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Vendrig T, Keizer MNJ, Brouwer RW, Houdijk H, Hoogeslag RAG. Lower anxiety level to perform movements after revision anterior cruciate ligament reconstruction with lateral extra-articular tenodesis compared to without lateral extra-articular tenodesis. Musculoskelet Surg 2024:10.1007/s12306-024-00818-0. [PMID: 38691322 DOI: 10.1007/s12306-024-00818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To evaluate the anxiety level to perform movements in patients after revision anterior cruciate ligament reconstruction (ACLR) combined with lateral extra-articular tenodesis (LET) compared to patients after revision ACLR without LET. METHODS Ninety patients who underwent revision ACLR with ipsilateral bone-patellar tendon-bone autograft and with a minimum of 12 months follow-up were included in this study. Patients were divided into two groups: patients who received revision ACLR in combination with LET (revision ACLR_LET group; mean follow-up: 29.4 months, range: 12-80 months), and patients who received revision ACLR without LET (revision ACLR group; mean follow-up: 61.1 months, range: 22-192 months). All patients filled in a questionnaire about anxiety level related to physical activity and sports, the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee subjective form (IKDCsubjective), and the Tegner Activity Score. RESULTS Patients in the revision ACLR_LET group had a significantly lower anxiety level to perform movements than patients in the revision ACLR group (p < 0.05). No significant differences were found in KOOS, IKDCsubjective, and Tegner Activity Scores. CONCLUSIONS Patients who received LET in addition to revision ACLR have a lower anxiety level to perform movements than patients with revision ACLR alone, despite non-different subjective functional outcomes. STUDY DESIGN Retrospective cohort study, Level of evidence: III.
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Affiliation(s)
- T Vendrig
- University Medical Center Groningen, Center for Human Movement Sciences, University of Groningen, UMCG Sector F, FA 23, PO Box 196, Groningen, 9713 AV, The Netherlands.
| | - M N J Keizer
- University Medical Center Groningen, Center for Human Movement Sciences, University of Groningen, UMCG Sector F, FA 23, PO Box 196, Groningen, 9713 AV, The Netherlands
| | - R W Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, Groningen, The Netherlands
| | - H Houdijk
- University Medical Center Groningen, Center for Human Movement Sciences, University of Groningen, UMCG Sector F, FA 23, PO Box 196, Groningen, 9713 AV, The Netherlands
| | - R A G Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, The Netherlands
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Kersten RFMR, de Vries AJ, van Raaij JJAM, Brouwer RW. 12-Year clinical and radiological results of a double-blind randomized controlled trial comparing posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty. Knee 2023; 45:110-116. [PMID: 37925801 DOI: 10.1016/j.knee.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/10/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A subject of ongoing debate among orthopedic surgeons is the importance of preserving the posterior cruciate ligament in total knee arthroplasty (TKA), but long-term survival studies are scarce. The aim of this study was to compare long-term survival rates, and clinical and radiological follow up of a double-blind randomized controlled trial comparing posterior cruciate-retaining (PCR) versus posterior-stabilizing (PS) implant design of an AGC TKA. METHODS A total of 114 patients were included in the survival analysis (PCR n = 61; PS n = 53). Forty-five patients (PCR n = 25; PS n = 20) participated in the long-term follow up using patient-reported outcome measures (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form Health Survey (SF-36) and Kujala score (measuring anterior knee pain)). Thirty-one patients were assessed with a physical test (Knee Society Score (KSS)) and radiographs. RESULTS Overall survival rate was 95.6% (PCR 98.4% vs. PS 92.5%), with five patients having a major revision (PCR n = 1 vs. PS n = 4, respectively). Satisfying outcome scores for both groups were described at on average 12-year follow up with no significant differences in KSS knee and function scores, WOMAC, SF-36, or Kujala scores between groups. Radiographically, there were no findings of femoral or tibial loosening or polyethylene wear in either group. CONCLUSIONS Good long-term survival rates were described for the PCR and the PS design of an AGC TKA. There were no significant differences in clinical and radiological outcomes between a PCR and a PS design 12 years postoperatively.
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Affiliation(s)
- R F M R Kersten
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands.
| | - A J de Vries
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - J J A M van Raaij
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - R W Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
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Brouwers HFG, de Vries AJ, van Zuilen M, van Kouswijk HW, Brouwer RW. The role of computer-assisted cryotherapy in the postoperative treatment after total knee arthroplasty: positive effects on pain and opioid consumption. Knee Surg Sports Traumatol Arthrosc 2022; 30:2698-2706. [PMID: 33903923 DOI: 10.1007/s00167-021-06568-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to investigate whether computer-assisted cryotherapy is effective in reducing postoperative pain and analgesics consumption, next to improving functional outcome and patient satisfaction after total knee arthroplasty (TKA). The hypothesis is that computer-assisted cryotherapy has positive effects on postoperative pain after TKA. METHODS A single-centre non-blinded randomised controlled trial was designed to study the early (first postoperative week) and late (2 and 6 weeks postoperatively) additive effect of computer-assisted cooling after TKA. Participants scheduled for a TKA were randomly allocated to a cold (cryotherapy) C-group or a regular (control) R-group. Next to usual postoperative care for both groups, the C-group received computer-assisted cryotherapy during the first seven postoperative days. Primary outcome was pain, monitored with the numerical rating scale for pain and use of opioid escape medication. Secondary outcomes were function and swelling, monitored by active range of motion, timed up and go test and circumference measurements; patient-reported outcome measurements (KOOS and WORQ questionnaires); and patient satisfaction, monitored by the numerical rating scale for satisfaction. RESULTS 102 patients participated in this study, both groups contained 51 patients. On most days during the first week, patients in the C-group scored significantly lower NRS pain scores and registered significantly less use of opioid escape medication. In a sub-analysis of 57 patients using the same standard pain protocol, patients in the C-group (n = 28) used less oxycodone during the first postoperative week. There were no significant differences between both groups in active range of motion, timed up and go, or circumference measurements. For the WORQ questionnaire, there was a significant difference between the two groups 6 weeks postoperatively in favour of the C-group. This could be however due to a reduced validity of this questionnaire shortly after TKA. The satisfaction score was not significantly different between both groups. CONCLUSION Computer-assisted cryotherapy following TKA can be beneficial during the first postoperative week in terms of pain reduction and diminished opioid consumption. No clear differences in knee function or swelling were seen. LEVEL OF EVIDENCE Therapeutic study with level of evidence I.
