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Introduction: Osteoarthritis of the knee is a common musculoskeletal diseases affecting a major population in India. It can impact the individual's functions and activities of daily living. Total knee arthroplasty may raise controversy when treating the younger, athletic patient with arthritis. Arthroscopic debridement, high tibial osteotomy, unicondylar knee arthroplasty, and total knee arthroplasty allow younger patients to maintain an active, healthy lifestyle but can take a longer time to rehabilitate. PFO could be used as an alternative procedure. The Proximal Fibular Osteotomy, which provides immediate short term relief in cases with medial compartment osteoarthritis. Resecting a segment of fibula, loosens the lateral side allowing the upper tibia to settle into a more favorable lateral alignment, shifting the mechanical axis towards neutral or valgus. Aims & objectives: Ÿ To assess the functional, clinical and radiological outcome of proximal fibular osteotomy in grade 2 and 3 OA of knee and followed up for 1 year. Ÿ The clinical and functional outcome is accessed by Knee Society Score and VAS observed pre-op , post-op ,3 months ,6 months and 12 months. Ÿ The improvement in radiology is accessed using change in the medial joint space improvements in CP angle, change in the ratio of medial joint space to lateral joint space observed pre-op and post-op Methodology: The patients selected had grade 2 and 3 Osteoarthritis of knee according to Kellgren Lawrence classification between the age groups 20yrs-80yrs and are admitted to RajaRajeswari Medical College and Hospital, Bangalore. The Sample Size is 30 and is calculated based on previous studies as well as approximate availability of number of cases in the above mentioned duration satisfying inclusion and exclusion criteria. Clinical, functional and radiological outcome were used, Results were calculated using Knee Society Scoring Scale score. This study Conclusion: suggested that Proximal Fibular Osteotomy is an alternative procedure that can be used to treat medial compartment knee Osteoarthritis, if the patients are selected carefully. Patients followed up for one year showed a significant improvement in radiological, clinical and functional outcomes and thereby is an effective method of treatment in younger patients with Grade 2 and Grade 3 Osteoarthritis with an average BMI of 26.2.
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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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BACKGROUND: The most common surgical methods for the treatment of medial interventricular osteoarthritis of the knee are high tibial osteotomy and monocondylar replacement, and systematic evaluation of the difference in efficacy between the two is still lacking. OBJECTIVE: To compare the clinical efficacy of high tibial osteotomy and monocondylar replacement in the treatment of medial interventricular osteoarthritis of the knee. METHODS: PubMed, The Cochrane library, EMBASE, ScienceDirect, CNKI, Wanfang, and VIP were searched by computer. Literature was collected on observational cohort studies or randomized controlled trials comparing high tibial osteotomy/monocondylar replacement in the treatment of medial interventricular osteoarthritis of the knee, with a retrieval period from 2000 to 2019. Two people independently read and screened literature, extracted data and evaluated the quality of the study. RevMan 5.3 software was used for data analysis. RESULTS AND CONCLUSION: (1) A total of 13 studies were included, with 711 patients. (2) Meta-analysis results showed that the knee range of motion of high tibial osteotomy group (MD=-5.47, 95%CI: -9.53 to -1.41, P=0.008) was significantly better than that of monocondylar replacement group. Lysholm knee score (MD=0.84, 95%CI: 0.29 to 1.39, P=0.003) in the monocondylar replacement group at the last follow-up was significantly better than that of the high tibial osteotomy group. (3) There were no significant differences between the two groups in the incidence of postoperative complications, revision rate of total knee replacement, postoperative infection rate, degeneration rate of patellofemoral articular cartilage, degeneration rate of lateral compartment, excellent and good rate, and tibiofemoral angle after surgery (P > 0.05). (4) It is concluded that in the treatment of medial interventricular osteoarthritis of the knee according to the indications of operation, high tibial osteotomy can obtain similar complications, postoperative revision rate of total knee arthroplasty, postoperative infection, degeneration rate of patellofemoral articular cartilage, degeneration rate of the lateral compartment, excellent and good rate, postoperative tibial angle as monocondylar replacement, but the postoperative motion range of high tibial osteotomy is better than that of monocondylar replacement, while monocondylar replacement enables better knee function.
