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Bin Abd Razak HR, Campos JP, Khakha RS, Wilson AJ, van Heerwaarden RJ. Role of joint distraction in osteoarthritis of the knee: Basic science, principles and outcomes. J Clin Orthop Trauma 2021; 24:101723. [PMID: 34938647 PMCID: PMC8654974 DOI: 10.1016/j.jcot.2021.101723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/25/2022] Open
Abstract
The burden of knee osteoarthritis (OA) is increasing worldwide. Advanced tibiofemoral joint OA in young patients is particularly a problem with inferior results seen with total knee arthroplasty in this patient population. Knee joint distraction (KJD) has been evaluated recently as a joint preserving procedure for young patients with advanced tibiofemoral osteoarthritis, to delay the need for a primary total knee arthroplasty (TKA). This will decrease the risk for revision TKA later in life. KJD temporarily unloads the knee joint and keeps the tibia and femur separated over a course of 6 weeks. Outcomes of KJD appear promising. Through this article, the authors hope to share from their collective experience as well as the available literature on the basic science, principles of surgery and outcomes of KJD.
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Affiliation(s)
- Hamid Rahmatullah Bin Abd Razak
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore,Corresponding author. Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore.
| | - João Pedro Campos
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Serviço de Ortopedia e Traumatologia, Hospital Pedro Hispano, Rua Dr. Eduardo Torres, Matosinhos, Portugal
| | - Raghbir S. Khakha
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Department of Orthopaedics, Guys & St Thomas's Hospital, Great Maze Pond, SE1 9RT, United Kingdom
| | - Adrian J. Wilson
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Department of Sports and Exercise, University of Winchester, Sparkford Road, Winchester, SO22 4NR, United Kingdom
| | - Ronald J. van Heerwaarden
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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Jansen MP, Mastbergen SC, Eckstein F, van Heerwaarden RJ, Spruijt S, Lafeber FPJG. Comparison between 2D radiographic weight-bearing joint space width and 3D MRI non-weight-bearing cartilage thickness measures in the knee using non-weight-bearing 2D and 3D CT as an intermediary. Ther Adv Chronic Dis 2021; 12:20406223211037868. [PMID: 34434539 PMCID: PMC8381425 DOI: 10.1177/20406223211037868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: In knee osteoarthritis, radiographic joint space width (JSW) is frequently
used as a surrogate marker for cartilage thickness; however, longitudinal
changes in radiographic JSW have shown poor correlations with those of
magnetic resonance imaging (MRI) cartilage thickness. There are fundamental
differences between the techniques: radiographic JSW represents
two-dimensional (2D), weight-bearing, bone-to-bone distance, while on MRI
three-dimensional (3D) non-weight-bearing cartilage thickness is measured.
In this exploratory study, computed tomography (CT) was included as a third
technique, as it can measure bone-to-bone under non-weight-bearing
conditions. The objective was to use CT to compare the impact of
weight-bearing versus non-weight-bearing, as well as
bone-to-bone JSW versus actual cartilage thickness, in the
knee. Methods: Osteoarthritis patients (n = 20) who were treated with knee
joint distraction were included. Weight-bearing radiographs,
non-weight-bearing MRIs and CTs were acquired before and 2 years after
treatment. The mean radiographic JSW and cartilage thickness of the most
affected compartment were measured. From CT, the 3D median JSW was
calculated and a 2D projectional image was rendered, positioned similarly
and measured identically to the radiograph. Pearson correlations between the
techniques were derived, both cross-sectionally and longitudinally. Results: Fourteen patients could be analyzed. Cross-sectionally, all comparisons
showed moderate to strong significant correlations (R = 0.43–0.81; all
p < 0.05). Longitudinal changes over time were
small; only the correlations between 2D CT and 3D CT (R = 0.65;
p = 0.01) and 3D CT and MRI (R = 0.62;
p = 0.02) were statistically significant. Conclusion: The poor correlation between changes in radiographic JSW and MRI cartilage
thickness appears primarily to result from the difference in weight-bearing,
and less so from measuring bone-to-bone distance versus
cartilage thickness.