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Affiliation(s)
- Hugo F G Brouwers
- Department of Orthopaedic Surgery, Martini Hospital Groningen, PO Box 30033, 9700 RM, Groningen, The Netherlands.
| | - A J de Vries
- Department of Orthopaedic Surgery, Martini Hospital Groningen, PO Box 30033, 9700 RM, Groningen, The Netherlands
| | - M van Zuilen
- Department of Orthopaedic Surgery, Martini Hospital Groningen, PO Box 30033, 9700 RM, Groningen, The Netherlands
| | - H W van Kouswijk
- Department of Orthopaedic Surgery, Martini Hospital Groningen, PO Box 30033, 9700 RM, Groningen, The Netherlands
| | - R W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital Groningen, PO Box 30033, 9700 RM, Groningen, The Netherlands
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van Keulen LZ, Hoogeslag RAG, Brouwer RW, Huis In 't Veld R, Verdonschot N. The importance of continuous remnant preservation in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1818-1827. [PMID: 34596694 DOI: 10.1007/s00167-021-06746-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Selective anteromedial or posterolateral bundle reconstruction is recognized as a treatment modality in partial anterior cruciate ligament (ACL) reconstruction (ACLR) with a biomechanically sufficient ACL remnant. However, there is paucity in literature investigating clinical outcomes of standard ACLR with preservation of residual continuous but biomechanically insufficient ACL tissue. The aim of this study was to investigate the influence of preservation of residual continuous but biomechanical insufficient ACL tissue in standard ACLR on complication and repeat surgery rate, and patient reported and clinical outcome. METHODS The retrospective cohort comprised 134 patients (age 23 ± 7 years; Tegner 6 ± 3) with an isolated acute ACL tear. In 67 patients, residual continuous but biomechanically insufficient ACL tissue was present and preserved based on visual inspection, probing of the ACL tissue and Lachman test under arthroscopic view (standard reconstruction with tissue preservation; SRTP). These patients were matched to 67 patients that underwent ACLR where no residual ACL tissue could be preserved (standard reconstruction; SR) based on gender, age and chondral and/or meniscal status. Clinical failure (recurrent instability, pathological ACL graft laxity and/or ACL graft discontinuity), other complication and repeat-surgery rate within index surgery and 1-year and within index surgery and 2-year follow-up, and patient reported and clinical outcomes at 1-year and at 2-year follow-up were compared. RESULTS A statistically significant lower clinical failure rate within index surgery and 1-year (SRTP, 3%; SR, 13%; P = 0.028) and within index surgery and 2-year follow-up (SRTP, 3%; SR, 23%; P = 0.001), and revision ACL surgery rate within index surgery and 1-year (SRTP, 2%; ST, 10%; P = 0.029) and within index surgery and 2-year follow-up (SRTP, 2%; SR, 18%; P = 0.001) was found in the SRTP group. No statistically significant differences were found for other investigated outcomes in patients that were without clinical failure. CONCLUSION This study shows that in ACLR surgery, preservation of residual continuous but biomechanical insufficient ACL tissue might lead to lower clinical failure rate and ACL revision surgery rate within index surgery and 1-year, and within index surgery and 2-year follow-up compared to standard ACLR where no residual continuous ACL tissue could be preserved. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L Z van Keulen
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Geerdinksweg 141, 7555 DL, Hengelo, The Netherlands
| | - R A G Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Geerdinksweg 141, 7555 DL, Hengelo, The Netherlands.
