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Do Lee W, Han HS, Du Ro H, Lee YS. Development of the machine learning model that is highly validated and easily applicable to predict radiographic knee osteoarthritis progression. J Orthop Res 2024. [PMID: 39354808 DOI: 10.1002/jor.25982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/24/2024] [Accepted: 09/16/2024] [Indexed: 10/03/2024]
Abstract
Many models using the aid of artificial intelligence have been recently proposed to predict the progression of knee osteoarthritis. However, previous models have not been properly validated with an external data set or have reported poor predictive performances. Therefore, the purpose of this study was to design a machine learning model for knee osteoarthritis progression, focusing on high validation quality and clinical applicability. A retrospective analysis was conducted on prospectively collected data, using the Osteoarthritis Initiative data set (5966 knees) for model development and the Multicenter Osteoarthritis Study data set (3392 knees) for validation. The analysis aimed to predict Kellgren-Lawrence grade (KLG) progression over 4-5 years in knees with initial KLG of 0, 1, or 2. Possible predictors included demographics, comorbidities, history of meniscectomy, gait speed, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and radiological findings. The Random Forest algorithm was employed for the predictive model development. Baseline KLG, contralateral knee osteoarthritis, lateral joint space narrowing (JSN) grade, BMI, medial JSN grade, and total WOMAC score were six features selected for the model in descending order of importance. Odds ratios of baseline KLG, contralateral knee osteoarthritis, and lateral JSN grade were 1.76, 2.59, and 4.74, respectively (all p < 0.001). The area-under-the-curve of the ROC curve in the validation set was 0.76 with an accuracy of 0.68 and an F1-score of 0.56. The progression of knee osteoarthritis in 4 ~ 5 years could be well-predicted using easily available variables. This simple and validated model may aid surgeons in knee osteoarthritis patient management.
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Affiliation(s)
- Weon Do Lee
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Hyuk-S Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hyun Du Ro
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
- CONNECTEVE Co., Ltd, Gangnam-gu, South Korea
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Yong S Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Longo UG, Mazzola A, Campi S, Salvatore G, Candela V, Casciaro C, Giannarelli D, D’Hooghe M, Papalia R. Annual Trends of High Tibial Osteotomy: Analysis of an Official Registry in Italy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1168. [PMID: 39064599 PMCID: PMC11279272 DOI: 10.3390/medicina60071168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high tibial osteotomy in Italy from 2001 to 2016. Materials and Methods: Data are sourced from the National Hospital Discharge Reports (SDO) of the Italian Ministry of Health between 2001 and 2016. Results: A total of 34,402 high tibial osteotomies were performed over the study period in Italy. The cumulative incidence was 3.6 cases per 100,000 residents. The age classes 50-54, 55-59 showed the higher number of procedures. In pediatric patients (0-19 years), high tibial osteotomies are also largely performed. The majority of patients having surgery were men with a M/F ratio of 1.5. The mean age of patients was 44.2 ± 19.2 years. Males were significantly younger than females (43.3 ± 20.7 vs. 45.6 ± 17.7). The average length of hospitalization was 6.1 ± 7.3 days. Over the course of the analysis, a declining trend in hospital stay length was seen. The main primary diagnosis codes were "Varus knee" (736.42 ICD-9-CM code, 33.9%), "Osteoarthrosis, localized, primary, leg region" (715.16 ICD-9-CM code, 9.5%). Conclusions: Over the study period, high tibial osteotomies in Italy almost halved. Varus deformity and knee osteoarthritis are the leading causes requiring high tibial osteotomy. Except for the pediatric setting, results showed that from the 20-24 age class to the 50-54 age class, there was an increasing request for knee osteotomy, whereas in those aged >60 years, the incidence progressively decreased. The evident decline in HTO performed over the years in Italy seems to reflect a minor role for knee osteotomy in the management of knee OA, as it seems to be primarily reserved for younger male patients.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Alessandro Mazzola
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Giuseppe Salvatore
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Vincenzo Candela
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Carlo Casciaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, 00168 Rome, Italy;
| | - Margaux D’Hooghe
- Department of Medicine, University of Navarra, 31008 Pamplona, Spain;
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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Kim TW, D'Lima DD, Moon NH, Shin WC, Suh KT, Yun MS, Lee SM. Effect of Meniscal Tear Patterns and Preoperative Cartilage Status on Joint Space Width After Medial Opening-Wedge High Tibial Osteotomy. Am J Sports Med 2024; 52:1535-1542. [PMID: 38623875 DOI: 10.1177/03635465241239327] [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] [Indexed: 04/17/2024]
Abstract
BACKGROUND Medial opening-wedge high tibial osteotomy (MOWHTO) is performed to treat young adults with medial compartment knee osteoarthritis associated with varus deformity. However, factors influencing joint space width (JSW) vary according to the type of medial meniscal tear and have not yet been completely elucidated. PURPOSE To examine changes in JSW according to the type of medial meniscal tear after MOWHTO and analyze the influencing factors. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study was conducted on 134 patients who underwent MOWHTO for medial osteoarthritis and were followed up for >2 years. The patients were classified into 3 groups based on medial meniscal status: intact, nonroot tear, and root tear. The authors then measured the JSW preoperatively and at 3 months, 6 months, 1 year, and >2 years postoperatively; analyzed whether the change in JSW varied according to meniscal status; and determined the association of these changes with the preoperative cartilage grade of the medial femoral condyle (MFC) and medial tibial plateau (MTP). International Knee Documentation Committee (IKDC) scores were used to evaluate clinical function. RESULTS Of the 134 patients, the medial meniscus was intact in 29 patients, a nonroot tear was observed in 58 patients, and a root tear was observed in 47 patients. Postoperatively, JSW increased for all groups, but the timing of the increase varied between the groups (P < .001). JSW increased the most 6 months postoperatively in the intact group and 3 months postoperatively in the nonroot tear and root tear groups (P < .001). Additionally, the increase in JSW was the greatest in the root tear group. Preoperatively, MFC and MTP cartilage status differed among the groups; MTP status did not affect the JSW, but MFC status did (P < .001). The IKDC score increased from the preoperative to postoperative time point in all groups, but there was no significant difference between groups. CONCLUSION The authors observed that the amount and timing of increase in JSW were dependent on the pattern of medial meniscal tear observed when MOWHTO was performed. In addition, the cartilage grade of MFC before surgery was associated with changes in JSW. The IKDC score was not significantly different between groups. However, a longer follow-up period is needed to analyze the correlation with the meniscal tear pattern and JSW.