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Affiliation(s)
- Mylène P Jansen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100 (G02.228), Utrecht 3584CX, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Felix Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
| | - Ronald J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Sander Spruijt
- Reinier Haga Orthopaedic Centre, Zoetermeer, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Jansen MP, Besselink NJ, van Heerwaarden RJ, Custers RJH, Emans PJ, Spruijt S, Mastbergen SC, Lafeber FPJG. Knee Joint Distraction Compared with High Tibial Osteotomy and Total Knee Arthroplasty: Two-Year Clinical, Radiographic, and Biochemical Marker Outcomes of Two Randomized Controlled Trials. Cartilage 2021; 12:181-191. [PMID: 30758214 PMCID: PMC7970375 DOI: 10.1177/1947603519828432] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Both, knee joint distraction (KJD) and high tibial osteotomy (HTO) are joint-preserving surgeries that postpone total knee arthroplasty (TKA) in younger osteoarthritis (OA) patients. Here we evaluate the 2-year follow-up of KJD versus TKA and KJD versus HTO in 2 noninferiority studies. DESIGN Knee OA patients indicated for TKA were randomized to KJD (n = 20; KJDTKA) or TKA (n = 40). Medial compartmental knee OA patients considered for HTO were randomized to KJD (n = 23; KJDHTO) or HTO (n = 46). Patient-reported outcome measures were assessed over 2 years of follow-up. The radiographic joint space width (JSW) was measured yearly. In the KJD groups, serum-PIIANP and urinary-CTXII levels were measured as collagen type-II synthesis and breakdown markers. It was hypothesized that there was no clinically important difference in the primary outcome, the total WOMAC, when comparing KJD with HTO and with TKA. RESULTS Both trials were completed, with 114 patients (19 KJDTKA; 34 TKA; 20 KJDHTO; 41 HTO) available for 2-year analyses. At 2 years, the total WOMAC score (KJDTKA: +30.4 [95% CI 23.0-37.9] points; TKA: +42.4 [95% CI 38.1-46.8]; KJDHTO: +21.6 [95% CI 13.8-29.4]; HTO: +29.2 [95% CI 23.6-34.8]; all: P < 0.05) and radiographic minimum JSW (KJDTKA: +0.9 [95% CI 0.2-1.6] mm; KJDHTO: +0.9 [95% CI 0.5-1.4]; HTO: +0.6 [95% CI 0.3-0.9]; all: P < 0.05) were still increased for all groups. The net collagen type-II synthesis 2 years after KJD was increased (P < 0.05). Half of KJD patients experienced pin tract infections, successfully treated with oral antibiotics. CONCLUSIONS Sustained improvement of clinical benefit and (hyaline) cartilage thickness increase after KJD is demonstrated. KJD was clinically noninferior to HTO and TKA in the primary outcome.
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Affiliation(s)
- Mylène P. Jansen
- Rheumatology & Clinical Immunology,
University Medical Center Utrecht, Utrecht, The Netherlands,Mylène P. Jansen, Rheumatology &
Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100
(G02.228), Utrecht, 3584CX, The Netherlands
| | - Nick J. Besselink
- Rheumatology & Clinical Immunology,
University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald J. van Heerwaarden
- Centre for Deformity Correction and
Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Roel J. H. Custers
- Department of Orthopedic Surgery,
University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter J. Emans
- Department of Orthopedics, Maastricht
University Medical Center, Maastricht, The Netherlands
| | - Sander Spruijt
- Department of Orthopedics,
HagaZiekenhuis, The Hague, The Netherlands
| | - Simon C. Mastbergen
- Rheumatology & Clinical Immunology,
University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris P. J. G. Lafeber
- Rheumatology & Clinical Immunology,
University Medical Center Utrecht, Utrecht, The Netherlands
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Jansen MP, Mastbergen SC, van Heerwaarden RJ, Spruijt S, van Empelen MD, Kester EC, Lafeber FPJG, Custers RJH. Knee joint distraction in regular care for treatment of knee osteoarthritis: A comparison with clinical trial data. PLoS One 2020; 15:e0227975. [PMID: 31968005 PMCID: PMC6975543 DOI: 10.1371/journal.pone.0227975] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/03/2020] [Indexed: 01/10/2023] Open
Abstract
Objectives Knee joint distraction (KJD) has been evaluated as a joint-preserving treatment to postpone total knee arthroplasty in knee osteoarthritis patients in three clinical trials. Since 2014 the treatment is used in regular care in some hospitals, which might lead to a deviation from the original indication and decreased treatment outcome. In this study, baseline characteristics, complications and clinical benefit are compared between patients treated in regular care and in clinical trials. Methods In our hospital, 84 patients were treated in regular care for 6 weeks with KJD. Surgical details, complications, and range of motion were assessed from patient hospital charts. Patient-reported outcome measures were evaluated in regular care before and one year after treatment. Trial patients (n = 62) were treated and followed as described in literature. Results Patient characteristics were not significantly different between groups, except for distraction duration (regular care 45.3±4.3; clinical trials 48.1±8.1 days; p = 0.019). Pin tract infections were the most occurring complication (70% regular care; 66% clinical trials), but there was no significant difference in treatment complications between groups (p>0.1). The range of motion was recovered within a year after treatment for both groups. WOMAC questionnaires showed statistically and clinically significant improvement for both groups (both p<0.001 and >15 points in all subscales) and no significant differences between groups (all differences p>0.05). After one year, 70% of patients were responders (regular care 61%, trial 75%; p = 0.120). Neither regular care compared to clinical trial, nor any other characteristic could predict clinical response. Conclusions KJD as joint-preserving treatment in clinical practice, to postpone arthroplasty for end-stage knee osteoarthritis patient below the age of 65, results in an outcome similar to that thus far demonstrated in clinical trials. Longer follow-up in regular care is needed to test whether also long-term results remain beneficial and comparable to trial data.