| | - R W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - R Huis In 't Veld
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Geerdinksweg 141, 7555 DL, Hengelo, The Netherlands.,Strategic Business Development, Techmed Centre, University of Twente, Enschede, The Netherlands
| | - N Verdonschot
- Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands.,Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen, The Netherlands
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de Vos FH, Meuffels DE, de Mul M, Askari M, Ista E, Polinder S, Waarsing E, Bierma-Zeinstra SM, Reijman M, van Arkel ERA, Brouwer RW, Langeveld ARJ, Riedijk R, Zijl JAC, Janssen RPA, Hofstee DJ, Zuurmond RG, van Rhee MA. Study protocol ROTATE-trial: anterior cruciate ligament rupture, the influence of a treatment algorithm and shared decision making on clinical outcome– a cluster randomized controlled trial. BMC Musculoskelet Disord 2022; 23:117. [PMID: 35123469 PMCID: PMC8818161 DOI: 10.1186/s12891-021-04867-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) rupture is a very common knee injury in the sport active population. There is much debate on which treatment (operative or non-operative) is best for the individual patient. In order to give a more personalized recommendation we aim to evaluate the effectiveness and cost-effectiveness of a treatment algorithm for patients with a complete primary ACL rupture. Methods The ROTATE-trial is a multicenter, open-labeled cluster randomized controlled trial with superiority design. Randomization will take place on hospital level (n = 10). Patients must meet all the following criteria: aged 18 year or older, with a complete primary ACL rupture (confirmed by MRI and physical examination) and maximum of 6 weeks of non-operative treatment. Exclusion criteria consists of multi ligament trauma indicated for surgical intervention, presence of another disorder that affects the activity level of the lower limb, pregnancy, and insufficient command of the Dutch language. The intervention to be investigated will be an adjusted treatment decision strategy, including an advice from our treatment algorithm. Patient reported outcomes will be conducted at baseline, 3, 6, 12 and 24 months. Physical examination of the knee at baseline, 12 and 24 months. Primary outcome will be function of the knee measured by the International Knee Documentation Committee (IKDC) questionnaire. Secondary outcomes are, among others, the Tegner activity score, the Knee injury and Osteoarthritis Outcome Score (KOOS) and the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Healthcare use, productivity and satisfaction with ((non-)operative) care are also measured by means of questionnaires. In total 230 patients will be included, resulting in 23 patients per hospital. Discussion The ROTATE study aims to evaluate the effectiveness and cost-effectiveness of a treatment algorithm for patients with a complete primary ACL rupture compared to current used treatment strategy. Using a treatment algorithm might give the much-wanted personalized treatment recommendation. Trial registration This study is approved by the Medical Research Ethics Committee of Erasmus Medical Center in Rotterdam and prospectively registered at the Dutch Trial Registry on May 13th, 2020. Registration number: NL8637.
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Gerbers JG, Pijpker PAJ, Brouwer RW, van der Veen HC. Anterolateral proximal tibial opening wedge osteotomy for biplanar correction in genu valgum recurvatum using patient specific instrumentation (PSI). A technical note. Knee 2021; 33:58-64. [PMID: 34560354 DOI: 10.1016/j.knee.2021.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/28/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Biplanar anterolateral proximal tibial opening wedge osteotomy has been described as successful for patients with combined recurvatum and valgus alignment. As it is a correction in two planes, it is a technically demanding procedure. We report the use of a novel technique with patient specific instrumentation (PSI) guides for different steps, aiming to reduce the complexity of this procedure. METHODS One patient was treated for genu valgum recurvatum. A virtual surgical plan was made. A two-step PSI approach was used, consisting of an osteotomy guide and a repositioning guide and a custom trial wedges. RESULTS Follow-up showed full function and improved VAS and KOOS scores. A neutral alignment was achieved. There was 2.76 degrees less varus compared to pre-operative planning, 1.24 degrees of excess slope and a rotational difference of 0.10 degrees. Saw plane accuracy was within 1 mm. CONCLUSIONS PSI is a recent technical addition to HTOs as a modality to improve accuracy and reduce surgical complexity. Pre-planning and PSI use in an anterolateral opening wedge PTO allowed for an accurate and reproducible biplanar correction in genu valgum recurvatum. Accuracy was comparable to PSI use in lateral open wedge high tibial osteotomies.
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Affiliation(s)
- J G Gerbers
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, the Netherlands.
| | - P A J Pijpker
- University of Groningen, University Medical Center Groningen, 3D-lab/Department of Neurosurgery, Groningen, the Netherlands
| | - R W Brouwer
- Department of Orthopedics, Martini Hospital, Groningen, the Netherlands
| | - H C van der Veen
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, the Netherlands
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7
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Hylkema TH, Stevens M, van Beveren J, Rijk PC, Brouwer RW, Bulstra SK, Kuijer PPFM, Brouwer S. Recovery Courses of Patients Who Return to Work by 3, 6 or 12 Months After Total Knee Arthroplasty. J Occup Rehabil 2021; 31:627-637. [PMID: 33515342 PMCID: PMC8298243 DOI: 10.1007/s10926-021-09959-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 05/26/2023]
Abstract
Purpose This study compared the preoperative levels and postoperative recovery courses of physical and mental impairments, activity limitations and participation restrictions of working-age patients who return to work (RTW) by 3, 6 or 12 months after total knee arthroplasty (TKA). Methods A prospective survey study including TKA patients (aged < 65) (n = 146) who returned to work (RdTW) in the first postoperative year. Three groups were compared: those who returned by 3 (n = 35), 6 (n = 40) or 12 (n = 29) months. Surveys were completed preoperatively and at 6 weeks and 3, 6 and 12 months postoperatively. Outcomes represented domains of the International Classification of Functioning, i.e. physical impairments (pain, stiffness, vitality), mental impairments (mental health and depressive symptoms), activity limitations (physical functioning) and participation restrictions (social and work functioning). Results Preoperative knee-specific pain and physical functioning levels were better among patients who RdTW by 3 months, compared to those who returned by 12 months. Patients who RdTW by 3 months experienced significantly better recovery from physical impairments than those who returned by 6 months (on general pain) or 12 months (on general and knee-specific pain and on stiffness). Patients returning by 3 months experienced significantly better recovery from activity limitations (on knee-specific physical functioning). Conclusions To optimize return to work outcome after TKA surgery, the focus should lie on physical impairments (general and knee-specific pain, stiffness) and activity limitations (knee-specific physical functioning) during recovery.