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Affiliation(s)
- Tae Woo Kim
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea
- Department of Orthopedic Surgery, Gupo Sungshim Hospital, Busan, Republic of Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Department of Molecular Medicine, Scripps Research, La Jolla, California, USA
| | - Nam Hoon Moon
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Department of Molecular Medicine, Scripps Research, La Jolla, California, USA
- Department of Orthopedic Surgery, Pusan National University Hospital, Busan, Republic of Korea
- Pusan National University, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Won Chul Shin
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea
- Pusan National University, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Kuen Tak Suh
- Pusan National University, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Orthopedic Surgery, Sehung Hospital, Busan, Republic of Korea
| | - Mi Sook Yun
- Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang-Min Lee
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Department of Molecular Medicine, Scripps Research, La Jolla, California, USA
- Pusan National University, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Mabrouk A, Risebury M, Yasen S. High survivorship and low complication rate in a single-centre series of 651 medial opening wedge high tibial osteotomy cases with a mean follow-up of 13 years. Knee Surg Sports Traumatol Arthrosc 2024; 32:736-749. [PMID: 38410856 DOI: 10.1002/ksa.12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE This study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single-centre osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient-reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisions and survivorship up to 10 years postoperatively. METHODS A prospectively maintained single-centre database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management; varus knee malalignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean body mass index of 29.6 ± 5.2 kg/m2 , were included. This comprised 71% males (n = 462) and 29% females (n = 189). The mean follow-up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee injury and Osteoarthritis Outcome Scores, the Oxford Knee Score, the Oxford Knee Score-Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ-5D, which is a standardised measure of health-related quality of life. All lower limb alignment measurements were recorded pre- and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5- and 10-year survivorship were recorded. RESULTS A total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 ± 3.4 and 8.9 ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from -5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean medial proximal tibial angle improved from preoperative 85.5° ± 2.3° to postoperative 91.6° ± 2.7° and the mean Mikulicz point improved from 21.7 ± 12.6% to 54.8 ± 11% (all p values < 0.001). All PROMs significantly improved at 24 months follow-up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively and 3.2% unicompartmental knee arthroplasty conversion at a mean of 5.7 ± 2.5 years postoperatively. An overall 10.3% complication rate was recorded. The 5 and 10-year survivorship was 97.2% and 91.9%, respectively. CONCLUSION MOWHTO is a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with an evidence of overload and a varus mechanical coronal plane axis. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Ahmed Mabrouk
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Michael Risebury
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Sam Yasen
- Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Reale D, Feltri P, Franceschini M, de Girolamo L, Laver L, Magalon J, Sanchez M, Tischer T, Filardo G. Biological intra-articular augmentation for osteotomy in knee osteoarthritis: strategies and results : A systematic review of the literature from the ESSKA Orthobiologics Initiative. Knee Surg Sports Traumatol Arthrosc 2023; 31:4327-4346. [PMID: 37330935 DOI: 10.1007/s00167-023-07469-x] [Citation(s) in RCA: 1] [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: 02/24/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE To assess whether there is evidence supporting the use of augmentation strategies, either cartilage surgical procedures or injective orthobiologic options, to improve the results of osteotomies in knees with osteoarthritis (OA). METHODS A systematic review of the literature was performed on the PubMed, Web of Science and the Cochrane databases in January 2023 on osteotomies around the knee associated with augmentation strategies (either cartilage surgical procedures or injective orthobiologic options), reporting clinical, radiological, or second-look/histological outcomes at any follow-up. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS). RESULTS Out of the 7650 records identified from the databases, 42 articles were included for a total of 3580 patients and 3609 knees treated; 33 articles focused on surgical treatments and 9 on injective treatments performed in association with knee osteotomy. Out of the 17 comparative studies with surgical augmentation, only 1 showed a significant clinical benefit of an augmentation procedure with a regenerative approach. Overall, other studies showed no differences with reparative techniques and even detrimental outcomes with microfractures. Regarding injective procedures, viscosupplementation showed no improvement, while the use of platelet-rich plasma or cell-based products derived from both bone marrow and adipose tissue showed overall positive tissue changes which translated into a clinical benefit. The mean modified CMS score was 60.0 ± 12.1. CONCLUSION There is no evidence to support the effectiveness of cartilage surgical treatments combined with osteotomies in terms of pain relief and functional recovery of patients affected by OA in misaligned joints. Orthobiologic injective treatments targeting the whole joint environment showed promising findings. However, overall the available literature presents a limited quality with only few heterogeneous studies investigating each treatment option. This ORBIT systematic analysis will help surgeons to choose their therapeutic strategy according to the available evidence, and to plan further and better studies to optimize biologic intra-articular osteotomy augmentation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Davide Reale
- Ortopedia e Traumatologia, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
| | - Marco Franceschini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli-1, 40136, Bologna, Italy.
| | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
| | - Lior Laver
- Department of Orthopaedics, Hillel Yaffe Medical Center (HYMC), 38100, Hadera, Israel
- Arthrosport Clinic, Tel-Aviv, Israel
- Rappaport Faculty of Medicine, Technion University Hospital, Israel Institute of Technology, 32000, Haifa, Israel
| | - Jeremy Magalon
- Cell Therapy Department, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille (AP-HM), INSERM CIC BT 1409, 13005, Marseille, France
- INSERM, INRA, C2VN, Aix Marseille Univ, 13005, Marseille, France
- SAS Remedex, 13008, Marseille, France
| | - Mikel Sanchez
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
| | - Thomas Tischer
- Department of Orthopaedic Surgery, University of Rostock, 18051, Rostock, Germany
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900, Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
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Yoo HJ, Choi JK, Heo YM, Moon SJ, Oh BH. Changes in Parameters after High Tibial Osteotomy: Comparison of EOS System and Computed Tomographic Analysis. J Clin Med 2023; 12:5638. [PMID: 37685705 PMCID: PMC10488862 DOI: 10.3390/jcm12175638] [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: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
Unintended rotation of the distal tibia occurs during medial open-wedge high tibial osteotomy (MOWHTO). Computed tomography (CT) is the standard method of measuring lower limb alignment; however, the new low-dose EOS system allows three-dimensional limb modeling with automated measurements of lower limb alignment. This study investigated the differences between the changes in lower limb alignment profiles obtained using the EOS system and CT in patients who underwent MOWHTO. We investigated whether any factors contributed to the degree of deformation. Thirty patients were prospectively enrolled between October 2019 and February 2023. Changes in femoral and tibial torsion, femorotibial rotation, and posterior tibial slope were measured using pre- and post-MOWHTO CT and EOS images. We found no significant difference in pre- and postoperative tibial torsion or posterior tibial slope between CT and EOS. No variables showed a significant correlation with changes in the tibial torsion or posterior tibial slope. This study confirmed the possibility that the EOS system could replace CT in measuring changes in several parameters pre- and postoperatively. Furthermore, we confirmed that the distal tibia tended to be internally rotated after MOWHTO; however, we found no significantly related parameters related to deformation caused by MOWHTO.
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Affiliation(s)
| | | | | | | | - Byung-Hak Oh
- Department of Orthopedic Surgery, College of Medicine, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Republic of Korea; (H.-J.Y.); (J.-K.C.); (Y.-M.H.); (S.-J.M.)
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Yazdi HR, Karimi Haris H, Rohani S, Karimi N. The results of allogenic cancellous bone graft in medial opening wedge high tibial osteotomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:623-627. [PMID: 35867166 DOI: 10.1007/s00590-022-03335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE There is no clear consensus regarding the optimal filling agent in the medial opening wedge high tibial osteotomy (MOWHTO). In this study, we evaluated the clinical and radiologic outcomes of MOWHTO with an allogeneic cancellous bone graft and TomoFix plate. METHODS Medical profiles of 122 patients who underwent MOWHTO with cancellous bone graft from iliac crest were retrospectively reviewed. One hundred and two patients (120 knees) who met the study criteria were included in the analysis. The osteotomy site was fixed with a TomoFix plate. The mean age of the patients was 40.85 ± 22.15 years. The mean follow-up of the patients was 33.2 ± 29 months. The primary outcome measures were the union of osteotomy site and loss of correction that were investigated on postoperative radiographs. Secondary outcome measures were postoperative complications that were extracted from the patients' medical records. RESULTS Union of the osteotomy site was observed in all patients within three months after the operation. Loss of correction at the osteotomy site occurred in two knees (1.7%), both of which underwent revision surgery. Three patients had non-infected prolonged wound drainage and underwent reoperation for allograft removal. Nine other complications were also recorded that did not require intervention, including superficial infection (n = 2), compartment syndrome (n = 1), deep vein thrombosis (n = 1), loss of knee flexion (n = 2), and transient pain at the site of the osteotomy (n = 3). CONCLUSION Allogenic cancellous bone graft provides efficient gap healing in MOWHTO and can be used as an effective alternative to the autogenous bone graft.
