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BACKGROUND: Open wedge high tibial osteotomy can achieve significant clinical efficacy for patients with medial compartment knee osteoarthritis and genu varus. However, Fujisawa point has been recognized as a reference for the correction of lower limb alignment. Can individualized orthopedics in lower limb alignment obtain better clinical efficacy? OBJECTIVE: To explore short-term efficacy of individualized orthopedics in lower limb alignment for medial compartment knee osteoarthritis through open wedge high tibial osteotomy. METHODS: Totally 46 patients with medial compartment knee osteoarthritis treated by open wedge high tibial osteotomy from June 2016 to May 2018 in Department of Orthopedics, Wuxi People's Hospital were enrolled in this study. X-ray and MRI were used to evaluate the knee and I-III degeneration grades were classified. Patients at Grade I and II were randomly divided into individualized orthopedics group and control group with 16 cases in each group. Patients at grade III were classified as Fujisawa group with 14 cases. In the individualized orthopedics group, mild grade I and moderate grade II respectively corrected lower limb alignment to 50% and 55% of lateral tibial plateau, while control group and Fujisawa group all corrected the alignment to 62.5% point. Postoperative lower limb alignment, pre- and post-operative range of motion, femoral-tibial angle and medial proximal tibial angle of the knee were measured and evaluated. The hospital for special surgery score and the Western Ontario and McMaster Universities osteoarthritis index score were followed up before operation, 3, 6 and 12 months after operation, while postoperative self-satisfaction of patients was also compared. RESULTS AND CONCLUSION: (1) All patients were followed up for 12 months. (2) Three groups achieved satisfactory lower limb alignment. Range of motion and medial proximal tibial angle increased and femoral-tibial angle decreased at postoperative stage (P 0.05). (4) All patients were satisfied with the surgical efficacy. Postoperative self-satisfaction scores of individualized orthopedics group were superior to that of control group (P < 0.05). (5) According to the results, individualized open wedge high tibial osteotomy is benefit to obtain early functional rehabilitation of the knee through accurate correction of lower limb alignment. It can also improve patient satisfaction.
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Introducción: La osteotomía tibial valguizante de apertura es un procedimiento ampliamente realizado para tratar la gonartrosis unicompartimental medial. Existen pacientes que se encuentran al límite de la indicación de dicha técnica quirúrgica. El objetivo del presente trabajo es comunicar nuestro algoritmo diagnóstico terapéutico y técnica quirúrgica empleada. Material y métodos: Estudio observacional, serie de casos, retrospectivo. Población de 14 pacientes (15 rodillas) sometidos a osteotomía valguizante aditiva de tibia asociada a plástica ligamentaria de LCA (mismo tiempo quirúrgico) durante el año 2015. Seguimiento promedio de 24 meses. Se evaluaron parámetros pre y postoperatorios. Resultados: Parámetros postoperatorios (14 rodillas): Dolor (EVA) 0.45/10; Lachman 40% negativos (-) y 60% una cruz (+); Lysholm 98,77 puntos y trofismo muscular cuadricipital 1,05 cm (negativo). En todos los casos, volvieron a la práctica deportiva recreacional. Se registró un caso con evolución negativa (6.66% de la población). Conclusión: La osteotomía tibial de apertura asociada a reconstrucción artroscopia de LCA la indicamos en aquellos pacientes que presentan un síndrome de inestabilidad (ruptura crónica de LCA) con deseje en varo independientemente de la presencia o no de dolor; o en presencia de un síndrome osteoartrítico (artrosis con predominio en compartimiento medial) con deseje en varo e inestabilidad. Obtuvimos buenos resultados a corto y mediano plazo, sin complicaciones médicas, en donde los pacientes regresan a la práctica recreacional deportiva previa, con un alto porcentaje de satisfacción en nuestra serie presentada (mayor al 93%). Nivel de evidencia: IV (serie de casos).
Introduction: The tibial valgus aperture osteotomy is a procedure widely used to treat medial unicompartmental gonarthrosis. There are patients who are at the limit of the indication of said surgical technique. The objective of the present work is to communicate our therapeutic diagnostic algorithm and surgical technique used. Material and Methods: Observational study, case series, retrospective. Population of 14 patients (15 knees) submitted to additive valgus osteotomy of tibia associated with ligamentous plastic of ACL, during the year 2015. Average follow-up of 24 months. Pre and postoperative parameters were evaluated. Results: Postoperative parameters (14 knees): Pain (EVA) 0.45 / 10; Lachman 40% negative (-) and 60% one cross (+); Lysholm 98,77 points and quadricipital muscle trophy 1.05 cm (negative). In all cases, they returned to recreational sports. There was a case with a negative evolution (6.66% of the population). Conclusion: The tibial opening osteotomy associated with ACL arthroscopy reconstruction is indicated in those patients who present with an instability syndrome (chronic ACL rupture) with varus malalignment independently of the presence or absence of pain; or in the presence of an osteoarthritic syndrome (osteoarthritis with predominance in medial compartment) with varus desire and instability. We obtained good results in the short and medium term, without medical complications, where patients return to previous recreational sports practice, with a high percentage of satisfaction in our presented series (greater than 93%). Level of evidence: IV (case series).