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Affiliation(s)
- T H Hylkema
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - M Stevens
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - J van Beveren
- Department of Orthopedics, Röpcke-Zweers Hospital Hardenberg, Hardenberg, The Netherlands
| | - P C Rijk
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - R W Brouwer
- Department of Orthopedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - S K Bulstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - P P F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Brouwer
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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van Outeren MV, Waarsing JH, Verhaar JAN, Reijman M, Brouwer RW, Bierma-Zeinstra SMA. Response to the Letter to the Editor: 'Is a high tibial osteotomy superior to non-surgical treatment in patients with varus malaligned medial knee osteoarthritis?'. Osteoarthritis Cartilage 2018; 26:e3-e4. [PMID: 29627445 DOI: 10.1016/j.joca.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/27/2018] [Indexed: 02/02/2023]
Affiliation(s)
- M V van Outeren
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J H Waarsing
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - J A N Verhaar
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - M Reijman
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - R W Brouwer
- Department of Orthopaedics, Martini Hospital, Groningen, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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van Outeren MV, Waarsing JH, Brouwer RW, Verhaar JAN, Reijman M, Bierma-Zeinstra SMA. Is a high tibial osteotomy (HTO) superior to non-surgical treatment in patients with varus malaligned medial knee osteoarthritis (OA)? A propensity matched study using 2 randomized controlled trial (RCT) datasets. Osteoarthritis Cartilage 2017; 25:1988-1993. [PMID: 28903017 DOI: 10.1016/j.joca.2017.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/31/2017] [Accepted: 09/04/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE No randomized controlled trial (RCT) has compared the high tibial osteotomy (HTO) with non-surgical treatment in patients with medial knee osteoarthritis (OA) and varus malalignment. The aim was to compare the effectiveness of an unloader brace treatment or a usual care program to the HTO regarding pain severity and knee function. DESIGN Surgical treatment (HTO) to two non-surgical options was compared by combining the data of two RCTs. One RCT (n = 117) compared an unloader brace to usual care treatment; the other RCT (n = 92) compared closing to opening wedge HTO. One-to-many propensity score matching was used to equalize patient characteristics. We compared clinical outcome at 1 year follow-up (VAS pain (0-10) and knee function (HSS, 0-100)) with mixed model analysis. RESULTS Propensity score matching resulted in a comparison of 30 brace patient with 83 HTO patients, and of 28 usual care patients with 71 HTO patients. Pain at 1 year after HTO (VAS 3.8) was lower than after valgus bracing (VAS 5.0) with a mean difference of -1.1 (95% CI -2.2; -0.1). Function showed a nonsignificant mean difference of 2.1 [95% CI -3.1; 7.3]. Comparing HTO to usual care a difference was seen in pain (-1.7 [95% CI -2.8; -0.6]) and function (6.6 [95% CI 0.2; 13.1]), in favor of the HTO. CONCLUSIONS Our data suggest that HTO was more effective in pain reduction compared to both non-surgical treatments. Function improved only when HTO was compared to usual care treatment. These small differences question the benefits of surgical treatment over the brace treatment.
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Affiliation(s)
- M V van Outeren
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J H Waarsing
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - R W Brouwer
- Department of Orthopaedics, Martini Hospital, Groningen, The Netherlands
| | - J A N Verhaar
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - M Reijman
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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10
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Huizinga MR, Gorter J, Demmer A, Bierma-Zeinstra SMA, Brouwer RW. Progression of medial compartmental osteoarthritis 2-8 years after lateral closing-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:3679-3686. [PMID: 27387307 DOI: 10.1007/s00167-016-4232-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 07/01/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE The primary purpose of this study is to investigate the progression of medial osteoarthritis (OA) following lateral closing-wedge high tibial osteotomy (HTO). Secondary outcomes included functional and pain scores. METHODS This prospective cohort study analysed 298 patients treated with lateral closing-wedge HTO surgery for medial compartmental OA. OA progression was measured by comparing the minimum joint space width (mJSW) and Kellgren-Lawrence (KL) score on radiographs preoperatively and postoperatively. The WOMAC score and NRS score for pain were obtained preoperatively and postoperatively to assess secondary outcomes. Failure was defined as revision surgery; survival was estimated. RESULTS Mean follow-up was 5.2 ± 1.8 years (range 2-8.5). Mean preoperative mJSW was 3.4 ± 1.6 mm, which changed nonsignificantly (p = 0.51) to 3.4 ± 1.7 mm postoperatively. Mean annual joint space narrowing was 0.02 ± 0.34 mm/year. Progression to 1 KL grade or more was seen in 132 (44 %) patients, and annual risk of KL progression was 8.6 %. No KL progression was seen in 56 % of patients. Mean NRS decreased from 7.3 ± 1.5 to 3.5 ± 2.5 (p < 0.001). WOMAC scores decreased from 48.0 ± 17.2 to 23.6 ± 19.7 (p < 0.001). Failure was seen in 21 patients. CONCLUSION Compared to demographic data in the literature, valgus high tibial osteotomy seems to reduce the progression of OA, reduces pain and improves knee function in patients with medial compartment OA and a varus alignment. LEVEL OF EVIDENCE III.
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Affiliation(s)
- M R Huizinga
- Department of Orthopaedic Surgery, Martini Hospital, PO Box 30033, 9700 RM, Groningen, The Netherlands.
| | - J Gorter
- Department of Orthopaedic Surgery, Martini Hospital, PO Box 30033, 9700 RM, Groningen, The Netherlands
| | - A Demmer
- Department of Orthopaedic Surgery, Martini Hospital, PO Box 30033, 9700 RM, Groningen, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of Orthopaedics and General Practice, University Medical Center Rotterdam, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - R W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, PO Box 30033, 9700 RM, Groningen, The Netherlands
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van Erp JHJ, Brouwer RW. [AbstractA woman with knee pain after a fall in childhood]. Ned Tijdschr Geneeskd 2016; 160:D289. [PMID: 27650016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 32-year-old woman presented with pain in her left knee ever since she had fallen down the stairs as a child and had landed on this knee. On the X-ray we saw two large patella fragments. We made the diagnosis of dislocated and subluxated fracture of the patella without consolidation. The previously missed fracture was treated conservatively.