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Affiliation(s)
- Hamid Reza Yazdi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hosein Karimi Haris
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Setareh Rohani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Neamat Karimi
- Department of Clinical Biochemistry, Cancer Research Laboratory, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Ishimatsu T, Takeuchi R, Ishikawa H, Maeyama A, Osawa K, Kimura N, Yamamoto T. Clinical outcomes of hybrid closed wedge high tibial osteotomy for advanced osteoarthritis of the knee compared with total knee arthroplasty. J Orthop Surg (Hong Kong) 2022; 30:10225536221137754. [PMID: 36331144 DOI: 10.1177/10225536221137754] [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] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate clinical outcomes between hybrid closed wedge high tibial osteotomy (HCWHTO) and total knee arthroplasty (TKA) for advanced medial compartmental osteoarthritis of the knee (advanced knee OA). METHODS In more than grade 3 OA based on the Kellgren-Lawrence classification, when patients' age was less than 60 years or activity level was more than level 5 based on the UCLA activity score, 22 knees (18 patients) underwent HCWHTO. The other 22 knees (18 patients) that underwent TKA were evaluated retrospectively. Muscle strength was evaluated preoperatively and at 1 year postoperatively. The visual analogue scale (VAS) and Japanese version of the Knee injury and Osteoarthritis Outcome Score (J-KOOS) were used to evaluate clinical outcomes preoperatively and at a mean 66-months follow-up. RESULTS All postoperative muscle strength measures improved to preoperative equivalent levels in the HCWHTO group; they were significantly higher in the HCWHTO group than in the TKA group (p < .05). The VAS score and total J-KOOS significantly improved in both groups (HCWHTO, p = .001; TKA, p = .040); there were no significant differences in the scores between the groups at the final follow-up. Hybrid closed wedge HTO significantly improved the activities of daily living and sport/recreation scores, whereas TKA did not at the final follow-up. CONCLUSIONS In advanced knee OA, HCWHTO led to improved muscle strength, and its midterm clinical outcomes were equivalent to those of TKA. To postpone or even to avoid TKA, HCWHTO is considered an appropriate treatment for young and high-activity patients with advanced knee OA. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Tetsuro Ishimatsu
- Department of Joint Surgery Center, 38068Yokosuka Municipal Hospital, Yokosuka city, Kanagawa, Japan.,Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Ryohei Takeuchi
- Department of Joint Surgery Center, 38068Yokosuka Municipal Hospital, Yokosuka city, Kanagawa, Japan.,Department of Joint Surgery Center, 50211Saiwaitsurumi Hospital, Yokosuka city, Kanagawa, Japan
| | - Hiroyuki Ishikawa
- Department of Joint Surgery Center, 38068Yokosuka Municipal Hospital, Yokosuka city, Kanagawa, Japan
| | - Akira Maeyama
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Katsunari Osawa
- Department of Joint Surgery Center, 38068Yokosuka Municipal Hospital, Yokosuka city, Kanagawa, Japan.,Department of Joint Surgery Center, 50211Saiwaitsurumi Hospital, Yokosuka city, Kanagawa, Japan
| | - Natsumi Kimura
- Department of Rehabilitation, Yokosuka Municipal Hospital, Yokosuka city, Kanagawa, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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The Surgical Treatment of Osteoarthritis. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070982. [PMID: 35888072 PMCID: PMC9319328 DOI: 10.3390/life12070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.
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Kang BY, Lee DK, Kim HS, Wang JH. How to achieve an optimal alignment in medial opening wedge high tibial osteotomy? Knee Surg Relat Res 2022; 34:3. [PMID: 35135631 PMCID: PMC8822774 DOI: 10.1186/s43019-021-00130-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used surgical treatment option for medial compartmental osteoarthritis with varus deformity. It is important that proper lower limb alignment is achieved. However, there has been no consensus about an optimal alignment in MOWHTO. Most studies suggest that achieving valgus alignment is necessary, and recent studies support slight valgus mechanical alignment of less than 3° of mechanical femorotibial angle. Overcorrection and undercorrection is not recommended for achieving good surgical outcomes. To prevent undercorrection and overcorrection in MOWHTO, the method of placing the weight-bearing line in the target range must be precise. There are several ways to place a weight-bearing line within the target range. While the most important factor for a successful MOWHTO is achieving an ideal mechanical axis correction, there are a few other factors to consider, including joint line obliquity, posterior tibial slope, ligament balancing, and patellar height. Several factors exist that lead to undercorrection and overcorrection. Preoperative amount of varus deformity, lateral hinge fracture, and fixation failure can result in undercorrection, while medial soft tissue laxity and the amount of correction angle and target point beyond hypomochlion can result in overcorrection. This study aimed to review the literature on optimal alignment in MOWHTO and report on the factors to be considered to prevent correction errors and how to achieve an optimal alignment.
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Affiliation(s)
- Byoung Youl Kang
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Do Kyung Lee
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyeon Soo Kim
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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11
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Nicolini AP, Christiano ES, Abdalla RJ, Cohen M, de Carvalho RT. Return to Sports After High Tibial Osteotomy Using the Opening Wedge Technique. Rev Bras Ortop 2021; 56:313-319. [PMID: 34239195 PMCID: PMC8249055 DOI: 10.1055/s-0040-1715514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The present paper evaluates the resuming of physical activities by young, active patients who practiced some sport modality and underwent a high tibial osteotomy (HTO) using the opening wedge technique. Methods A total of 12 patients submitted to HTO using the opening wedge technique were prospectively analyzed. All patients were not playing sports at that time. Pre- and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores, visual analog scale for pain and performance level were compared. The average follow-up time was of 12 months. Results One patient resumed sporting activities at a performance level significantly lower compared to the preoperative level, while eight patients returned at a slightly below level, two returned at the same level and one patient returned at a higher level in comparison with the preoperative period. Conclusion For isolated medial osteoarthrosis treatment, HTO using the opening wedge technique has favorable clinical and functional results, allowing patients to resume their sporting activities.
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Affiliation(s)
- Alexandre Pedro Nicolini
- Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Suñe Christiano
- Centro de Traumatologia do Esporte, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rene Jorge Abdalla
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Moises Cohen
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Rogério Teixeira de Carvalho
- Departamento de Ortopedia e Traumatologia, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brasil
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12
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Yin Y, Zhang X, Zhang K, He X. Unicompartmental knee replacement and high tibial osteotomy for medial unicompartmental knee osteoarthritis: A comparative study protocol. Medicine (Baltimore) 2020; 99:e23454. [PMID: 33285742 PMCID: PMC7717739 DOI: 10.1097/md.0000000000023454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Many clinical studies have been published in the literature to compare the outcomes of unicompartmental knee replacement (UKR) and high tibial osteotomy (HTO), but reached different conclusions. Therefore, the relative merits and demerits of these 2 procedures remain under debate. The purpose of the present protocol was to design a retrospective comparative study to further investigate the clinical effectiveness of HTO compared to UKR in the medial unicompartmental osteoarthritis of knee patients. METHODS This is an observational retrospective research, which prospectively collected the data from several surgeons in our center and utilized the above 2 methods to treat the unicompartmental osteoarthritis of knee. In our single hospital, we reviewed unicompartmental knee osteoarthritis patients treated using UKR or HTO from June 2016 to February 2018. For the HTO, its criteria included:For the UKR, its inclusion criteria containedIn our cohorts, the clinical investigations of the knee were composed of the objective parameters, which were recorded and then documented through utilizing the Function Score and Orthopedic American Knee Society Knee Score. The extra clinical findings evaluated involved operative time, postoperative requirements of blood transfusion, possible postoperative complications, as well as the range of motion. CONCLUSION AND DISCUSSION The results of this study will provide clinical evidence on appropriate surgical treatment for patients with medial unicompartmental knee osteoarthritis. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6152).
