Prospective Outcomes of Young and Middle-Aged Adults With Medial Compartment Osteoarthritis Treated With a Proximal Tibial Opening Wedge Osteotomy (original) (raw)
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The Journal of bone and joint surgery. American volume, 2014
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. 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 tota...
Annals of International medical and Dental Research, 2018
Background: Osteoarthritis is now considered to be primarily a disease of cartilage in which intrinsic biomechanical and mechanical alterations lead to its breakdown. Increasing failure of conservative treatment lead surgeons to explore the operative arena. High Tibial Osteotomy (HTO) is a satisfactory surgical method in knees with unicompartmental osteoarthritis and angular deformity. Objectives: To manage medial uni-compartment osteoarthritis of knee with medial open wedge or lateral closing wedge osteotomy and to compare between the two. Methods: HTO of 20 adult patients with medial compartment osteoarthritis or medial bicompartment osteoarthritis with genu varum deformity and their followup with functional and radiological parameters. Results: Following operation 12 patients having excellent results & 8 patients (40%) having good results. 19(95%) patients were satisfied. Conclusion: There is no significant statistical difference between the patients undergoing medial open wedge and lateral close wedge high tibial osteotomy except for medial joint space. Medial Open Wedge is technically easy with fewer risks, hence preferred over lateral close wedge.
The Knee, 2017
Background: To report time dependent functional improvement and predictive risk factors for failure when the load in varus knees with medial osteoarthritis is shifted from the medial to the lateral knee compartment. Methods: Forty-nine consecutive patients (52 knees), mean age 47 (31-64) years, underwent a high tibial opening-wedge valgus osteotomy stabilized with a Puddu plate and bone grafting. The patients were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at three and six months, one, two, five and 10 years postoperatively with a mean follow-up time of 8.3 years (2.0-10.6). Results: Mean angular correction was 8.0°(four to 12). The five subscores of KOOS increased significantly during the first year by 40-131% from preoperative values, the good results remaining throughout the 10-year follow-up for those with a surviving osteotomy. The outcome was related to the grade of preoperative osteoarthritis. Seven knees were converted to total knee arthroplasty (TKA) mean 6.2 years (two to nine) post-operatively, and had a lower KOOS preoperatively than those of surviving osteotomies. The osteotomy survival rate at five years was 94% and at 10 years 83%. Patients with KOOS subscore quality of life (QoL) b44 at the two-year follow-up had a 11.7 times higher risk for later TKA than those with QoL ≥44 (P = 0.017). Conclusion: High tibial opening-wedge osteotomy for medial knee osteoarthritis resulted in good functional recovery after one year and favorable mid-term results. It may be a good treatment option for middle-aged patients with varus knees and medial osteoarthritis in order to prevent or postpone TKA.
Evaluation of Medial Open Wedge High Tibial Osteotomy in Osteoarthritis of Knee
International Journal of Innovative Research in Medical Science
Study Design: Prospective and Interventional Randomized Comparative Study. Duration of study: 18 months. Objective: 1. To estimate pain relief in a patient with primary degenerative osteoarthritis of knee after medial open wedge high tibial osteotomy (HTO) using visual analog scale(VAS). 2. To assess the change in femorotibial angle, weight bearing line deviation and tibial slope pre and post operatively. 3. To compare pre- and post-operative WOMAC (The Western Ontario and McMaster Universities Osteoarthritis Index) index. Methodology: This study is a prospective analysis of patients with the requisite inclusion criteria, done over 18 months in the Central Institute of Orthopaedics, VMMC & SJH, and New Delhi. It includes a total of 20 patients who were followed up for 6 months. After initial preoperative evaluation, they underwent medial open wedge HTO for primary degenerative osteoarthritis of knee. Post operatively, patients were assessed clinically, functionally and radiologicall...