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Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SMA, Verhaar JAN. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. J Bone Joint Surg Am 2014; 96:1425-32. [PMID: 25187580 DOI: 10.2106/jbjs.m.00786] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Varus deformity increases the risk of progression of medial compartment knee osteoarthritis. The aim of this study was to investigate the clinical and radiographic mid-term results of closing-wedge and opening-wedge high tibial osteotomy when used to treat this condition. METHODS From January 2001 to April 2004, ninety-two patients were randomized to receive either a closing-wedge or an opening-wedge high tibial osteotomy. The clinical outcome and radiographic results were examined preoperatively; at one year; and, for the present study, at six years postoperatively. The outcomes that we reviewed included maintenance of the achieved correction, progression of osteoarthritis (based on the Kellgren and Lawrence classification), severity of pain (as assessed on a visual analog scale [VAS]), knee function (as measured with the Hospital for Special Surgery [HSS] score and Knee injury and Osteoarthritis Outcome Score [KOOS]), walking distance, complications, and survival with conversion to a total knee arthroplasty as the end point. The results were analyzed on the basis of the intention-to-treat principle. RESULTS Six years postoperatively, the mean hip-knee-ankle (HKA) angle (and standard deviation) was 3.2° ± 4.1° of valgus after a closing-wedge high tibial osteotomy and 1.3° ± 5.0° of valgus after an opening-wedge high tibial osteotomy (p = 0.343). In both groups, the six-year postoperative HKA angles did not differ from the respective one-year postoperative angles. No difference in the severity of pain or in knee function was found between the two groups. Four complications (9%) occurred in the closing-wedge group and seventeen (38%), in the opening-wedge group. Ten (22%) of the patients in the closing-wedge group and three (8%) in the opening-wedge group needed conversion to a total knee arthroplasty within the six-year period (p = 0.05). The difference in the percentage of cases with conversion to total knee arthroplasty was 14% (95% confidence interval [CI] = 21.7 to 0.2). CONCLUSIONS In the group of patients without conversion to a total knee arthroplasty, there was no difference between the high tibial closing-wedge and opening-wedge osteotomies in terms of clinical outcomes or radiographic alignment at six years postoperatively. Opening-wedge osteotomy was associated with more complications, but closing-wedge osteotomy was associated with more early conversions to total knee arthroplasty. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- T Duivenvoorden
- Department of Orthopedics, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address for T. Duivenvoorden:
| | - R W Brouwer
- Department of Orthopedics, Martini Ziekenhuis, Van Swietenplein 1, 9728 NX, Groningen, The Netherlands
| | - A Baan
- Department of Orthopedics, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address for T. Duivenvoorden:
| | - P K Bos
- Department of Orthopedics, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address for T. Duivenvoorden:
| | - M Reijman
- Department of Orthopedics, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address for T. Duivenvoorden:
| | - S M A Bierma-Zeinstra
- Department of Orthopedics, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address for T. Duivenvoorden:
| | - J A N Verhaar
- Department of Orthopedics, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address for T. Duivenvoorden:
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Abstract
BACKGROUND Patients with unicompartmental osteoarthritis of the knee can be treated with a correction osteotomy. The goal of the correction osteotomy is to transfer the load bearing from the pathologic to the normal compartment of the knee. A successful outcome of the osteotomy relies on proper patient selection, stage of osteoarthritis, achievement and maintenance of adequate operative correction. This is an update of the original review published in Issue 1, 2005. OBJECTIVES To assess the effectiveness and safety of an osteotomy for treating osteoarthritis of the knee. SEARCH STRATEGY Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE (Current contents, Health STAR) up to October 2002 in the original review and in the update until May 2007. Reference lists of identified trials were screened. SELECTION CRITERIA Randomised and controlled clinical trials comparing a high tibial osteotomy or a distal femoral osteotomy in patients with unicompartmental osteoarthritis of the medial or lateral compartment of the knee. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data and assessed trial quality. Due to heterogeneity of the studies, pooling of outcome measures was not possible. MAIN RESULTS Thirteen studies involving over 693 people were included; 11 studies were included in the first version and two studies and one longer follow-up study were included in this update. All studies concerned a valgus high tibial osteotomy (HTO) for medial compartment osteoarthritis of the knee. Six studies, in which two studies were included in this update, compared two techniques of HTO. One study compared HTO alone versus HTO with additional treatment. Four studies compared within the same type of HTO, different peri-operative conditions (two studies) or two different types of post-operative treatment (two studies). Two studies, including the longer follow up, compared HTO with unicompartmental joint replacement. No study compared an osteotomy with conservative treatment. Most studies showed improvement of the patient (less pain and improvement of function scores) after osteotomy surgery, but in the majority of the studies there was no significant difference with other operative treatment (other technique of HTO/ unicompartmental joint replacement). Overall, the methodological quality was low. AUTHORS' CONCLUSIONS Based on 13 studies, we conclude that there is 'silver' level evidence (www.cochranemsk.org) that valgus HTO improves knee function and reduces pain. There is no evidence whether an osteotomy is more effective than conservative treatment and the results so far do not justify a conclusion about effectiveness of specific surgical techniques.
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Affiliation(s)
- R W Brouwer
- Erasmus Medical Centre Rotterdam, Orthopaedic Surgery, Dr. Molewaterplein 40, Rotterdam, Netherlands, 3015 GD.