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13
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Schreiner AJ, Stoker AM, Bozynski CC, Kuroki K, Stannard JP, Cook JL. Clinical Application of the Basic Science of Articular Cartilage Pathology and Treatment. J Knee Surg 2020; 33:1056-1068. [PMID: 32583400 DOI: 10.1055/s-0040-1712944] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The joint is an organ with each tissue playing critical roles in health and disease. Intact articular cartilage is an exquisite tissue that withstands incredible biologic and biomechanical demands in allowing movement and function, which is why hyaline cartilage must be maintained within a very narrow range of biochemical composition and morphologic architecture to meet demands while maintaining health and integrity. Unfortunately, insult, injury, and/or aging can initiate a cascade of events that result in erosion, degradation, and loss of articular cartilage such that joint pain and dysfunction ensue. Importantly, articular cartilage pathology affects the health of the entire joint and therefore should not be considered or addressed in isolation. Treating articular cartilage lesions is challenging because left alone, the tissue is incapable of regeneration or highly functional and durable repair. Nonoperative treatments can alleviate symptoms associated with cartilage pathology but are not curative or lasting. Current surgical treatments range from stimulation of intrinsic repair to whole-surface and whole-joint restoration. Unfortunately, there is a relative paucity of prospective, randomized controlled, or well-designed cohort-based clinical trials with respect to cartilage repair and restoration surgeries, such that there is a gap in knowledge that must be addressed to determine optimal treatment strategies for this ubiquitous problem in orthopedic health care. This review article discusses the basic science rationale and principles that influence pathology, symptoms, treatment algorithms, and outcomes associated with articular cartilage defects in the knee.
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Affiliation(s)
- Anna J Schreiner
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,BG Center for Trauma and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Aaron M Stoker
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Chantelle C Bozynski
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Keiichi Kuroki
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - James P Stannard
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Yin Z, Qian P, Wu X, Gao F, Xu F. Unicondylar knee arthroplasty versus total knee arthroplasty in adults with isolated medial osteoarthritis: A matched study protocol. Medicine (Baltimore) 2020; 99:e21868. [PMID: 32871911 PMCID: PMC7458234 DOI: 10.1097/md.0000000000021868] [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: 12/02/2022] Open
Abstract
BACKGROUND The choice between unicondylar knee arthroplasty (UKA) and total knee arthroplasty (TKA) is likely to have long-term implications for patient-reported health outcomes. However, high-quality studies that compare the outcomes of TKA and UKA and their effects are still lacking in the literature. Thus, the aim of the present study was to compare the UKA and TKA techniques with regard to functional outcomes and perioperative complications in patients who had isolated medial osteoarthritis. METHODS This was a retrospective, single-center, matched-controlled study performed with approval of our hospital (Kunshan hospital of Traditional Chinese Medicine affiliated to Nanjing University of Traditional Chinese Medicine), with the ethics number KZY2020-37. To reduce the effect of selection bias and potential confounding in this observational study, a 1:1 matching algorithm was applied. The groups were split by sex, age to within 6 years, and body mass index within 5 kg/m. Thus, we retrospectively reviewed the records of 240 consecutively enrolled patients who underwent UKA and 240 patients who underwent TKA from January 2013 to June 2015 from the database of our institution. Written informed consent was obtained from all subjects participating in the trial. Clinical outcomes included range of motion, Short Form 12 score, new Knee Society Score, Western Ontario and McMaster Universities Arthritis Index, and the complications. The outcome measures were evaluated by a physiotherapist and were assessed preoperatively and postoperatively at 6 months and 2 years. The mean follow-up time was 3 years. CONCLUSION We hypothesized that there was no significant difference between the 2 groups in terms of postoperative outcomes. TRIAL REGISTRATION Our study was registered in Research Registry (researchregistry5828).
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15
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Kim YT, Choi JY, Lee JK, Lee YM, Kim JI. Coronal tibiofemoral subluxation is a risk factor for postoperative overcorrection in high tibial osteotomy. Knee 2019; 26:832-837. [PMID: 31229290 DOI: 10.1016/j.knee.2019.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Severe tibiofemoral (TF) subluxation > 10 mm is a contraindication for high tibial osteotomy (HTO). However, the relationship between the degree of preoperative TF subluxation at < 10 mm and postoperative radiographic/clinical outcomes remains unclear. METHODS Sixty-seven patients who underwent open wedge HTO with a planned postoperative mechanical femorotibial angle (mFTA) of three degrees valgus were retrospectively studied. The minimal subluxation (MIN) group included 39 patients with TF subluxation < 5 mm, while the moderate subluxation (MOD) group included 28 patients with TF subluxation of five to 10 mm. The preoperative and one-year postoperative mFTA, TF subluxation, medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), preoperative Kellgren-Lawrence (K-L) grade and varus-valgus laxity were evaluated. Clinical scores and pain visual analogue scale (VAS) were also analyzed. RESULTS The mean preoperative TF values in the MIN and MOD groups were 3.1±1.0 mm and 6.7±1.6 mm (mean±standard deviation, p < 0.001), respectively, with no significant difference in K-L grades. The MIN group demonstrated a significantly smaller varus preoperative mFTA (p < 0.001), larger MPTA (p = 0.011), smaller JLCA (p = 0.004), and less varus laxity (p = 0.023). Postoperative TF subluxation, MPTAs, and JLCAs did not differ significantly between the two groups, while the postoperative mFTA was significantly different (p = 0.001), with unintended overcorrection in the MOD group. No significant difference in clinical scores and VAS were observed. CONCLUSIONS After HTO, compared to patients with TF subluxation < 5 mm, patients with TF subluxation of five to 10 mm were more likely to demonstrate unintended valgus overcorrection on one-year postoperative radiography.
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Affiliation(s)
- Yong Tae Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Jun Young Choi
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Young Min Lee
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea.
