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Kim DH, Kim SC, Yoon JS, Lee YS. Are There Harmful Effects of Preoperative Mild Lateral or Patellofemoral Degeneration on the Outcomes of Open Wedge High Tibial Osteotomy for Medial Compartmental Osteoarthritis? Orthop J Sports Med 2020; 8:2325967120927481. [PMID: 32637430 PMCID: PMC7313345 DOI: 10.1177/2325967120927481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background Early osteoarthritis of the knee joint mostly affects the medial compartment, making osteotomy a rational approach to slow the progression of the disease. However, some patients show asymptomatic mild degeneration in the lateral or patellofemoral compartment. Purpose To evaluate the effect of asymptomatic mild lateral or patellofemoral degeneration on the outcomes of medial open wedge high tibial osteotomy (OWHTO) by assessing the outcomes according to the preoperative status of the lateral or patellofemoral degenerative changes. Study Design Cohort study; Level of evidence, 3. Methods A total of 114 patients (121 knees) who underwent biplanar OWHTO with second-look arthroscopic surgery and postoperative magnetic resonance imaging (MRI) were retrospectively enrolled. Patients were categorized into 4 groups according to the Osteoarthritis Research Society International (OARSI) and MRI Osteoarthritis Knee Score (MOAKS) classification systems. The International Cartilage Repair Society (ICRS) grade was used to evaluate the preoperative and postoperative cartilage status. Clinical outcomes were assessed by the American Knee Society (AKS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-item Short Form Health Survey (SF-36). Results No degenerative changes in the lateral and patellofemoral compartments of knees (group I) were identified in 51.2% of cases (62 knees). Asymptomatic degenerative changes only in the lateral compartment (group II: OARSI grades 1-3 and MOAKS grades 1-3) were identified in 15.7% of cases (19 knees), changes only in the patellofemoral compartment (group III: OARSI grades 1-3 and MOAKS grades 1-3) were identified in 10.7% of cases (13 knees), and changes in both the lateral and the patellofemoral compartments (group IV) were identified in 22.3% of cases (27 knees). In the medial compartment, there was no significant difference in the improvement of MOAKS and ICRS grades among all groups (P = .813 and .985, respectively). In the lateral and patellofemoral compartments, there was no significant difference in the decline of MOAKS (P = .649 and .421, respectively) and ICRS grades (P = .927 and .676, respectively) among all groups. Conclusion The presence of mild lateral or patellofemoral degenerative changes did not affect the MRI, arthroscopic, and clinical outcomes of OWHTO. However, long-term observations are necessary to draw definitive conclusions as to whether OWHTO can be indicated in such patients without harmful effects.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seong Chan Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ji Soo Yoon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Nishino K, Omori G, Koga Y, Kobayashi K, Sakamoto M, Tanabe Y, Tanaka M, Arakawa M. Three-dimensional dynamic analysis of knee joint during gait in medial knee osteoarthritis using loading axis of knee. Gait Posture 2015; 42:127-32. [PMID: 26002602 DOI: 10.1016/j.gaitpost.2015.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 03/31/2015] [Accepted: 04/30/2015] [Indexed: 02/02/2023]
Abstract
We recently developed a new method for three-dimensional evaluation of mechanical factors affecting knee joint in order to help identify factors that contribute to the progression of knee osteoarthritis (KOA). This study aimed to verify the clinical validity of our method by evaluating knee joint dynamics during gait. Subjects were 41 individuals (14 normal knees; 8 mild KOAs; 19 severe KOAs). The positions of skin markers attached to the body were captured during gait, and bi-planar X-ray images of the lower extremities were obtained in standing position. The positional relationship between the markers and femorotibial bones was determined from the X-ray images. Combining this relationship with gait capture allowed for the estimation of relative movement between femorotibial bones. We also calculated the point of intersection of loading axis of knee on the tibial proximal surface (LAK point) to analyze knee joint dynamics. Knee flexion range in subjects with severe KOA during gait was significantly smaller than that in those with normal knees (p=0.011), and knee adduction in those with severe KOA was significantly larger than in those with mild KOA (p<0.000). LAK point was locally loaded on the medial compartment of the tibial surface as KOA progressed, with LAK point of subjects with severe KOA rapidly shifting medially during loading response. Local loading and medial shear force were applied to the tibial surface during stance phase as medial KOA progressed. Our findings suggest that our method is useful for the quantitative evaluation of mechanical factors that affect KOA progression.