Subject(s)
Adult , Genu Varum/surgery , Knee Joint/surgery , Osteoarthritis, Knee , Osteotomy/methods , Follow-Up Studies , Retrospective StudiesABSTRACT
The aim of this study was to test whether quiet stance body sway is associated with ankle and knee joint angles in elderly women. Joint angles were measured using a manual goniometer and body sway was assessed using a force platform and four postural tasks with a combination of feet positions and eye condition. The sample (N = 58) showed the following angle values: 102 (100-104) for the tibiotarsal joint, 176 (174-180) for the subtalar joint, 184 (181-187) for knee flexion-extension, and 13 (10-15) for the Q-angle. Q-angle was significantly correlated (p < 0.05) with center of foot pressure (CP) displacement area (r = 0.36), anteroposterior (SDy, r = 0.34) and lateral (SDx, r = 0.31) CP standard deviation, and anteroposterior CP range (r = 0.38) during the closed base, eyes opened trial (CBEO). The valgus group showed statistically higher values than the normal and varus groups for SDy (0.56 vs. 0.52 and 0.46 mm; p = 0.02), SDx (0.55 vs. 0.49 and 0.36 mm; p = 0.02) and anteroposterior range (3.32 vs. 2.78 and 2.38 mm; p = 0.01), CBEO. The displacement velocity of the CP was significantly higher for the asymmetric than the symmetric Q-angle group (8.0 vs. 5.3 mm/s - closed base, eyes closed trial). Knee alignment was correlated with measures of body sway in elderly women, but ankle alignment showed no correlation. Knee morphology should be considered an associated factor for quiet stance postural control.
O objetivo do estudo foi verificar se a oscilação corporal na postura quieta está associada aos ângulos articulares de tornozelo e joelho em idosas. Os ângulos foram medidos por um goniômetro manual e a oscilação corporal foi obtida por uma plataforma de força em quatro situações (combinando posição dos pés e condição visual). A amostra (N = 58) apresentou os seguintes valores angulares: 102 (100-104) para o tibiotársico, 176 (174-180) para o subtalar, 184 (181-187) para flexão-extensão de joelho e 13 (10-15) para ângulo Q. O ângulo Q se correlacionou significativamente (p < 0,05) com a área do deslocamento do centro de pressão dos pés (CP) (r = 0,36); com o desvio padrão anteroposterior (SDy, r = 0,34) e lateral (SDx, r = 0,31) do CP; e com a amplitude anteroposterior do CP (r = 0,38), durante a condição de base fechada, olhos abertos (BFOA). O grupo valgo, quando comparado aos grupos normal e varo, apresentou valores estatisticamente maiores de SDy (0,56 vs. 0,52 and 0,46 mm; p = 0,02), SDx (0,55 vs. 0,49 and 0,36 mm; p = 0,02) e amplitude anteroposterior (3,32 vs. 2,78 and 2,38 mm; p = 0,01), BFOA. A velocidade de deslocamento do CP foi significativamente maior para o grupo com ângulo Q assimétrico, comparando com o simétrico (8,0 vs. 5,3 mm/s - condição de base fechada, olhos fechados). O alinhamento do joelho se correlacionou com medidas de oscilação corporal em idosas, mas o tornozelo não mostrou nenhuma correlação. A morfologia do joelho deve ser considerada um fator influenciador no controle postural estático.
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@#ObjectiveTo compare the effect and prognosis of two kinds of internal fixation (improved Giebel blade plate and traditional straddle nail) after high tibial osteotomy (HTO) on osteoarthritis of knee with genu varus deformity. Methods37 knees of 32 cases were treated with straddle nail (25 knees) or Giebel blade plate (12 knees). All the cases were followed up for 6～28 months. ResultsThe clinical bone healing time of osteotomy was 8～12 weeks. There was no significant differences between 2 groups in the increased score in HSS Standard and in the clinical bone healing time. ConclusionBoth internal fixation with improved Giebel blade plate and traditional straddle nail get similarly satisfactory prognosis, while the former shows more advantages to allow early functional exercises.