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Byalik VE, Makarov SA, Alekseeva LI, Byalik EI. Medium- and long-term results of high tibial osteotomy in patients with primary and secondary knee osteoarthritis with varus deformity. MODERN RHEUMATOLOGY JOURNAL 2019. [DOI: 10.14412/1996-7012-2019-2-38-46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The most common operation for knee osteoarthritis (OA) is total knee arthroplasty (TKA); however, the latter is associated with the development of severe complications. This was the reason for the revival of the interest of orthopedic traumatologists in high tibial osteotomy (HTO), the essence of which is to transfer the load away from the affected medial part of the knee joint (KJ) to the intact lateral one.Objective: to evaluate the medium- and long-term results of open-wedge (OW) HTO in primary and secondary I–III stage knee OA.Patients and methods. The Laboratory of Orthopedic Rheumatology and Rehabilitation, V.A. Nasonova Research Institute of Rheumatology, performed 10 OW HTOs in 9 patients in 2005 to 2009 and 21 more OW HTOs in 19 patients in 2014 to 2018 (a total of 31 operations). The male/female ratio was 2.5:1. The mean age of the patients was 57.6±12.5 years; the body mass index (BMI) was 28.5±3.6 kg/m2 ; the correction angle was 11.7±2.5°. Preoperative planning was performed using the Miniaci method; the X-ray stage of knee OA was evaluated according to the Kellgren–Lawrence classification. OW HTO was carried out. For assessment of its results, the investigators determined the degree of pain using a visual analogue scale (VAS) and the KJ status by the Knee Society Score (KSS) scale. The results were assessed at one (n=31), 3.5±0.6 (n=28), and 8.5±1.3 (n=10) years.Results and discussion. There was a tendency to worsen surgical results over time. The mean VAS values for pain at 1, 3.5, and 8.5 years were as follows: 9.8±10.3; 21.2±16.2 and 38±15.5 mm, respectively. In the same periods, the KSS functional scores were 83.6±14.8, 85.2±12.6, and 80.5±14.2; the objective scores were 80.7±8.5, 75.2±12.7, and 67.8±16.3. There was a strong correlation between the severity of pain and the functional and objective KSS scores (-0.78, -0.81 years, and -0.91 at 1, 3.5, and 8.5 years, respectively; p<0.05). At 3.5±0.6 years, the survival rate after OW HTO was 96.6%. None of the patients examined at 8.5±1.3 years after OW HTO needed TKA. The surgical result was studied in 2 patients at 14 years; one patient underwent TKA, the other refused surgical intervention, the result was satisfactory.Conclusion. OW HTO has limited indications for use. However, in patients who are allowed to undergo this operation, pain syndrome can be relieved, by maintaining and/or improving KJ function; in most cases, TKA can be delayed for more than 10 years.
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Affiliation(s)
- V. E. Byalik
- V.A. Nasonova Research Institute of Rheumatology
| | | | | | - E. I. Byalik
- V.A. Nasonova Research Institute of Rheumatology
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Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, Magnitskaya N, Mukhanov V, Neyret P, Solomin LN, Sorokin E, Staubli AE, Stone KR, Vilenskiy V, Zayats V, Pape D, Korolev A. Advances in modern osteotomies around the knee : Report on the Association of Sports Traumatology, Arthroscopy, Orthopaedic surgery, Rehabilitation (ASTAOR) Moscow International Osteotomy Congress 2017. J Exp Orthop 2019; 6:9. [PMID: 30805738 PMCID: PMC6389998 DOI: 10.1186/s40634-019-0177-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/13/2019] [Indexed: 01/03/2023] Open
Abstract
Corrective lower limb osteotomies are innovative and efficient therapeutic procedures for restoring axial alignment and managing unicompartmental knee osteoarthritis. This review presents critical insights into the up-dated clinical knowledge on osteotomies for complex posttraumatic or congenital lower limb deformities with a focus on high tibial osteotomies, including a comprehensive overview of basic principles of osteotomy planning, biomechanical considerations of different implants for osteotomies and insights in specific bone deformity correction techniques. Emphasis is placed on complex cases of lower limb osteotomies associated with ligament and multiaxial instability including pediatric cases, computer-assisted navigation, external fixation for long bone deformity correction and return to sport after such osteotomies. Altogether, these advances in the experimental and clinical knowledge of complex lower limb osteotomies allow generating improved, adapted therapeutic regimens to treat congenital and acquired lower limb deformities.
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Affiliation(s)
- Liang Gao
- Center of Experimental Orthopaedics, Saarland University, Homburg/Saar, Germany.,Cartilage Net of the Greater Region, Homburg/Saar, Germany
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University, Homburg/Saar, Germany. .,Cartilage Net of the Greater Region, Homburg/Saar, Germany. .,Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
| | - Dmitrii V Chugaev
- Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg State University, St. Petersburg, Russia
| | - Matteo Denti
- Department of Knee Surgery and Sports Traumatology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Aleksandr Frolov
- People's Friendship University of Russia, Moscow, Russia.,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - Mikhail Burtsev
- People's Friendship University of Russia, Moscow, Russia.,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - Nina Magnitskaya
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - Victor Mukhanov
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - Philippe Neyret
- Healthpoint, Abu Dhabi Knee & Sports Medicine Center, Zayed Sports City, Abu Dhabi, United Arab Emirates
| | - Leonid N Solomin
- Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg State University, St. Petersburg, Russia
| | - Evgeniy Sorokin
- Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg State University, St. Petersburg, Russia
| | | | | | - Viktor Vilenskiy
- Department of Bone Pathology, The Turner Scientific and Research Institute for Children's Orthopedics, St. Petersburg, Russia
| | - Vitaliy Zayats
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Dietrich Pape
- Cartilage Net of the Greater Region, Homburg/Saar, Germany.,Department of Orthopedic Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Public Research Centre for Health, Luxembourg, Centre Médical de La Fondation Norbert Metz, Luxembourg, Luxembourg
| | - Andrey Korolev
- People's Friendship University of Russia, Moscow, Russia.,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
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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.
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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.
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No evidence for combining cartilage treatment and knee osteotomy in osteoarthritic joints: a systematic literature review. Knee Surg Sports Traumatol Arthrosc 2018; 26:3290-3299. [PMID: 29453488 DOI: 10.1007/s00167-018-4871-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/12/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess whether the combination of HTO and cartilage treatment produced an additional clinical benefit compared to HTO alone. The secondary aim was to identify if there was any difference among different cartilage procedures in terms of healing potential and clinical outcome. METHODS A systematic review of the literature was performed on PubMed database by three independent observers according to the following inclusion criteria: clinical reports of any level of evidence, written in the English language, with no time limitation, about HTO associated with cartilage surgical and injective treatment, including surveys reporting clinical, radiological, or second-look outcomes at any follow-up time. RESULTS The database search identified 1956 records: 21 studies were included for the final analysis, for a total of 1068 patients; 10 case series and 11 comparative studies. While overall good results were reported in the case series, the analysis of the comparative studies showed less uniform results. Among the eight studies investigating HTO with cartilage surgical procedures, improved tissue regeneration was found in 5/8 studies, whereas a clinical improvement was reported only in two studies. Three studies on HTO combination with injective treatment showed better tissue regeneration and clinical benefit. CONCLUSIONS Literature presents low-quality studies, with only few heterogeneous comparative papers. While surgical treatments targeting only the cartilage layer did not achieve clinical improvements, injective treatments targeting the overall joint environment showed promising findings. This prompts further research towards the development of treatments able to improve knee osteotomies outcomes. However, until new evidence will prove otherwise, there is no indication for a combined cartilage treatment in routine clinical practice. LEVEL OF EVIDENCE Level IV.