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Affiliation(s)
- Katsutoshi Nishino
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata, Japan.
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopaedic Surgery, Ninouji Spa Hospital, 452 Toramaru, Shibata-shi, Niigata, Japan
| | - Koichi Kobayashi
- Department of Health Sciences, Niigata University School of Medicine, 2-746 Asahimachi-dori, Chuoh-ku, Niigata, Japan
| | - Makoto Sakamoto
- Department of Health Sciences, Niigata University School of Medicine, 2-746 Asahimachi-dori, Chuoh-ku, Niigata, Japan
| | - Yuji Tanabe
- Department of Mechanical Engineering, Faculty of Engineering Niigata University, 2-8050 Ikarashi, Nishi-ku, Niigata, Japan
| | - Masaei Tanaka
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata, Japan
| | - Masaaki Arakawa
- Niigata Institute for Health and Sports Medicine, 67-12 Seigorou, Chuoh-ku, Niigata, Japan
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Nakamura E, Okamoto N, Nishioka H, Karasugi T, Hirose J, Mizuta H. The long-term outcome of open-wedge osteotomy of the proximal tibia with hemicallotasis. Bone Joint J 2014; 96-B:467-72. [PMID: 24692612 DOI: 10.1302/0301-620x.96b4.31345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the long-term outcome of 33 patients (37 knees) who underwent proximal tibial open-wedge osteotomy with hemicallotasis (HCO) for medial osteoarthritis of the knee between 1995 and 2000. Among these, 29 patients with unilateral HCO were enrolled and 19 were available for review at a mean of 14.2 years (10 to 15.7) post-operatively. For these 19 patients, the mean Hospital for Special Surgery knee score was 60 (57 to 62) pre-operatively and 85 (82 to 87) at final follow-up (p < 0.001; paired t-test). The femorotibial angle and tibial inclination angle (IA) were measured at short-term follow-up, one to four years post-operatively, and showed no significant subsequent changes. The clinical scores and radiological measurements showed little change over time. One patient required conversion to total knee replacement during this time. These results suggest that the coronal angle achieved at operation is maintained at long-term follow up after HCO without alteration of the IA, providing a good long-term clinical outcome. Cite this article: Bone Joint J 2014;96-B:467–72.
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Affiliation(s)
- E. Nakamura
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - N. Okamoto
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - H. Nishioka
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - T. Karasugi
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - J. Hirose
- Kumamoto University, Department
of Medical Information Science and Administration Planning, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - H. Mizuta
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
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Clifford AG, Gabriel SM, O'Connell M, Lowe D, Miller LE, Block JE. The KineSpring(®) Knee Implant System: an implantable joint-unloading prosthesis for treatment of medial knee osteoarthritis. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2013; 6:69-76. [PMID: 23717052 PMCID: PMC3663478 DOI: 10.2147/mder.s44385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Symptomatic medial compartment knee osteoarthritis (OA) is the leading cause of musculoskeletal pain and disability in adults. Therapies intended to unload the medial knee compartment have yielded unsatisfactory results due to low patient compliance with conservative treatments and high complication rates with surgical options. There is no widely available joint-unloading treatment for medial knee OA that offers clinically important symptom alleviation, low complication risk, and high patient acceptance. The KineSpring® Knee Implant System (Moximed, Inc, Hayward, CA, USA) is a first-of-its-kind, implantable, extra-articular, extra-capsular prosthesis intended to alleviate knee OA-related symptoms by reducing medial knee compartment loading while overcoming the limitations of traditional joint-unloading therapies. Preclinical and clinical studies have demonstrated excellent prosthesis durability, substantial reductions in medial compartment and total joint loads, and clinically important improvements in OA-related pain and function. The purpose of this report is to describe the KineSpring System, including implant characteristics, principles of operation, indications for use, patient selection criteria, surgical technique, postoperative care, preclinical testing, and clinical experience. The KineSpring System has potential to bridge the gap between ineffective conservative treatments and irreversible surgical interventions for medial compartment knee OA.