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For medial compartment knee OA, which is usually seen in the age group 40-50 years, total knee replacement is not recommended ideally. Hence, for these patients, there is need of a new procedure which would be safe, effective & affordable. Objective: The aim of this study is to evaluate the early benefits of proximal fibular osteotomy (PFO) in medial compartment knee OA. Methods: Total 50 patients (70 knees) with medial compartment OA included in this study from march 2017 to august 2017. All patients were managed by PFO and followed-up prospectively for minimum upto 12 months. Visual analogue scale to assess knee pain, American knee society score (AKSS) to evaluate knee functions and medial/lateral joint space ratio were used for radiological assessment. Statistical analysis done by using SPSS 20.0 software.. Results: All patients observed significant relief in knee pain after PFO. AKSS and medial/lateral joint space ratio improved significantly postoperatively. Most of the patients showed increased walking distance post-operatively. Conclusion: This study concludes that PFO is a safe & effective method for the management of medial compartment knee OA. It relieves knee pain significantly and improves knee joint function
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Knee osteoarthritis (KOA) is a common chronic degenerative joint disease. Hip muscle training, with the advantage of convenience and non-invasion, has been attached great importance by people gradually. Hip muscle training may affect keen medial compartment load, the strength and the electromyography signal of the muscle around the knee joint, and strong hip abductor can protect cartilage, which leads to change the load of the knee joint, and alleviate clinical symptoms. This article reviewed the mechanism of hip muscle training for knee osteoarthritis from the views of biomechanical simulation and electromyography.
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Objective: To investigate the effectiveness of double-plane high tibial osteotomy in treatment of medial compartment osteoarthritis. Methods: The clinical data of 65 patients with medial compartment osteoarthritis who were treated with double-plane high tibial osteotomy between January 2014 and January 2017 was retrospectively analyzed. There were 28 males and 37 females. The age ranged from 46 to 75 years with an average of 53.2 years. There were 30 cases in the left knee and 35 cases in the right knee. The disease duration was 3-7 years (mean, 4.0 years). The patients had different degrees of pain in the knee joint and difficulty walking. The knee joint compression test was positive. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score and knee society score (KSS) clinical and functional scores. The visual analogue scale (VAS) score was adopted to pain measurement. The healing of osteotomy was observed by X-ray films during follow-up; the femur tibia angle (FTA), posterior tibial slope (PTS), medial proximal tibial angle (MPTA), and knee varus angle (KVA) were also calculated. Results: All the incisions healed by first intention after operation. Only 1 case had numbness of the toe, and the symptoms disappeared after symptomatic treatment. All patients were followed up 13-18 months with an average of 15.4 months. X-ray examination showed that all patients had bone healing at 12 weeks after operation. There were significant differences in MPTA, FTA, PTS, and KVA between pre- and post-operation ( P0.05). There was no loosening and rupture of the fixator during the follow-up. The HSS score and KSS clinical and functional scores at 12 months after operation were significantly higher than those before operation ( P<0.05). The VAS scores at 1 week, 6 months, and 12 months after operation were significantly lower than that before operation ( P<0.05). Conclusion: Double-plane high tibial osteotomy for medial compartment osteoarthritis can effectively relieve pain symptoms and improve joint function.
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Objective To observe the clinical efficacy of arthroscopy and fibula osteotomy in the treatment of medial knee osteoarthritis.Methods Thirty-six patients with medial knee osteoarthritis treated in our hospital from September 2014 to September 2016 were divided into two groups according to the acceptable surgical protocol.The control group was treated by fibula osteotomy,and the observation group received arthroscopy combined with fibula osteotomy.The clinical signs and symptoms,VAS and ISOA scores were evaluated and compared between the two groups.Results The control group of 18 cases,clinical recovery in 0 cases,markedly effective in 7 cases,effective in 8 cases,3 cases with no effect,the effective rate was 38.9％;observation group of 18 cases,3 cases clinically cured,effective in 10 cases,effective in 5 cases,the effective rate was 72.2％.The effective rate of observation group was better than that of the control group,the difference was signicant (P ＜ 0.05).VAS and ISOA in both groups were significantly improved after operation,the difference was signicant (P ＜ 0.05);VAS improvement in observation group was better than that in control group,the difference was signicant(P ＜ 0.05),ISOA score in observation group was significantly better than that in control group,the difference was signicant(P ＜0.01).The clinical signs and symptoms(pain and numbness,walking,living and working abilities,tenderness,straight leg raising test,knee and Achilles reflex,total score) in two groups were improved respectively compared with those before treatment,and the differences were statistically significant(P ＜ 0.05).The pain and numbness,walking,tenderness,straight leg raising test and total score in the observation group were significantly different from those in the control group(P ＜ 0.05).Conclusion The arthroscopy and fibula osteotomy is safe and feasible to treat patients of medial knee osteoarthritis with less traumatic,more effective and better functional recovery.