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Krettek C, Clausen JD, Neunaber C. Komplexe Gelenkrekonstruktion und Gelenktransplantation mit dem FLOCSAT-Konzept – Planung und chirurgische Umsetzung. Unfallchirurg 2017; 120:950-960. [DOI: 10.1007/s00113-017-0429-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Salim R, Fogagnolo F, Perina MM, Rubio UM, Kfuri Junior M. Conventional plate and screws in medial opening-wedge high tibial osteotomy: are they sufficiently stable? A retrospective study. Rev Bras Ortop 2017; 52:549-554. [PMID: 29062819 PMCID: PMC5643892 DOI: 10.1016/j.rboe.2016.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/09/2016] [Indexed: 11/28/2022] Open
Abstract
Objective Opening-wedge osteotomy of the proximal tibia is a widely performed procedure for treating medial gonarthrosis in active patients and in the presence of varus malalignment of the lower limb. The fixation method is controversial, and the use of conventional implants has been abandoned in favor of implants with more modern locking screws. The aim of the present clinical study was to assess the maintenance of the correction achieved in cases wherein fixation was performed using conventional implants. Methods This retrospective study included 51 patients who underwent opening-wedge high tibial osteotomy wherein fixation was performed using conventional implants (4.5-mm DCP plate and non-locking screws). Radiological findings regarding patellar height, tibial slope, and varus correction postoperatively and after consolidation were analyzed to assess the maintenance of the correction achieved by osteotomy. Results The mean loss of correction angle, calculated by the difference between the correction angle in the immediate postoperative period and that after consolidation, was 0.92° ± 0.9°. In addition, changes in patellar height determined by the Blackburne–Peel method and in the sagittal slope of the tibial plateau were not significant or clinically relevant. Conclusions The use of conventional plates and screws is viable in the fixation of opening-wedge high tibial osteotomy because they provide enough stability to maintain the achieved correction until consolidation, without significant changes.
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Affiliation(s)
- Rodrigo Salim
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Ribeirão Preto, SP, Brazil
| | - Fabricio Fogagnolo
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Ribeirão Preto, SP, Brazil
| | - Mauricio Martins Perina
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Ribeirão Preto, SP, Brazil
| | - Ugo Messas Rubio
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Ribeirão Preto, SP, Brazil
| | - Mauricio Kfuri Junior
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Ribeirão Preto, SP, Brazil
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O sistema convencional de placa e parafusos na osteotomia tibial alta em cunha de abertura medial é suficientemente estável? Um estudo retrospectivo. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Munier M, Donnez M, Ollivier M, Flecher X, Chabrand P, Argenson JN, Parratte S. Can three-dimensional patient-specific cutting guides be used to achieve optimal correction for high tibial osteotomy? Pilot study. Orthop Traumatol Surg Res 2017; 103:245-250. [PMID: 28137553 DOI: 10.1016/j.otsr.2016.11.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/23/2016] [Accepted: 11/30/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of medial tibiofemoral osteoarthritis with a high-tibial osteotomy (HTO) is most effective when the optimal angular correction is achieved. However, conventional instrumentation is limited when multiplanar correction is needed. HYPOTHESIS Use of patient-specific cutting guides (PSCGs) for HTO provides an accurate correction (difference<2°) relative to the preoperative planning. MATERIALS AND METHODS Between February 2014 and February 2015, 10 patients (mean age: 46 years [range: 31-59]; grade 1 or 2 osteoarthritis in Ahlbäck's classification) were included prospectively in this reliability and safety study. All patients were operated using the same medial opening-wedge osteotomy technique. Preoperative planning was based on long-leg radiographs and CT scans with 3D reconstruction. The PSGCs were used to align the osteotomy cut and position the screw holes for the plate. The desired correction was achieved in the three planes when the holes on the plate were aligned with the holes drilled based on the PSCG. Preoperatively, the mean HKA angle was 171.9° (range: 166-179°), the mean proximal tibial angle was 87° (86-88°) and the mean tibial slope was 7.8° (1-22°). The postoperative correction was compared to the planned correction using 3D CT scan transformations. Intraoperative and postoperative complications were assessed at a minimum follow-up of 1 year. RESULTS The procedure was successfully carried out in all patients with the PSCGs. On postoperative long-leg radiographs, the mean HKA was 182.3° (180-185°); on the CT scan, the mean tibial mechanical angle was 94° (90-98°) and the mean tibial slope was 7.1° (4-11°). In 19 out of 20 postoperative HKA and slope measurements, the difference between the planned and achieved correction was <2° based on the 3D analysis of the three planes in space; in the other case, the slope was 13° instead of the planned 10°. The intra-class correlation coefficients between the postoperative and planned parameters were 0.98 [0.92-0.99] for the HKA and 0.96 [0.79-0.99] for the tibial slope. There were no surgical site infections; one patient had a postoperative hematoma that resolved spontaneously. DISCUSSION The results of this study showed that use of PSCGs in HTO procedures helps to achieve optimal correction in a safe and reliable manner. LEVEL OF EVIDENCE IV - Prospective cohort study.
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Affiliation(s)
- M Munier
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - M Donnez
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France; Newclip Technics, 44115 Haute-Goulaine, France
| | - M Ollivier
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - X Flecher
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - P Chabrand
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - J-N Argenson
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - S Parratte
- UMR CNRS 787/AMU, institut du mouvement et de l'appareil locomoteur, groupe interdisciplinaire en biomécanique, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France.
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Jang KM, Lee JH, Park HJ, Kim JL, Han SB. Unintended Rotational Changes of the Distal Tibia After Biplane Medial Open-Wedge High Tibial Osteotomy. J Arthroplasty 2016; 31:59-63. [PMID: 26387921 DOI: 10.1016/j.arth.2015.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/01/2015] [Accepted: 08/04/2015] [Indexed: 02/01/2023] Open
Abstract
This study involved 35 knees undergoing biplane medial open-wedge high tibial osteotomy (OWHTO) to assess the axial rotation of the distal tibia. The distal tibiae were internally rotated by 3.0° ± 7.1° after OWHTO. The opening width showed a Pearson correlation coefficient of -0.743 (P < .001), and the tuberosity osteotomy angle showed that of -0.678 (P < .001) with distal tibial rotation. However, changes in hip-knee-ankle angle, medial proximal tibial angle, and posterior tibial slope were not significantly correlated with the change in distal tibial rotation. In conclusion, there was an unintended tendency of increasing internal rotation of the distal tibia after biplane medial OWHTO, and this tendency was positively related to the opening width and tuberosity osteotomy angle.
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Affiliation(s)
- Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University School of Medicine, Seoul, South Korea
| | - Jong-Hee Lee
- Department of Orthopaedic Surgery, Anam Hospital, Korea University School of Medicine, Seoul, South Korea
| | - Hyung-Jun Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University School of Medicine, Seoul, South Korea
| | - Jeong Lae Kim
- Department of Orthopaedic Surgery, Anam Hospital, Korea University School of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University School of Medicine, Seoul, South Korea
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Rao AJ, Erickson BJ, Cvetanovich GL, Yanke AB, Bach BR, Cole BJ. The Meniscus-Deficient Knee: Biomechanics, Evaluation, and Treatment Options. Orthop J Sports Med 2015; 3:2325967115611386. [PMID: 26779547 PMCID: PMC4714576 DOI: 10.1177/2325967115611386] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Meniscal tears are the most common knee injury, and partial meniscectomies are the most common orthopaedic surgical procedure. The injured meniscus has an impaired ability to distribute load and resist tibial translation. Partial or complete loss of the meniscus promotes early development of chondromalacia and osteoarthritis. The primary goal of treatment for meniscus-deficient knees is to provide symptomatic relief, ideally to delay advanced joint space narrowing, and ultimately, joint replacement. Surgical treatments, including meniscal allograft transplantation (MAT), high tibial osteotomy (HTO), and distal femoral osteotomy (DFO), are options that attempt to decrease the loads on the articular cartilage of the meniscus-deficient compartment by replacing meniscal tissue or altering joint alignment. Clinical and biomechanical studies have reported promising outcomes for MAT, HTO, and DFO in the postmeniscectomized knee. These procedures can be performed alone or in conjunction with ligament reconstruction or chondral procedures (reparative, restorative, or reconstructive) to optimize stability and longevity of the knee. Complications can include fracture, nonunion, patella baja, compartment syndrome, infection, and deep venous thrombosis. MAT, HTO, and DFO are effective options for young patients suffering from pain and functional limitations secondary to meniscal deficiency.