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Affiliation(s)
- Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Sander Spruijt
- Department of Orthopedics, HagaZiekenhuis, Den Haag, The Netherlands
| | - Michelle D van Empelen
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esmee C Kester
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel J H Custers
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Hoorntje A, Kuijer PPFM, van Ginneken BT, Koenraadt KLM, van Geenen RCI, Kerkhoffs GMMJ, van Heerwaarden RJ. Predictors of Return to Work After High Tibial Osteotomy: The Importance of Being a Breadwinner. Orthop J Sports Med 2020; 7:2325967119890056. [PMID: 31909053 PMCID: PMC6935877 DOI: 10.1177/2325967119890056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Limited evidence exists on patient-relevant outcomes after high tibial osteotomy (HTO), including return to work (RTW). Furthermore, prognostic factors for RTW have never been described. Purpose To investigate the extent and timing of RTW in the largest HTO cohort investigated for RTW to date and to identify prognostic factors for RTW after HTO. Study Design Cohort study; Level of evidence, 3. Methods Consecutive patients who underwent HTO between 2012 and 2015 were included. Patients received a questionnaire at a mean follow-up of 3.6 years. Questions were asked pre- and postoperatively regarding work status, job title, working hours, preoperative sick leave, employment status, and whether patients were their family's breadwinner. The validated Work Rehabilitation Questionnaire (WORQ) was used to assess difficulty with knee-demanding activities. Prognostic factors for RTW were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. Results We identified 402 consecutive patients who underwent HTO, of whom 349 were included. Preoperatively, 299 patients worked, of whom 284 (95%) achieved RTW and 255 (90%) returned within 6 months. Patients reported significant postoperative improvements in performing knee-demanding activities. Being the family's breadwinner was the strongest predictor of RTW (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.27-6.69). In contrast, preoperative sick leave was associated with lower odds of RTW (OR, 0.20; 95% CI, 0.08-0.46). Conclusion After HTO, 95% of patients were able to RTW, of whom 9 of 10 returned within 6 months. Breadwinners were more likely to RTW, and patients with preoperative sick leave were less likely to RTW within 6 months. These findings may be used to improve preoperative counseling and expectation management and thereby enhance work-related outcomes after HTO.
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Affiliation(s)
- Alexander Hoorntje
- Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Berbke T van Ginneken
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Gino M M J Kerkhoffs
- Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health & Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Foundation for Orthopaedic Research Care and Education, Amphia Hospital, Breda, the Netherlands
| | - Ronald J van Heerwaarden
- Department of Orthopaedic Surgery, Maartenskliniek Woerden, Woerden, the Netherlands.,Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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Besselink NJ, Vincken KL, Bartels LW, van Heerwaarden RJ, Concepcion AN, Marijnissen ACA, Spruijt S, Custers RJH, van der Woude JTAD, Wiegant K, Welsing PMJ, Mastbergen SC, Lafeber FPJG. Cartilage Quality (dGEMRIC Index) Following Knee Joint Distraction or High Tibial Osteotomy. Cartilage 2020; 11:19-31. [PMID: 29862834 PMCID: PMC6918034 DOI: 10.1177/1947603518777578] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE High tibial osteotomy (HTO) and knee joint distraction (KJD) are treatments to unload the osteoarthritic (OA) joint with proven success in postponing a total knee arthroplasty (TKA). While both treatments demonstrate joint repair, there is limited information about the quality of the regenerated tissue. Therefore, the change in quality of the repaired cartilaginous tissue after KJD and HTO was studied using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). DESIGN Forty patients (20 KJD and 20 HTO), treated for medial tibiofemoral OA, were included in this study. Radiographic outcomes, clinical characteristics, and cartilage quality were evaluated at baseline, and at 1- and 2-year follow-up. RESULTS Two years after KJD treatment, clear clinical improvement was observed. Moreover, a statistically significant increased medial (Δ 0.99 mm), minimal (Δ 1.04 mm), and mean (Δ 0.68 mm) radiographic joint space width (JSW) was demonstrated. Likewise, medial (Δ 1.03 mm), minimal (Δ 0.72 mm), and mean (Δ 0.46 mm) JSW were statistically significantly increased on radiographs after HTO. There was on average no statistically significant change in dGEMRIC indices over two years and no difference between treatments. Yet there seemed to be a clinically relevant, positive relation between increase in cartilage quality and patients' experienced clinical benefit. CONCLUSIONS Treatment of knee OA by either HTO or KJD leads to clinical benefit, and an increase in cartilage thickness on weightbearing radiographs for over 2 years posttreatment. This cartilaginous tissue was on average not different from baseline, as determined by dGEMRIC, whereas changes in quality at the individual level correlated with clinical benefit.