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PURPOSE: The purpose of this study was to compare the clinical and radiologic results of medial open wedge high tibial osteotomy (HTO) using either TomoFix(R) plate (group A) or Aescula(R) plate (group B) in patients with medial compartment osteoarthritis. MATERIALS AND METHODS: Sixty-four consecutive patients who underwent HTO for medial compartmental osteoarthritis from 2008 were included. Mean follow-up duration was 37.1 months. Twenty men and 44 women with a mean age of 50 years (range, 41 to 62 years) were divided into group A (locking plate, n=20) and group B (spacer plate, n=44). Clinical results were evaluated using knee society rating system (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiological results were obtained by measuring the mechanical axis, posterior tibial slope, and medial joint space width preoperatively, 3 months postoperatively, and at the final follow-up. RESULTS: In overall patients, the mechanical axis was corrected from 7.8degrees+/-2.4degrees of varus preoperatively to 1.9degrees+/-2.2degrees of valgus 3 months after HTO. At the final follow-up, the mechanical axis was to 2.1degrees+/-3.1degrees of valgus which showed no statistical difference in group A. However, loss of correction was observed at the final follow-up, at 0.1degrees+/-3.1degrees of valgus angulation in group B. The increase of the posterior tibial slope was significantly greater in group A than group B. The joint space width in both groups was improved at last follow-up. All clinical results showed improvement after HTO, with significantly improved KSS and WOMAC scores (p<0.001). CONCLUSION: The overall clinical results after HTO for medial compartment osteoarthritis were satisfactory. A group of spacer plates needed for prolonged protective weight bearing and locking plate was effective in maintenance of correction.
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Female , Humans , Male , Axis, Cervical Vertebra , Follow-Up Studies , Joints , Knee , Ontario , Osteoarthritis , Osteotomy , Weight-BearingABSTRACT
PURPOSE: The aim of this study is to evaluate the clinical and radiologic outcomes of supramalleolar tibial osteotomy for medial compartment ankle osteoarthritis (OA) and to verify the efficacy of the supramalleolar osteotomy. MATERIALS AND METHODS: This study is based on 9 ankles of the medial compartment ankle OA treated with supramalleolar tibial osteotomy from August 2007 to June 2011 with at least 1 year follow-up. As for the functional evaluation, visual analogue scale (VAS) pain scores and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were evaluated. On radiographs, tibial anterior surface (TAS) angles, tibial lateral surface angles were measured. The severity of ankle OA was classified by the Takaura staging system. RESULTS: The mean VAS pain scores improved to 0.6 and AOFAS scores improved to 89.3. Radiographically, TAS angle increased to 93.5degrees postoperatively. Seven ankles showed improvement of the ankle arthritis grading from IIIa to II according to Takakura's staging. CONCLUSION: Supramalleolar tibial osteotomy for patients with medial compartment varus ankle OA showed satisfactory clinical and radiological outcome. We confirmed that the procedure is recommendable for medial compartment varus ankle OA especially for Takakura stage IIIa.
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Animals , Humans , Ankle , Arthritis , Follow-Up Studies , Foot , Osteoarthritis , OsteotomyABSTRACT
PURPOSE: To compare the radiographic and clinical results of medial open wedge high tibial osteotomy (OWHTO) using autogenous bone graft and allogenous cancellous bone graft for medial compartment osteoarthritis of the knee with two-year follow-up. MATERIALS AND METHODS: Fifty-one patients (52 knees) who underwent medial OWHTO from October 2007 to April. 2010 were included in the study. The patients were divided into group I (n=29) that received an autogenous tricortical bone graft and group II (n=23) that received an allogenous cancellous bone chip graft. The radiographic parameters (preoperative anatomical and mechanical femorotibial angles, modified tibial bone varus angle, and posterior tibial slope), clinical parameters, bone union period, and complications were evaluated from medical records. RESULTS: The radiographic and clinical outcomes did not show significant difference between two groups. The average bone union period was 11.7 weeks in group I and 12.1 weeks in group II. The visual analog scale score on the first postoperative day was significantly higher in group I than group II. CONCLUSIONS: Medial OWHTO using allogenous cancellous bone graft for medial compartment osteoarthritis of the knee can be considered as an alternative treatment method that provides equivalent radiographic and clinical results of OWHTO using autogenous bone graft and causes less immediate postoperative pain.
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Humans , Follow-Up Studies , Knee , Osteoarthritis , Osteotomy , Pain, Postoperative , TransplantsABSTRACT
PURPOSE: To evaluate the influence of degenerative changes in the patellofemoral joint on the clinical results of medial unicompartmental knee arthroplasty (UKA). MATERIALS AND METHODS: Between January and December 2002, we operated on 180 cases of minimally invasive UKA using the Oxford(R) phase 3. Of the 180 cases, 156 were followed up for a minimum period of 5 years. Based on intraoperative degenerative findings of the patellofemoral joint, we classified cases into 4 groups (Group I-78 cases, Group II-40 cases, Group III-27 cases, Group IV-11 cases), and the clinical data were analyzed prospectively. RESULTS: During follow-up, which averaged 6 years and 2 months, the knee score, the knee function score, the range of knee motion and the tibiofemoral angle were improved significantly (p0.05). To date, no complication or failure involving the patellofemoral joint has been observed. CONCLUSION: Clinical results of UKA are satisfactory for all groups, and the severity of patellofemoral degeneration has no influence on clinical outcome. Symptomless degenerative arthritis of the patellofemoral joint is not a contraindication for medial UKA.