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Affiliation(s)
- Allison J Rao
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Koh IJ, Kim MW, Kim JH, Han SY, In Y. Trends in High Tibial Osteotomy and Knee Arthroplasty Utilizations and Demographics in Korea From 2009 to 2013. J Arthroplasty 2015; 30:939-44. [PMID: 25639855 DOI: 10.1016/j.arth.2015.01.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 12/10/2014] [Accepted: 01/02/2015] [Indexed: 02/01/2023] Open
Abstract
We analyzed the records of 29,895 high tibial osteotomies (HTOs), 12,589 unicompartmental knee arthroplasties (UKAs) and 363,386 total knee arthroplasties (TKAs) performed from 2009 to 2013 in Korea. They were compared with the latest nationwide registry reports of seven Western countries. Over the last 5 years, in Korea, the number of HTO, UKA and TKA increased by 210%, 138%, and 18%, respectively. The largest increase was observed in 55-64 year olds in HTO and UKA, while the largest increase in TKA was in ≥75 year olds. Females commonly had a three- to seven-fold higher rate in all procedures. Worldwide, the use of HTO and UKA decreased or remained stable, whereas that of TKA increased steadily, even in younger patients.
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Affiliation(s)
- In Jun Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea; Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Min Woo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Ju Hwan Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Sang Yup Han
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea; Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
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Konopka JF, Gomoll AH, Thornhill TS, Katz JN, Losina E. The cost-effectiveness of surgical treatment of medial unicompartmental knee osteoarthritis in younger patients: a computer model-based evaluation. J Bone Joint Surg Am 2015; 97:807-17. [PMID: 25995491 PMCID: PMC4430101 DOI: 10.2106/jbjs.n.00925] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical options for the management of medial compartment osteoarthritis of the varus knee include high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty. We sought to determine the cost-effectiveness of high tibial osteotomy and unicompartmental knee arthroplasty as alternatives to total knee arthroplasty for patients fifty to sixty years of age. METHODS We built a probabilistic state-transition computer model with health states defined by pain, postoperative complications, and subsequent surgical procedures. We estimated transition probabilities from published literature. Costs were determined from Medicare reimbursement schedules. Health outcomes were measured in quality-adjusted life-years (QALYs). We conducted analyses over patients' lifetimes from the societal perspective, with health and cost outcomes discounted by 3% annually. We used probabilistic sensitivity analyses to account for uncertainty in data inputs. RESULTS The estimated discounted QALYs were 14.62, 14.63, and 14.64 for high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty, respectively. Discounted total direct medical costs were $20,436 for high tibial osteotomy, $24,637 for unicompartmental knee arthroplasty, and $24,761 for total knee arthroplasty (in 2012 U.S. dollars). The incremental cost-effectiveness ratio (ICER) was $231,900 per QALY for total knee arthroplasty and $420,100 per QALY for unicompartmental knee arthroplasty. Probabilistic sensitivity analyses showed that, at a willingness-to-pay (WTP) threshold of $50,000 per QALY, high tibial osteotomy was cost-effective 57% of the time; total knee arthroplasty, 24%; and unicompartmental knee arthroplasty, 19%. At a WTP threshold of $100,000 per QALY, high tibial osteotomy was cost-effective 43% of time; total knee arthroplasty, 31%; and unicompartmental knee arthroplasty, 26%. CONCLUSIONS In fifty to sixty-year-old patients with medial unicompartmental knee osteoarthritis, high tibial osteotomy is an attractive option compared with unicompartmental knee arthroplasty and total knee arthroplasty. This finding supports greater utilization of high tibial osteotomy for these patients. The cost-effectiveness of high tibial osteotomy and of unicompartmental knee arthroplasty depend on rates of conversion to total knee arthroplasty and the clinical outcomes of the conversions.
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Affiliation(s)
- Joseph F. Konopka
- Orthopedic and Arthritis Center for Outcomes Research (J.F.K., J.N.K., and E.L.), Department of Orthopedic Surgery (J.F.K., T.S.T., J.N.K., and E.L.), Brigham and Women’s Hospital, 75 Francis Street, BC-4016, Boston, MA 02115. E-mail address for E. Losina:
| | - Andreas H. Gomoll
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 850 Boylston Street, Chestnut Hill, MA 02467
| | - Thomas S. Thornhill
- Orthopedic and Arthritis Center for Outcomes Research (J.F.K., J.N.K., and E.L.), Department of Orthopedic Surgery (J.F.K., T.S.T., J.N.K., and E.L.), Brigham and Women’s Hospital, 75 Francis Street, BC-4016, Boston, MA 02115. E-mail address for E. Losina:
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research (J.F.K., J.N.K., and E.L.), Department of Orthopedic Surgery (J.F.K., T.S.T., J.N.K., and E.L.), Brigham and Women’s Hospital, 75 Francis Street, BC-4016, Boston, MA 02115. E-mail address for E. Losina:
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research (J.F.K., J.N.K., and E.L.), Department of Orthopedic Surgery (J.F.K., T.S.T., J.N.K., and E.L.), Brigham and Women’s Hospital, 75 Francis Street, BC-4016, Boston, MA 02115. E-mail address for E. Losina:
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Waterman BR, Hoffmann JD, Laughlin MD, Burks R, Pallis MP, Tokish JM, Belmont PJ. Success of High Tibial Osteotomy in the United States Military. Orthop J Sports Med 2015; 3:2325967115574670. [PMID: 26665031 PMCID: PMC4622358 DOI: 10.1177/2325967115574670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Historically, high tibial osteotomy (HTO) has been performed to treat isolated medial gonarthrosis with varus deformity. PURPOSE To evaluate the occupational outcomes of HTO in a high-demand military cohort. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A retrospective analysis of active duty service members undergoing HTO for coronal plane malalignment and/or intra-articular pathology was performed using the Military Health System between 2003 and 2011. Demographic parameters and surgical variables, including rates of perioperative complications, secondary surgery, activity limitations, and medical discharge, were extracted from electronic medical records. For the current study, cumulative failure was defined as conversion to knee arthroplasty or postoperative medical discharge for persistent knee dysfunction. Univariate and multivariate analyses were performed to identify statistical associations with cumulative failure after HTO. RESULTS A total of 181 service members (202 HTOs) were identified at an average follow-up of 47.5 months (range, 24-96 months). Mean age was 35.7 years (range, 19-55 years), and the majority were men (93%) and of enlisted rank (78%). All index procedures utilized a valgus-producing, opening wedge technique. Concomitant or staged procedures were performed in 87 patients (48%), including 40 ligamentous, 48 meniscal, and 48 chondral procedures. Complications occurred in 19.3% of knees (n = 39), with unplanned reoperation in 26 knees (12.8%). Fifty-three patients (40.7%) had minor activity limitations during military duty postoperatively. Eleven knees (5.4%) underwent conversion to total knee arthroplasty. The cumulative failure rate was 28.2% (n = 51) at 2- to 8-year follow-up. Patient age younger than 30 years at the time of surgery was associated with an independently higher risk of failure, whereas sex, concomitant/staged procedures, and perioperative complications were not significantly associated with subsequent failure. CONCLUSION At short- to midterm follow-up, nearly 72% of all service members undergoing HTO returned to military duty and were free from conversion knee arthroplasty.