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14
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Abstract
Full-length anteroposterior (AP) radiographs provide the basis for evaluating leg alignment. A cadaver study was performed to determine the effect of knee flexion and hip rotation on projected angles on full-length AP radiographs. The outcomes were verified mathematically. The results of the cadaver study were similar to the mathematical results. Flexion of the knee without rotation of the lower extremity has little effect on angles as projected on full-length AP radiographs. Rotation of the lower extremity without flexion of the knee also has little effect. Simultaneous flexion of the knee and rotation of the leg, however, cause large changes in projected angles. Full-length radiographs can be taken without fluoroscopic control as long as the knee can be fully extended. In flexion contracture, a full-length AP radiograph taken under lateral fluoroscopic control is necessary to obtain accurate determination of the mechanical axis.
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Affiliation(s)
- R W Brouwer
- Department of Orthopedics, Martini Hospital, Groningen, The Netherlands
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Brouwer RW, Bierma-Zeinstra SMA, van Raaij TM, Verhaar JAN. Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate. A one-year randomised, controlled study. ACTA ACUST UNITED AC 2006; 88:1454-9. [PMID: 17075089 DOI: 10.1302/0301-620x.88b11.17743] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A prospective, randomised, controlled trial compared two different techniques of high tibial osteotomy with a lateral closing wedge or a medial opening wedge, stabilised by a Puddu plate. The clinical outcome and radiological results were examined at one year. The primary outcome measure was the achievement of an overcorrection of valgus of 4 degrees . Secondary outcome measures were the severity of pain (visual analogue scale), knee function (Hospital for Special Surgery score), and walking distance. Between January 2001 and April 2004, 92 patients were randomised to one or other of the techniques. At follow-up at one year the post-operative hip-knee-ankle angle was 3.4 degrees (+/- 3.6 degrees SD) valgus after a closing wedge and 1.3 degrees (+/- 4.7 degrees SD) of valgus after an opening wedge. The adjusted mean difference of 2.1 degrees was significant (p = 0.02). The deviation from 4 degrees of valgus alignment was 2.7 degrees (+/- 2.4 degrees SD) in the closing wedge and 4.0 degrees (+/- 3.6 degrees sd) in the opening-wedge groups. The adjusted mean difference of 1.67 degrees was also significant (p = 0.01). The severity of pain, knee score and walking ability improved in both groups, but the difference was not significant. Because of pain, the staples required removal in 11 (23%) patients in the closing-wedge group and a Puddu plate was removed in 27 (60%) patients in the opening-wedge group. This difference was significant (p < 0.001). We conclude that closing-wedge osteotomy achieves a more accurate correction with less morbidity, although both techniques had improved the function of the knee at one year after the procedure.
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Affiliation(s)
- R W Brouwer
- Erasmus Medical Centre, Rotterdam, The Netherlands.
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16
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Brouwer RW, van Raaij TM, Verhaar JAN, Coene LNJEM, Bierma-Zeinstra SMA. Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. Osteoarthritis Cartilage 2006; 14:777-83. [PMID: 16563810 DOI: 10.1016/j.joca.2006.02.004] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2005] [Accepted: 02/04/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effect of a brace intended to reduce load in patients with medial or lateral compartmental osteoarthritis (OA) and concurrent varus or valgus alignment, respectively. DESIGN This multi-centre randomized controlled trial (performed 2001-2003) studies the additive effect of a brace intended to reduce load in conservative treatment of unicompartmental OA of the knee. SETTING Orthopedic department of a university medical centre and of one general hospital. The follow-up was 12 months. PATIENTS 117 patients with unicompartmental OA of the knee. Intervention group (n=60) comprising conservative treatment with additional brace treatment and a control group (n=57) comprising conservative treatment alone. PRIMARY OUTCOME MEASURES Pain severity and knee function score. SECONDARY OUTCOME MEASURES Walking distance and quality of life. ANALYSIS Multiple linear regression models according to the intention-to-treat-principle were used to assess outcome differences for the entire group of patients. In addition, we performed explorative subgroup analyses on primary overall outcomes stratified for alignment, degree of OA, origin of OA, and age. RESULTS Although the primary outcome measures were improved in the intervention group in comparison with the controls at each assessment point, the differences reached only borderline significance. The reported walking distances at 3 months, 12 months and overall were significantly longer in the brace group (P=0.03, P=0.04 and P=0.02, respectively). Subgroup analysis showed a better effect in the varus group, in patients with severe OA, in patients with secondary OA and in patients younger then 60 years. In total 25 patients in the brace group and 14 in the control group changed their initial treatment, mostly (74%) because of a lack of beneficial effect. CONCLUSIONS The results indicate that a brace intended to reduce load shows small effects in patients with unicompartmental OA. However, many patients do not adhere in the long run to this kind of conservative treatment.
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Affiliation(s)
- R W Brouwer
- Department of Orthopedics, Erasmus Medical Centre, Rotterdam, The Netherlands.
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17
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Veneman NGP, Waalkens HJ, van Raaij JJAM, Brouwer RW. [Septic polyarthritis due to an infected nail bed around an ingrown toenail in a previously healthy boy]. Ned Tijdschr Geneeskd 2006; 150:973-6. [PMID: 17225739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A 17-year-old, previously healthy boy was admitted with complaints of fever, malaise and pain in the pubic region and groin. His left elbow was also warm and swollen and could not be extended fully. Cultures of fluid drained from both hips and the elbow, blood and inflamed tissue from the nail bed of the right big toe yielded Staphylococcus aureus. The patient was treated with intravenous antibiotics for septic arthritis of both hips, the left elbow and possibly the pubic symphysis. The infected nail bed, which was the most likely port of entry, was also treated. One year later, the original painful symptoms had disappeared but the right hip was almost immobile. In a patient with indications of septic arthritis, timely diagnosis and adequate therapy reduce the risk of permanent damage to the joint.