Outcome Analysis Following Medial Open Wedge High Tibial Osteotomy in Osteoarthritis of Knee
Due to changing lifestyle and increase in pace of life Osteoarthritis of knee is increasing in young age group. Treatment of a painful osteoarthritic knee joint in a young , active patient is extremely challenging and controversial. Excessive premature loading of articular cartilage result in early degenerative changes in knee joint. Instability may also be an contributing factor. In young age group medial unicondylar Osteoarthitis is more common. Lateral closing Wedge High tibial Osteotomy has been described as a treatment option for misalignment in the older ,less active adult. A New type of High Tibial Osteotomy in the form of Medial Open Wedge High Tibial Osteotomy is showing promising results in young osteoarthritis patients with several benefits and comparatively less complications. We conducted this study with twenty patients for eighteen months to evaluate the outcome of Medial Open Wedge High Tibial Osteotomy in young indian osteoarthritis knee patients
The Journal of Bone & Joint Surgery, 2006
Background: The results of tibial osteotomy used to treat osteoarthritis of the medial compartment of the knee deteriorate over time even when the initiai correction is optimal. Studies have shown that tibiai and femorai torsion and the femorotibiai index (tibiai torsion minus femorai torsion) contribute, together with ooronal malaiignment, to the development of singie-oompartment knee osteoarthritis. The objective of our study was to evaiuate the impact of femorai and tibiai torsion and of ooronai realignment on the long-term oiinioai and radiographie outcomes of vaigus tibiai osteotomy. IVIethods: A function score was caiouiated for sixty-eight patients at a mean of thirteen years after the osteotomy. Anteroposterior singie-leg-stanoe radiographs were used to evaiuate ioss of the femorotibiai joint spaoe. Goniometry was used to measure ooronai maiaiignment preoperativeiy, at one year, and at the time of the last follow-up, and postoperative computed tomography was performed to measure femoral anteversion and tibiai torsion and to oaiouiate the femorotibiai index. We looked for associations linking body mass index, initial ioss of joint space, coronal malaiignment, femoral and tibial torsion, the femorotibiai index, and functional outcomes. Results: Worse outcomes were associated with changes in coronal alignment (>2°) overtime, which were associated with deterioration of the femorotibiai space. Femoral anteversion was significantly greater in patients in whom valgus increased over time than in those in whom valgus decreased over time. Stability of coronal alignment seemed to be dependent on a linear relationship between the femorotibiai index and the degree of postoperative realignment. A body mass index of >25 kg/m' was associated with a long-term loss of coronal realignment. Preoperative loss of the medial femorotibiai joint space, coronal alignment at one year, and age were not associated with secondary malaiignment or functional outcomes. Conclusions: Long-term success of a valgus tibial osteotomy is related to the stability over time of the postoperative coronal realignment. Therefore, the results of our study suggest that modifying the realignment according to the extent of femoral anteversion may improve long-term outcomes. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
IP International Journal of Orthopaedic Rheumatology
Knee osteoarthritis (OA) is a chronic, progressive degenerative disease with joint pain, stiffness, and deformity. Knee OA is a common joint disease, with an incidence of 30% of the population older than 60 years. High tibial osteotomy and total knee arthroplasty are the 2 commonly used methods for treating knee OA. Total knee Arthroplasty (TKA), which aims to relieve pain and improve joint function and mobility, primal fibular osteotomy (PFO) is the main surgical alternative in this patient population. Materials and Methods: From September 2017 to September 2019, the PFO was performed for patients presenting with medial compartment osteoarthritis. Preoperative and postoperative weight-bearing whole lower extremity radiographs were obtained to analyze the alignment of the lower extremity and the ratio of the knee joint spaces (medial/lateral compartment) were ascertained. Knee pain was assessed using a visual analog scale (VAS), and knee ambulation activities were evaluated using the Knee Society Score (KSS). Results: A total of 20 patients and 26 knees were followed-up for a minimum period of one year. Of these, 7 were male and 13 were female patient. The average age was 57 years. According to Kellgren Lawrence grading, there were 18 knees of grade 2 and 2 knees of grade 3. The average preoperational VAS score and KSS were 6.3 and 33.5 respectively. The average postoperative VAS score and KSS improved significantly to 2.8 (P<0.01) and 83.7 (p=0.002) respectively. The medial joint space opening has improved significantly from preoperatively 1.15mm to postoperatively 3.4mm. Conclusion : PFO is a promising alternative procedure in the management of medial compartment osteoarthritis of the knee being a simple and cost-effective alternative to the traditional total knee or unicondylar knee replacements. A longer period of follow-up is necessary to evaluate whether the beneficial effects of PFO are sustained over a period of time.
Journal of International Medical Research, 2007
This study aimed to evaluate the clinical and radiological results of closed wedge osteotomy (11 knees) and focal dome osteotomy (14 knees) in cases of high tibial osteotomy undertaken for varus knee with medial compartment osteoarthritis. Clinical evaluation was performed using the Knee Society Score and no significant difference was seen between the two groups at final follow-up. Radiological evaluation was made on the basis of the pre- and postoperative mechanical axis, postoperative movement of the tibial axis, loss of correction at final follow-up and patellar height measured using the Insall-Salvati index. Statistically significant differences were seen with focal dome osteotomy compared with closed wedge osteotomy in the Insall-Salvati index at final follow-up, the amount of correction loss and the change in tibial axis location. It is concluded that, in the treatment of medial compartment osteoarthritis by high tibial osteotomy, focal dome osteotomy is more beneficial than c...
Journal of Clinical Orthopaedics and Trauma, 2021
Knee osteoarthritis (OA) is the most common joint disorder worldwide. In particular, primary knee OA often presents with a varus malalignment. This increases the loads going through the medial compartment resulting in cartilage degeneration and symptomatic arthritis. High tibial osteotomy (HTO) is the workhorse surgical procedure for treating medial knee OA. When performed precisely in the hands of an experienced surgeon, HTO can delay or avoid knee arthroplasty. Of note, outcomes of knee arthroplasty are at best unpredictable in patients of younger age. Hence, there is a growing need for joint preservation procedures for younger patients presenting with knee OA, of which HTO is one. Through this article, the authors of whom all are joint preservation surgeons with a special interest in osteotomy hope to share from their experience as well as the available literature on the indications, perioperative planning, surgical technique, outcomes as well as pearls and pitfalls of HTO.