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Affiliation(s)
- Nick J. Besselink
- Rheumatology & Clinical Immunology,
UMC Utrecht, Utrecht, The Netherlands,Nick J. Besselink, Rheumatology &
Clinical Immunology, UMC Utrecht, F02.127, P.O. Box 85500, 3508GA Utrecht, The
Netherlands.
| | - Koen L. Vincken
- Image Sciences Institute, UMC Utrecht,
Utrecht, The Netherlands
| | | | | | - Arno N. Concepcion
- Rheumatology & Clinical Immunology,
UMC Utrecht, Utrecht, The Netherlands
| | | | | | - Roel J. H. Custers
- Department of Orthopaedic Surgery, UMC
Utrecht, Utrecht, The Netherlands
| | | | - Karen Wiegant
- Department of Orthopedics, Haaglanden
Medical Centre, Den Haag, Zuid-Holland, The Netherlands
| | - Paco M. J. Welsing
- Rheumatology & Clinical Immunology,
UMC Utrecht, Utrecht, The Netherlands
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Hoorntje A, Kuijer PPF, van Ginneken BT, Koenraadt KL, van Geenen RC, Kerkhoffs GM, van Heerwaarden RJ. Prognostic Factors for Return to Sport After High Tibial Osteotomy: A Directed Acyclic Graph Approach. Am J Sports Med 2019; 47:1854-1862. [PMID: 31157542 PMCID: PMC6604251 DOI: 10.1177/0363546519849476] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is increasingly used in young and physically active patients with knee osteoarthritis. These patients have high expectations, including return to sport (RTS). By retaining native knee structures, a return to highly knee-demanding activities seems possible. However, evidence on patient-related outcomes, including RTS, is sparse. Also, time to RTS has never been described. Furthermore, prognostic factors for RTS after HTO have never been investigated. These data may further justify HTO as a surgical alternative to knee arthroplasty. PURPOSE To investigate the extent and timing of RTS after HTO in the largest cohort investigated for RTS to date and to identify prognostic factors for successful RTS. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Consecutive patients with HTO, operated on between 2012 and 2015, received a questionnaire. First, pre- and postoperative sports participation questions were asked. Also, time to RTS, sports level and frequency, impact level, the presymptomatic and postoperative Tegner activity score (1-10; higher is more active), and the postoperative Lysholm score (0-100; higher is better) were collected. Finally, prognostic factors for RTS were analyzed using a logistic regression model. Covariates were selected based on univariate analysis and a directed acyclic graph. RESULTS We included 340 eligible patients of whom 294 sufficiently completed the questionnaire. The mean follow-up was 3.7 years (± 1.0 years). Out of 256 patients participating in sports preoperatively, 210 patients (82%) returned to sport postoperatively, of whom 158 (75%) returned within 6 months. We observed a shift to participation in lower-impact activities, although 44% of reported sports activities at final follow-up were intermediate- or high-impact sports. The median Tegner score decreased from 5.0 (interquartile range [IQR], 4.0-6.0) presymptomatically to 4.0 (IQR, 3.0-4.0) at follow-up (P < .001). The mean Lysholm score at follow-up was 68 (SD, ± 22). No significant differences were found between patients with varus or valgus osteoarthritis. The strongest prognostic factor for RTS was continued sports participation in the year before surgery (odds ratio, 2.81; 95% CI, 1.37-5.76). CONCLUSION More than 8 of 10 patients returned to sport after HTO. Continued preoperative sports participation was associated with a successful RTS. Future studies need to identify additional prognostic factors.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery,
Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
- Academic Center for Evidence-Based
Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration on Health &
Safety in Sports, Amsterdam UMC IOC Research Center, Amsterdam, the
Netherlands
- Department of Orthopaedic Surgery,
Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia
Hospital, Breda, the Netherlands
| | - P. Paul F.M. Kuijer
- Amsterdam UMC, University of Amsterdam,
Coronel Institute of Occupational Health, Amsterdam Public Health Research
Institute, Amsterdam, the Netherlands
| | - Berbke T. van Ginneken
- Department of Orthopaedic Surgery, Sint
Maartenskliniek Woerden, Woerden, the Netherlands
| | - Koen L.M. Koenraadt
- Department of Orthopaedic Surgery,
Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia
Hospital, Breda, the Netherlands
| | - Rutger C.I. van Geenen
- Department of Orthopaedic Surgery,
Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia
Hospital, Breda, the Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery,
Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
- Academic Center for Evidence-Based
Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration on Health &
Safety in Sports, Amsterdam UMC IOC Research Center, Amsterdam, the
Netherlands
| | - Ronald J. van Heerwaarden
- Department of Orthopaedic Surgery, Sint
Maartenskliniek Woerden, Woerden, the Netherlands
- Centre for Deformity Correction and
Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands
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8
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Pronk Y, Pilot P, Brinkman JM, van Heerwaarden RJ, van der Weegen W. Response rate and costs for automated patient-reported outcomes collection alone compared to combined automated and manual collection. J Patient Rep Outcomes 2019; 3:31. [PMID: 31155689 PMCID: PMC6545294 DOI: 10.1186/s41687-019-0121-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/05/2019] [Indexed: 12/30/2022] Open