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The Evaluation of Knee Bone Mineral Density Following Open-Wedge High Tibial Osteotomy. J Appl Biomech 2012; 28:359-65. [DOI: 10.1123/jab.28.4.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Examinations of bone density changes in selected knee bone ends were evaluated prospectively in a randomized group of 28 patients, aged from 41 to 65 (mean: 55.3 years), who had varus deformations of their mechanic limb axes, mean 8 degrees. The examinations were conducted during the preoperative period, 10 days, 3, 6, and 12 weeks, as well as 6 and 12 months after the procedure. A statistically significant increase in bone density was observed in the medial tibial condyle area, while a statistically insignificant decrease of bone density was noted in the medial femoral condyles. Bone density increased in the lateral tibial condyle area, whereas there were no density changes in the area of the lateral femoral condyles. The research results demonstrate that the relief achieved in ailments after high tibial osteotomies does not directly correspond to the bone density of the affected areas.
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Abstract
The pathophysiology of osteoarthritis (OA) has been extensively studied. However, the basic approach to therapy, which consists of pain relief and maintenance of function, has not changed for decades. At present, there are no nonsurgical methods that clearly interfere with the natural history of OA or provide prolonged pain palliation. Much of OA disease progression is mediated by aberrant biomechanical forces or through pathologic responses to those forces. As understanding of these mechanisms improves, novel therapeutic approaches are being studied that may provide prolonged reductions in loading of OA joints. These new therapies may ultimately be shown to retard disease progression and palliate pain. This article reviews some of these strategies.
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Affiliation(s)
- Joel A Block
- Section of Rheumatology, Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA.
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Abstract
High tibial osteotomy is a well-established procedure for the management of medial compartment arthritis that is currently experiencing a resurgence in popularity. A number of techniques have been described, with the ultimate goal of obtaining appropriate alignment to provide pain relief and functional improvement over a long-term period. Appropriate patient selection and careful surgical technique is necessary to achieve these goals with a minimal risk of complication. Newer technology such as computer navigation promises to improve the overall accuracy of the procedure. The need for alignment correction in combination with ligament reconstruction and chondral resurfacing surgery will increase the indications for this procedure. This article discusses the techniques available for high tibial osteotomy, the results and relative advantages of each, and the appropriate surgical technique to achieve optimal results while minimizing complications.
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Hohmann E, Bryant A. Closing or Opening Wedge High Tibial Osteotomy: Watch Out for the Slope. ACTA ACUST UNITED AC 2007. [DOI: 10.1053/j.oto.2006.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lafeber FPJG, Intema F, Van Roermund PM, Marijnissen ACA. Unloading joints to treat osteoarthritis, including joint distraction. Curr Opin Rheumatol 2006; 18:519-25. [PMID: 16896294 DOI: 10.1097/01.bor.0000240366.54960.a1] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients are increasingly becoming interested in nonpharmacologic approaches to manage their osteoarthritis. This review examines the recent literature on the potential beneficial effects of unloading joints in the treatment of osteoarthritis, with a focus on joint distraction. RECENT FINDINGS Mechanical factors are involved in the development and progression of osteoarthritis. If "loading" is a major cause in development and progression of osteoarthritis, then "unloading" may be able to prevent progression. There is evidence that unloading may be effective in reducing pain and slowing down structural damage. This review describes unloading by footwear and bracing (nonsurgical), unloading by osteotomy (surgical), and has a focus on unloading by joint distraction. Excellent reviews in all these three fields have been published over the past few years. Recent studies argue for the usefulness of a biomechanical approach to improve function and possibly reduce disease progression in osteoarthritis. SUMMARY To improve patient function and possibly reduce disease progression, a biomechanical approach should be considered in treating patients with osteoarthritis. Further research (appropriate high-quality clinical trials) and analysis (clinical as well as preclinical and fundamental) are still necessary, however, to understand, validate, and refine the different approaches of unloading to treat osteoarthritis.
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Affiliation(s)
- Floris P J G Lafeber
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands.
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