracing is an ankle-foot orthosis (AFO) with a lever arm that presses the lower leg into valgus or varus. The aim of this study is to evaluate the clinical benefits of this AFO for patients with unicompartmental knee OA. MATERIALS AND METHODS Twenty-three patients with knee OA were enrolled in this observational study. The primary clinical outcome measure was the Western Ontario and McMasters Universities Arthritis Index (WOMAC) total score. Secondary outcome measures included WOMAC subscores, visual analogue pain scale, activity restriction and complication rate. Clinical scores were collected at start and 3, 6, 9, and 12 months after enrollment. Statistical evaluation was performed using the Student's t test. RESULTS Of the patients enrolled, 83 % suffered from medial compartment OA. Most patients had Grade II OA according to the Kellgren and Lawrence classification. WOMAC total score, both subscores and visual analogue pain scale were significantly improved over time. Patients also noted a reduction in restrictions to activities of daily living and sport-related activities while using the AFO. No patients discontinued orthosis use because of adverse effects. Two types of complications were noted: discomfort or light pressure sores around the ankle (7 patients), and wear and tear of the shoe in which the AFO was worn (14 patients). CONCLUSIONS This observational study suggests that this AFO is effective at significantly reducing pain and stiffness as well as improving the physical function of patients with mild to moderate unicompartmental osteoarthritis of the knee.
Collapse
Affiliation(s)
- Björn Menger
- Department of Orthopaedic and Trauma Surgery, School of Medicine, University of Göttingen, Göttingen, Germany
| | | | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Berlin, Germany
| | | | | | | |
Collapse
|