Abstract
Background The response rate on patient-reported outcome measurements (PROMs) necessary to adequately evaluate a treatment and improve patient care is unknown. Hospitals generally aim for the highest possible response rate without insight into the increase in costs involved. This study aimed to investigate which PROMs response rate is achievable in relation to the costs in an orthopaedic practice. Methods In an observational study, patients planned for orthopaedic surgery were asked to participate per surgical procedure (5769 surgical procedures at 5300 patients). Patient-reported outcomes (PROs) collection with a digital online automated PROMs collection system (minimal effort) was compared to a combined automated system and manual collection (maximal effort). Response rate was calculated preoperative and at two postoperative time points separately, and on all three time points together. Costs were calculated for the study period, per year and per surgical procedure. Calculations were executed for all surgical procedures and for three subgroups: knee arthroplasty, hip arthroplasty and anterior cruciate ligament reconstruction (ACLR). Results Using maximal effort the response rate increased for all surgical procedures compared to minimal effort; the preoperative response rate from 86% to 100% and the postoperative response rates from 55% to 83% (3 or 6 months) and 53% to 83% (12 months). Concerning the response at all three time points for all surgical procedures, minimal effort resulted in 44% response rate and increased to 76% with maximal effort. Lowest postoperative response rates were found in the ACLR group for both maximal and minimal effort. A costs difference of €5.55–€5.98 per surgical procedure between maximal and minimal effort was found. Conclusions A two times higher PROMs response rate for patients responding at all three time points (44% versus 76%) is achievable with maximal effort compared to the use of an automated PROMs collection system only. Manual collection adds a cost of €5.5–€6 per surgical procedure to automated PROMs collection alone. It is debatable if these additional costs are justifiable from a value-based health care perspective as the response rate for adequate evaluation of a treatment is still unknown.
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Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, The Netherlands.
| | - Peter Pilot
- Zimmer Biomet NL, Dordrecht, The Netherlands
| | - Justus M Brinkman
- Department of orthopaedic surgery, Kliniek ViaSana, Mill, The Netherlands
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Hoorntje A, van Ginneken BT, Kuijer PPFM, Koenraadt KLM, van Geenen RCI, Kerkhoffs GMMJ, van Heerwaarden RJ. Eight respectively nine out of ten patients return to sport and work after distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2019; 27:2345-2353. [PMID: 30349947 PMCID: PMC6609586 DOI: 10.1007/s00167-018-5206-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/04/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Distal femoral osteotomy (DFO) is a well-accepted procedure for the treatment of femoral deformities and associated symptoms including osteoarthritis, especially in younger and physically active patients in whom knee arthroplasty is undesirable. Still, there is an apparent need for evidence on relevant patient outcomes, including return to sport (RTS) and work (RTW), to further justify the use of knee osteotomy instead of surgical alternatives. Therefore, the purpose of the present study was to investigate the extent and timing of patients' RTS and RTW after DFO. METHODS This monocentre, retrospective cohort study included consecutive DFO patients, operated between 2012 and 2015. Out of 126 eligible patients (18-70 years, 63% female), all patients responded, and 100 patients completed the questionnaire. Median follow-up was 3.4 years (range 1.5-5.2). The predominant indication for surgery was symptomatic unicompartmental osteoarthritis and valgus or varus leg alignment caused by a femoral deformity. The primary outcome measure was the percentage of RTS and RTW. Secondary outcome measures included time to RTS/RTW, sports level and frequency, the median pre-symptomatic and postoperative Tegner activity score (1-10, higher is more active) and the postoperative Lysholm score (0-100, higher is better). RESULTS Out of 84 patients participating in sports preoperatively, 65 patients (77%) returned to sport postoperatively. Forty-six patients (71%) returned to sports within 6 months. Postoperative participation in high-impact sports was possible though less frequent compared to preoperative participation. Out of 80 patients working preoperatively, 73 (91%) returned to work postoperatively, of whom 59 patients (77%) returned within 6 months. The median pre-symptomatic Tegner activity score [4.0 (range 0-10)] was significantly higher (p < 0.01) than the reported Tegner score at follow-up [3.0 (range 0-10)]. The mean Lysholm score at follow-up was 68 (± 22). No significant differences were found between the osteoarthritis- and non-osteoarthritis group. CONCLUSION Eight out of ten patients return to sport and nine out of ten patients return to work after DFO. These are clinically relevant findings, because they further justify DFO as a surgical alternative to KA in young, active knee OA patients who wish to return to high activity levels. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands. .,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands.