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Affiliation(s)
- N G P Veneman
- Universitair Medisch Centrum Groningen, Centrum voor Kinder- en Jeugdpsychiatrie, Postbus 30.001, 9700 RB Groningen.
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18
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Brouwer RW, Bierma-Zeinstra SMA, van Koeveringe AJ, Verhaar JAN. Patellar height and the inclination of the tibial plateau after high tibial osteotomy. The open versus the closed-wedge technique. ACTA ACUST UNITED AC 2005; 87:1227-32. [PMID: 16129748 DOI: 10.1302/0301-620x.87b9.15972] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Our aim was to compare the degree of patellar descent and alteration in angle of the inclination of the tibial plateau in lateral closing-wedge and medial opening-wedge high tibial osteotomy (HTO) in 51 consecutive patients with osteoarthritis of the medial compartment and varus malalignment. Patellar height was measured by the Insall-Salvati (IS) and the Blackburne-Peel (BP) ratios. The tibial inclination was determined by the Moore-Harvey (MH) method. Multivariate linear regression analysis was used to determine the influence of the type of HTO (closing vs opening wedge) on the post-operative patellar height or tibial inclination. The intra- and interobserver variability of these methods was determined before operation and at follow-up at one year. After an opening-wedge HTO the patellar height was significantly more decreased (mean post-operative difference: IS = 0.15; 95% confidence interval (CI) 0.06 to 0.23; BP = 0.11; 95% CI 0.05 to 0.18) compared with a closing-wedge HTO. The angle of tibial inclination differed significantly (mean post-operative difference MH = -6.40 degrees; 95% CI -8.74 to -4.02) between the two HTO techniques, increasing after opening-wedge HTO and decreasing after closing-wedge HTO. There was no clinically-relevant difference in the intra- and interobserver variability of measurements of patellar height either before or after HTO.
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Affiliation(s)
- R W Brouwer
- Erasmus Medical Centre, Rotterdam, The Netherlands.
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Abstract
BACKGROUND Patients with osteoarthritis of the knee can be treated with a brace or orthosis (shoe insole). The main purpose of these aids is to reduce pain, improve physical function and, possibly, to slow disease progression. OBJECTIVES To assess the effectiveness of a brace or orthosis in the treatment of osteoarthritis of the knee. SEARCH STRATEGY We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE (Current contents, Health STAR) up to October 2002. The reference lists of the publications in the identified trials were also screened. SELECTION CRITERIA Extracted studies were included in the final analysis if they met the pre-defined inclusion criteria: 1) a randomised controlled clinical trial or a controlled clinical trial, 2) all patients had osteoarthritis of the knee, 3) the intervention in one of the studied groups was a brace or an orthosis. DATA COLLECTION AND ANALYSIS Two reviewers independently selected the trials and assessed the methodological quality using the Delphi-list and one additional question about care programs. Three reviewers independently extracted the data on the intervention, type of outcome measures, follow-up, loss to follow-up, and results, using a pre-tested standardized form. Study authors were contacted for additional information. MAIN RESULTS Four trials involving a total of 444 people were included in this review. One study investigated a knee brace and three studies examined different types of orthoses for medial compartment osteoarthritis of the knee. Two studies were of high methodological quality while the other two studies were low. Notably, the randomisation and the blinding procedures were either insufficient or not described. The follow-up period (six weeks to six months) was too short to demonstrate long-term results. Pooling was difficult primarily due to the heterogeneity of the data and the way the information was presented. The pain, stiffness and physical function (WOMAC and MACTAR) scores of a brace group showed greater improvement at six months compared with a neoprene sleeve group, which showed greater improvement compared with a control group. The numbers of days of non-steroidal anti-inflammatory drug (NSAID) intake decreased significantly (relative percentage difference 23.9%) compared with baseline in a group with laterally wedged insoles,and remained unchanged in the neutrally wedged group. Patient compliance with the laterally wedged insole was significantly better compared with the neutrally wedged insole. In one study, the Visual Analogue Pain (VAS) pain score was significantly decreased from baseline in a strapped insole group (RPD - 24%), but not in the traditional lateral wedge group, but this strapped insole showed more adverse effects (popliteal pain, low back pain, and foot sole pain) compared with the traditional lateral wedge insole. Pain during bed rest, after getting up, after getting up from seated position and walking distance was significantly improved in a subtalar strapped group compared with baseline, and no improvement was found in a sock type group. No studies were found that assessed the effectiveness of a brace or orthosis to treat lateral compartment osteoarthritis or general osteoarthritis of the knee, or that compared a knee brace with a wedge insole, or that compared a brace or orthosis with operative treatment. AUTHORS' CONCLUSIONS Based on one brace study we conclude there is limited evidence that: a brace has additional beneficial effect (WOMAC, MACTAR, function tests) for knee osteoarthritis compared with medical treatment alone.(Silver) a sleeve has additional beneficial effect (WOMAC, function tests) for knee osteoarthritis compared with medical treatment alone.(Silver) a brace is more effective (WOMAC, function tests) than a neoprene sleeve.(Silver) Based on 3 orthoses studies, of which 2 were high quality, (n=2) we conclude there is limited evidence that: a laterally wedged insole decreases NSAID intake compared with a neutral insole. (Silver) patient compliance is better in the laterally wedged insole compared with a neutral insole. (Silver) a strapped insole has more adverse effects than a lateral wedge insole. (Silver).
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Affiliation(s)
- R W Brouwer
- Orthopaedic surgery, Erasmus Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, Netherlands, 3015 GD.