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Affiliation(s)
- Brian R. Waterman
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Jeffrey D. Hoffmann
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Matthew D. Laughlin
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Robert Burks
- Naval Postgraduate School, Monterey, California, USA
| | - Mark P. Pallis
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - John M. Tokish
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
| | - Philip J. Belmont
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas, USA
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Nwachukwu BU, McCormick FM, Schairer WW, Frank RM, Provencher MT, Roche MW. Unicompartmental knee arthroplasty versus high tibial osteotomy: United States practice patterns for the surgical treatment of unicompartmental arthritis. J Arthroplasty 2014; 29:1586-9. [PMID: 24814891 DOI: 10.1016/j.arth.2014.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/24/2014] [Accepted: 04/02/2014] [Indexed: 02/01/2023] Open
Abstract
Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) produce satisfactory outcomes in the management of unicompartmental knee osteoarthritis (OA). The purpose of this study is to compare UKA and HTO practice patterns in a large US private payer insurance database. Utilization data for UKA and HTO were captured from the database between 2007 and 2011. Chi square analysis, parametric testing and Poisson regressions were performed where appropriate. Between 2007 and 2011, the compound annual growth rate in utilization of UKA was +4.7%, while that for HTO was -3.9%. Utilization of UKA and HTO were inversely correlated (P = 0.001). UKA utilization is increasing, while HTO utilization is decreasing in the management of OA. More work is required to understand specific indications and outcomes.
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Affiliation(s)
| | | | | | - Rachel M Frank
- Department of Sports Medicine, Rush Medical Center, Chicago, Illinois
| | - Matthew T Provencher
- Department of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Medial opening-wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 24:1549-55. [DOI: 10.1007/s00590-014-1417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
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Thienpont E, Price A. Bicompartmental knee arthroplasty of the patellofemoral and medial compartments. Knee Surg Sports Traumatol Arthrosc 2013. [PMID: 23184084 DOI: 10.1007/s00167-012-2303-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Studies have shown that after total knee arthroplasty neither normal biomechanics nor function is obtained. Selective resurfacing of diseased compartments could be a solution. A narrative review of the available literature on bicompartmental arthroplasty is presented. METHODS A literature review of all peer reviewed published articles on bicompartmental arthroplasty of the knee was performed. Bicompartmental arthroplasty is by definition the replacement of the tibiofemoral and the patellofemoral joint. It can be performed with a modular unlinked or a monolithic femoral component. RESULTS Bicompartmental arthroplasty performed with modular components obtains good to excellent results at ± 10 years follow-up. Function and biomechanics are superior to total knee arthroplasty. Modern monolithic femoral components are reported to give early failure and high revision rates and should be avoided. CONCLUSION Modular bicompartmental arthroplasty is an excellent alternative to treat bicompartmental arthritis of the knee leading to good functional results and superior biomechanics in well-selected patients. Caution is needed since only a few peer reviewed articles with small series and old implant designs are available on this type of arthritis treatment. Survivorship in these studies is inferior to total knee arthroplasty.
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Affiliation(s)
- Emmanuel Thienpont
- Department of Orthopaedic Surgery, University Hospital Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium,
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Harris JD, Erickson BJ, Abrams GD, Cvetanovich GL, McCormick FM, Gupta AK, Bach BR, Cole BJ. Methodologic quality of knee articular cartilage studies. Arthroscopy 2013; 29:1243-1252.e5. [PMID: 23623292 DOI: 10.1016/j.arthro.2013.02.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 01/26/2013] [Accepted: 02/20/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To evaluate the quality of knee articular cartilage surgery literature using established methodologic quality instruments, and (2) to assess whether study quality has improved with time. METHODS A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies of autologous chondrocyte implantation (ACI), osteochondral autograft and allograft transplant, and microfracture were analyzed. Study methodologic quality was assessed by the level of evidence and 9 different methodologic quality questionnaires. Comparisons were made between different surgical technique groups by use of Student's t tests. Assessment of study quality improvement with time was performed by comparison of the Coleman Methodology Score (CMS) from the included studies (2004 to present) and CMS from a prior study assessing quality of articular cartilage studies (1985 to 2004). Furthermore, assessment of study quality improvement with time was performed over the period of the included studies (2004 to present). RESULTS We included 194 studies (11,787 subjects). Most evidence was Level IV (76%) and nonrandomized (91%). ACI was the most commonly reported technique (62% of studies). Only 34% of studies denied the presence of a financial conflict of interest. The mean subject age was 33.5 ± 8.2 years, and the mean length of follow-up was 3.7 ± 2.3 years. By use of study quality questionnaires, the methodologic quality of articular cartilage studies was poor. However, study quality (after 2004) was significantly improved versus that reported from a prior study (before 2004) using the CMS (P < .01). The mean level of evidence, CMS, CONSORT (Consolidated Standards of Reporting Trials) score, and Jadad score showed no significant improvement over the period of the included studies (P > .05). The quality of randomized controlled trials (RCTs) was significantly higher than that of non-RCTs (P < .05). The most common study weaknesses included blinding, subject selection process, study type, sample size calculation, and outcome measures and assessment. CONCLUSIONS The methodologic quality of knee articular cartilage surgery studies was poor overall and also for individual techniques (ACI, osteochondral autograft transplant, osteochondral allograft transplant, and microfracture). However, the overall quality of the investigations in this review (after June 2004) has significantly improved in comparison to those published before 2004. The quality of RCTs was significantly higher than that of non-RCTs. Level of evidence, CMS, CONSORT score, and Jadad score did not significantly improve with later publication date within the period of the studies analyzed. Methodologic quality deficiencies identified in this investigation may be used to guide future articular cartilage studies' design, conduct, and reporting. LEVEL OF EVIDENCE Level IV, systematic review of studies with Levels of Evidence I-IV.
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Affiliation(s)
- Joshua D Harris
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL 60612, USA.
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Siddiqui NA, Herzenberg JE, Lamm BM. Supramalleolar osteotomy for realignment of the ankle joint. Clin Podiatr Med Surg 2012; 29:465-82. [PMID: 23044057 DOI: 10.1016/j.cpm.2012.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ankle replacement systems have not been as reliable as hip replacements in providing long-term relief of pain, increased motion, and return to full activity. Supramalleolar Osteotomy is an extraarticular procedure that realigns the mechanical axis, thereby restoring ankle function. The literature discussing knee arthritis has shown that realignment osteotomies of the tibia improve function and prolong total knee replacement surgery. The success of the procedure is predicated on understanding the patient's clinical and radiographic presentation and proper preoperative assessment and planning.
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Affiliation(s)
- Noman A Siddiqui
- International Center for Limb Lenghtening/Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Avenue, Baltimore MD 21215, USA.
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Abstract
Large symptomatic osteochondral defects in a young active population represent a therapeutic challenge for orthopedic surgeons, since standard interventions such as debridement, microfracture and autologous osteochondral transfer are not suitable for the treatment of these larger lesions. Fresh osteochondral allograft transplantation provides a surgical option for these challenging defects, both as a primary procedure and for salvage of prior failed treatment attempts. This article reviews the basic science, indications, technique, and evidence for osteochondral allograft transplantation in the knee.
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Affiliation(s)
- Marco Demange
- Cartilage Repair Center Department of Orthopaedic Surgery, Brigham and Women’s Hospital Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Andreas H. Gomoll
- Cartilage Repair Center Department of Orthopaedic Surgery, Brigham and Women’s Hospital Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
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