| | | | - P. Paul F. M. Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Koen L. M. Koenraadt
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Rutger C. I. van Geenen
- Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - Ronald J. van Heerwaarden
- Department of Orthopaedic Surgery, Maartenskliniek Woerden, Woerden, The Netherlands ,Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
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van Heerwaarden RJ, Hirschmann MT. Knee joint preservation: a call for daily practice revival of realignment surgery and osteotomies around the knee. Knee Surg Sports Traumatol Arthrosc 2017; 25:3655-3656. [PMID: 28914341 DOI: 10.1007/s00167-017-4702-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Ronald J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA, Mill, The Netherlands.
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz Liestal, Laufen), 4101, Bruderholz, Switzerland
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11
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Brinkman JM, Hurschler C, Agneskirchner J, Lobenhoffer P, Castelein RM, van Heerwaarden RJ. Biomechanical testing of distal femur osteotomy plate fixation techniques: the role of simulated physiological loading. J Exp Orthop 2014; 1:1. [PMID: 26914746 PMCID: PMC4648847 DOI: 10.1186/s40634-014-0001-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 04/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implants for fracture and/or osteotomy fixation are often tested according to basic mechanical test models such as open gap tests or 4-point-bending tests. These may be suitable to test and compare different implants for safety and clinical approval, but are not always representative of the post-operative situation, which is decisive when it comes to bone healing. In the current study the Knee Expert Group of the Association for the Study of Internal Fixation has compared the available open gap test results of the latest version of the TomoFix Medial Distal Femoral Plate and the antecedent plate design, with the test results of a more physiological and life-like test model. In the open gap test model the antecedent plate design was found to have superior stiffness and fatigue strength. METHODS In the current study simulated postoperative conditions for medial closing wedge supracondylar osteotomies were used. The constructs were subjected to cyclical axial and torsional loading and were subsequently tested to failure. RESULTS The more life-like tests in this study showed that the latest version was either more or equally stable and stiff than the antecedent version of the plate, in all of the tests. It is argued that the difference in results between the two loading models is due to differences in test design. CONCLUSIONS These test results stress the importance of not only using standard open gap and 4-point-bending tests, but also to use as life-like as possible test conditions for any form of biomechanical testing of new implants.
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Affiliation(s)
- Justus-Martijn Brinkman
- Department of Orthopaedics, Limb deformity reconstruction unit, Sint Maartensclinic, Woerden, The Netherlands.
| | - Christof Hurschler
- Labor für Biomechanik und Biomaterialien, Orthopädische Klinik der Medizinischen Hochschule Hanover, Hanover, Germany.
| | | | | | - René M Castelein
- Department of Orthopedics, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Ronald J van Heerwaarden
- Department of Orthopaedics, Limb deformity reconstruction unit, Sint Maartensclinic, Woerden, The Netherlands.