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20
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Abstract
BACKGROUND Patients with unicompartmental osteoarthritis of the knee can be treated with a correction osteotomy. The goal of the correction osteotomy is to transfer the load bearing from the pathologic to the normal compartment of the knee. A successful outcome of the osteotomy relies on proper patient selection, stage of osteoarthritis, achievement and maintenance of adequate operative correction. OBJECTIVES To assess the effectiveness and safety of an osteotomy for treating osteoarthritis of the knee. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE (Current contents, Health STAR) were searched up until October 2002 for controlled clinical trials. The reference lists of publications in the identified trials were also screened. SELECTION CRITERIA Extracted studies were included in the final analysis if they met the pre-defined inclusion criteria: 1) a randomised controlled clinical trial or a controlled clinical trial 2) all patients had unicompartmental osteoarthritis of the medial or lateral compartment of the knee 3) the intervention in one of the studied groups was a high tibial osteotomy or a distal femoral osteotomy. DATA COLLECTION AND ANALYSIS Two reviewers independently selected the trials, assessed the methodological quality using a validated tool and extracted the data. The planned analysis was to pool the results where appropriate, however, due the heterogeneity of the studies, pooling of the outcome measures was not possible. Results are described for each study and presented as a best evidence synthesis. MAIN RESULTS Following the search strategy and applications of selection criteria, eleven studies were included in this review. All the studies concerned a valgus high tibial osteotomy (HTO) for medial compartment osteoarthritis of the knee. Four studies compared two techniques of HTO. One study compared HTO alone versus HTO with additional treatment. Four studies compared within the same type of HTO, different per-operative conditions (two studies) or two different types of post-operative treatment (two studies). Two studies compared HTO with unicompartmental joint replacement. No study compared an osteotomy with conservative treatment. Most studies showed improvement of the patient (less pain and improvement of function scores) after osteotomy surgery, but in the majority of the studies there was no significant difference with other operative treatment (other technique of HTO/ unicompartmental joint replacement). Overall, the methodological quality was low. AUTHORS' CONCLUSIONS Based on 11 studies, of which 6 were high quality, we conclude that there is silver level evidence that valgus HTO improves knee function and reduces pain. There is no evidence whether an osteotomy is more effective than conservative treatment and the results so far do not justify a conclusion about effectiveness of specific surgical techniques.
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Affiliation(s)
- R W Brouwer
- Orthopaedic surgery, Erasmus Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, Netherlands, 3015 GD.
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Brouwer RW, Verhaar JAN. [Osteotomy at knee level for young patients with gonarthrosis]. Ned Tijdschr Geneeskd 2004; 148:1955-60. [PMID: 15524129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Young patients with gonarthrosis that does not respond adequately to conservative therapy can be treated by corrective osteotomy. Osteoarthritis of one compartment more often has a mechanical aetiology than osteoarthritis of the entire knee. Patients with osteoarthritis of the medial compartment often have a genu varum (bow-legs) while patients with osteoarthritis of the lateral compartment often have a genu valgum (knock-knees). The goal of corrective osteotomy is to transfer the load bearing to the normal compartment, which will reduce the symptoms and permit arthroplasty to be postponed. In retrospective studies, the procedure resulted in less pain, improved knee function or postponement of knee arthroplasty in 28-87% of the patients. Possible complications include pseudarthrosis, thromboembolism, contracture of the patellar tendon, paresis of the N. peroneus, compartment syndrome. The outcome of osteotomy for gonarthrosis depends on careful patient selection, the stage of osteoarthritis, and the achievement and maintenance of the correction of the load axis that was calculated before the operation.
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Affiliation(s)
- R W Brouwer
- Erasmus Medisch Centrum, afd. Orthopedie, Rotterdam.
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De Jong JJ, Brouwer RW, Veen HF, Jonkman JG. [Free air below the diaphragm: not always an acute surgical problem]. Ned Tijdschr Geneeskd 1999; 143:2033-7. [PMID: 10560542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
In three patients, two males aged 66 and 67 years with among other disorders chronic obstructive pulmonary disease (COPD) and one woman aged 24 years with a history of intestinal surgery and current abdominal pain, the chest X-ray showed free air below the diaphragm. The two males had no major abdominal symptoms, but they did have pneumonia. All were treated conservatively. Of the males, one died from pneumonia, the other recovered. The woman presented recurrent symptoms and was subjected to extensive diagnostic examinations. This revealed a marked sigmoid perforation which was repaired, after which the symptoms did not recur. Pneumoperitoneum indicates rupture or perforation of a hollow viscus in up to 90%. In these cases, prompt surgical management is the therapy of choice. In at least 10% free air under the diaphragm is due to causes which do not require surgical treatment. These causes can be divided into intra-abdominal, intrathoracic, gynaecological and iatrogenic diseases. Conservative management should only be considered if followed by frequent and intensive evaluation of the patient's condition.
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Affiliation(s)
- J J De Jong
- Afd. Interne Geneeskunde, Ikazia Ziekenhuis, Rotterdam
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van Dalen IV, Ham SJ, Brouwer RW, Deutman R. [Rupture of the quadriceps tendon; cannot be missed?]. Ned Tijdschr Geneeskd 1996; 140:2044-6. [PMID: 8965943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In four patients, two men aged 59 and 68 years and two women aged 59 and 50 years, a unilateral rupture of the quadriceps tendon was diagnosed. In two patients the disease was initially misdiagnosed. A depression was palpable in all patients just on the proximal side of the patella. All patients were treated operatively and all recovered with satisfactory knee function. In order to obtain full recovery early aetiological diagnosis is important; quadriceps tendon rupture should be considered in patients with haemarthrosis and inability to stretch the knee.
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