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12
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van Houten AH, Heesterbeek PJC, van Heerwaarden RJ, van Tienen TG, Wymenga AB. Medial open wedge high tibial osteotomy: can delayed or nonunion be predicted? Clin Orthop Relat Res 2014; 472:1217-23. [PMID: 24249537 PMCID: PMC3940751 DOI: 10.1007/s11999-013-3383-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [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: 06/20/2013] [Accepted: 11/07/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The opening wedge approach to high tibial osteotomy (HTO) is perceived to have some advantages relative to the closing wedge approach but it may be associated with delayed and nonunions. Because nonunions evolve over months, it would be advantageous to be able to identify risk factors for and early predictors of nonunion after medial opening wedge HTO. QUESTIONS/PURPOSES We sought to determine whether (1) preoperatively identifiable patient factors, including tobacco use, body mass index > 30 kg/m(2), and degree of correction, are associated with nonunion, and (2) a modified Radiographic Union Score for Tibial Fractures (RUST) score, taken at 6 weeks and 3 months, would be predictive for delayed or nonunion after medial opening wedge HTO. METHODS The medical records and radiographs of 185 patients, 21 bilateral cases, treated with a medial open wedge HTO using the TomoFix(®) device were retrospectively evaluated. For all patients, demographic data regarding risk factors were collected from their records. Diagnosis for delayed or nonunion was already done earlier for standard medical care by the orthopaedic surgeon based on clinical and radiographic grounds. For the retrospective radiographic evaluation, a modified RUST score was used in which each tibial cortex is scored by one observer. Logistic regression analysis was used to identify preoperative and postoperative predictive factors for developing delayed or nonunion. In the series, a total of 19 patients (9.2%) developed clinically delayed/nonunion of whom 10 patients (4.9%) developed a nonunion. RESULTS Smoking was identified as a risk factor for developing delayed/nonunion (19% for smokers versus 5.4% for nonsmokers; p = 0.005; odds ratio, 4.1; 95% confidence interval, 1.5-10.7). By contrast, body mass index, lateral cortical hinge fracture, age, infection, and degree of correction were not risk factors. Patients with delayed/nonunion had lower RUST scores at all time points when a radiograph was taken compared with the total study group. CONCLUSIONS The RUST score at 6 weeks and 3 months after surgery and the use of tobacco were identified as predictive factors for development of delayed union and nonunion after open wedge HTO. Based on these results, we now actively try to stop patients from smoking and these data are helpful in doing that. The RUST score may be of use to identify which patients are at risk for developing a delayed union so that interventions may be offered earlier in the course of care. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Albert H van Houten
- Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands,
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Pot JH, van Heerwaarden RJ, Patt TW. An unusual way of intramedullar fixation after a periprosthetic supracondylar femur fracture. J Arthroplasty 2012; 27:494.e5-8. [PMID: 22019319 DOI: 10.1016/j.arth.2011.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 01/18/2011] [Revised: 05/04/2011] [Accepted: 06/22/2011] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic supracondylar femoral fractures after a total knee arthroplasty are difficult surgical problems. We report a case of an 84-year-old woman with an osteoporotic fracture that was not deemed amenable to conventional treatment. In this case, a complete consolidation was achieved by using a proximal femur nail antirotation nail upside down and through the fracture for fixation.
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Affiliation(s)
- Johan H Pot
- Department of Orthopaedic Surgery, Knee Reconstruction Unit, Sint Maartenkliniek, Woerden, Netherlands
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14
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van Wensen RJA, van den Bekerom MPJ, Marti RK, van Heerwaarden RJ. Reconstructive osteotomy of fibular malunion: review of the literature. Strategies Trauma Limb Reconstr 2011; 6:51-7. [PMID: 21818702 PMCID: PMC3150649 DOI: 10.1007/s11751-011-0107-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 03/14/2011] [Indexed: 11/28/2022] Open
Abstract
The treatment of ankle fractures has a primary goal of restoring the full function of the injured extremity. Malunion of the fibula is the most common and most difficult ankle malunion to reconstruct. The most frequent malunions of the fibula are shortening and malrotation resulting in widening of the ankle mortise and talar instability, which may lead to posttraumatic osteoarthritis. The objective of this article is to review the literature concerning the results of osteotomies for correcting fibular malunions and to formulate recommendations for clinical practice. Based on available literature, corrective osteotomies for fibular malunion have good or excellent results in more than 75% of the patients. Reconstructive fibular osteotomy has been recommended to avoid or postpone sequela of posttraumatic degeneration, an ankle arthrodesis or supramalleolar osteotomy. The development of degenerative changes is not fully predictable; therefore, it is advisable to reconstruct a fibular malunion soon after the diagnosis is made and in presence of a good ankle function. Recommendations were made for future research because of the low level of evidence of available literature on reconstructive osteotomies of fibular malunions.
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Affiliation(s)
- Remco J A van Wensen
- Department of Orthopaedic Surgery, Sint Maartenskliniek Woerden, P.O. Box 8000, 3440 JD, Woerden, The Netherlands,
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Abstract
BACKGROUND AND PURPOSE In open-wedge, valgus osteotomy of the upper tibia, there are concerns regarding the initial stability and ability to retain the correction. Rehabilitation protocols vary depending on the osteotomy technique and the fixation method. Angle-stable implants offer superior initial stability. Early full weight bearing appears to be possible using these implants. In this prospective cohort study, we measured migration in open-wedge osteotomy in patients following an early full weight bearing protocol and compared the results to those from a historical cohort of open-wedge osteotomy patients who followed a standard protocol (full weight bearing after 6 weeks) using radiostereometry. METHODS 14 open-wedge osteotomies fixated with the angle-stable Tomofix implant were performed; patients were allowed full weight bearing as soon as pain and wound healing permitted. Radiostereometry was used to measure motion across the osteotomy at regular intervals. Improvement in pain and functional outcome were assessed postoperatively. The results were compared to those from a group of 23 patients who had undergone the same operation but had used a standard rehabilitation protocol. RESULTS There were no adverse effects because of the early full weight bearing protocol. There were no differences in motion at the osteotomy between groups as measured by radiostereometry. In both groups, pain and function improved substantially without any differences between groups. Patients in the early weight bearing group achieved the same result but in a shorter time. INTERPRETATION Tomofix-plate-fixated open-wedge high tibial osteotomy allows early full weight bearing without loss of correction.
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Affiliation(s)
| | - Joan WH Luites
- Department of Research, Development and Education, OrthoResearch Unit, Sint Maartenskliniek, Nijmegen & Woerdenthe Netherlands
| | - Ate B Wymenga
- Limb Deformity Reconstruction Unit, Department of Orthopaedics
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Gaasbeek RDA, Groen BE, Hampsink B, van Heerwaarden RJ, Duysens J. Valgus bracing in patients with medial compartment osteoarthritis of the knee. A gait analysis study of a new brace. Gait Posture 2007; 26:3-10. [PMID: 16962329 DOI: 10.1016/j.gaitpost.2006.07.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [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: 10/14/2005] [Revised: 07/05/2006] [Accepted: 07/08/2006] [Indexed: 02/02/2023]
Abstract
A new valgus brace was evaluated in 15 patients with medial osteoarthritis of the knee and a varus leg axis. Significant improvement of pain and function were found after 6 weeks of brace treatment. Gait analysis showed that the brace had a tendency of lowering the peak varus moment about the knee. This effect was more profound in the presence of higher initial varus deformity angle of the knee. Furthermore, bracing led to a small decrease of knee extension at the end of the swing phase and an increase of walking velocity. The mechanisms identified by gait analysis in this study may be of clinical importance for future developments in brace treatment.
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Affiliation(s)
- Robert D A Gaasbeek
- Limb Deformity Reconstruction Unit, Department of Orthopaedic Surgery, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands.
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Gaasbeek RDA, Toonen HG, van Heerwaarden RJ, Buma P. Mechanism of bone incorporation of β-TCP bone substitute in open wedge tibial osteotomy in patients. Biomaterials 2005; 26:6713-9. [PMID: 15950278 DOI: 10.1016/j.biomaterials.2005.04.056] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 04/12/2005] [Indexed: 10/25/2022]
Abstract
A histological study was performed of bone biopsies from 16 patients (17 biopsies) treated with open wedge high tibial osteotomies for medial knee osteoarthritis. The open wedge osteotomies were filled with a wedge of osteoconductive beta tricalcium phosphate (beta-TCP) ceramic bone replacement. At the time of removal of the fixation material, core biopsies of the area where the beta-TCP was located were taken at different follow-up periods (6-25 months). beta-TCP resorption, bone ingrowth and bone remodelling were studied. We hypothesized that the incorporation and remodelling process occurs similarly as in animals. Histology showed a good resorption of the beta-TCP with complete incorporation and remodelling into new bone. The different phases as described in animal studies were found. A correlation was found between histological findings and radiological assessment. In conclusion, beta-TCP appeared to be a bone replacement material with optimal biocompatibility, resorption characteristics and bone conduction properties for the clinical use.
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Affiliation(s)
- Robert D A Gaasbeek
- Laboratory of Orthopaedic Research, Department Orthopaedics, University Hospital Nijmegen, Th. Craanenlaan 7, 6525 GH, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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18
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van Hemert WLW, Willems K, Anderson PG, van Heerwaarden RJ, Wymenga AB. Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiological study with a new evaluation system. Knee 2004; 11:451-6. [PMID: 15581763 DOI: 10.1016/j.knee.2004.08.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [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: 06/20/2004] [Accepted: 08/14/2004] [Indexed: 02/02/2023]
Abstract
The capacity of two forms of porous beta-tricalcium phosphate bone substitutes (TCP) to promote bone healing in open wedge high tibial osteotomy (OWHTO) was studied. We reviewed the X-rays of 27 osteotomies, with either TCP wedges or TCP granules as filling material, to compare the bone healing rates and bone remodelling, at specific postoperative intervals. A new radiologic rating system for OWHTO was created and tested for clinical applicability. All osteotomies healed uneventfully and complete resorption of TCP was demonstrated at 1 year postoperative in 85% (n = 23) of the procedures. In 44% (n = 10) of these 23 procedures, the osteotomy site was no longer visible. No difference in bone healing rate and bone remodelling was found when comparing the use of granules to a wedge, and no adverse effects of TCP were observed. The good inter- (k = 0.7) and intraobserver (k = 0.6) reliability of the new radiologic rating system enables clinical use. Good bone healing was found in OWHTO with both wedges and granules of TCP.
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Affiliation(s)
- Wouter L W van Hemert
- Department of Orthopaedic Surgery, Limb Deformity Reconstruction Unit, Sint Maartenskliniek, Nijmegen, The Netherlands
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