ABSTRACT
Electroacupuncture (EA) has been widely used in pain relief. Clinical evidence has revealed its unique advantages and effectiveness in alleviating pain. Studies on EA and pain relief have revealed that EA displays greater analgesic effects for different types of pain in comparison to manual acupuncture. Here, we reviewed the clinical application and mechanism of EA in treating osteoarthritic knee pain and its influence factors in curative effect.
ABSTRACT
PURPOSE: To evaluate the clinical and radiological results of an opening wedge osteotomy for an osteoarthritic knee, and compared these results with those of a closing wedge osteotomy. MATERIALS AND METHODS: The study included 27 patients (29 cases) with an opening wedge osteotomy (Group A) and 30 patients (30 cases) with a closing wedge osteotomy (Group B). The radiological results obtained regarding the degree of osteoarthritis, femur-tibia angle, tibial alignment, posterior tibial slope and patellar height using the Insall-Salvati's method were analyzed. HSS score was used for evaluation of the clinical results. RESULTS: Preoperatively, there were no significant differences between the two groups regarding the degree of osteoarthritis, the femur-tibia angle, tibial alignment, posterior tibial slope, and patellar height. Two years after surgery, the femur-tibia angle and tibial alignment were significantly improved to 7.7degrees valgus and 1.3degrees valgus, respectively, and the patellar height was not changed significantly in group A. Similar degrees RESULTs were obtained in group B. The tibial posterior slope increased from 3degrees to 10.7degrees in group A and decreased from 4degrees to 3.7degrees in group B. Clinically, the HSS score was improved from 74 points preoperatively to 93 points 2 years postoperatively in the opening group, and was similar to the improvement observed in the closing group. The complications included 1 delayed union in the opening group, and 3 cases of superficial peroneal nerve palsy and 1 delayed union in the closing group. CONCLUSION: An opening wedge osteotomy is a relatively simple and safe procedure that gives similar radiological and clinical outcomes to a closing wedge osteotomy, without peroneal nerve palsy. However, surgeons should take care in preventing an increase in the tibial posterior slope.
Subject(s)
Humans , Knee , Osteoarthritis , Osteotomy , Paralysis , Peroneal NerveABSTRACT
This study reviews the simplified medial opening step wedge technique for upper tibial osteotomy by performing the operation without osteotomy of fibula and using narrow straight plate instead of T-plate fixation of the tibia. During 1991-1993, this simplified osteotomy technique was used in 19 patients 2 males and 19 females with age ranged 51-69 years old, whose 21 knees had degenerative varus osteoarthritic, 15 right and 6 left knees. Among these 19 patients, both joint debridement of the knees and the osteotomy were done in 2 patients suffered from osteoarthritic knees with excessive osteophytes near the joint surface. The result of 1-2 year follow up showed that the technique provided increased stability of osteotomy site, decreased postoperative swelling and pain during exercise and ragne of motion of the knees. Moreover, it could reduce the operative time. For the union of osteotomy, radiologic changing appearance of the knees and used the knees in daily activities were similar to the results of the treatment of osteoarthritic knees by technique of medial opening and lateral closing step wedge upper tibial soteotomy.
ABSTRACT
This study reviews the results of the osteotomy technique of the upper tibia as medial opening step wedge using two iliac bone grafts fixed with a T-plate for the treatment of degenerative varus osteoarthritic knee. The technique was used in 32 patients twenty six females and six males with ages ranging from 50-65 years. During the two to four years postoperative follow up, we found that postoperative casting was nit necessary. The patients could move their knees after 3-5 days and a full range of motion was noted in one-and-a half months. However in 8 cases who had coincidentally suffered joint debridement, the full range of motion was obtained in about two and half months. The union of the graft osteotomy took one and a half months. Most importantly there was no alteration in the angle the corrected joint. Roentgeon appearances of the knees after one year showed the widening of the medial joint space, the decrease of subchondral bone sclerosis and the size of osteophytes and the knee joints were stable.
ABSTRACT
Osteoarthritis (OA) and rheumatoid arthritis (RA) are the most frequently seen among the disorders belonging to rheumatism. But the surgical treatment of RA is different from that of OA. Although both diseases affect the various joints, the surgical intervention for the knee is mainly described as they cause to the severe disturbance of the gait.<br>Osteoarthritic knee has the varus deformity and the joint destruction of medial compartment. But the osteoarthritic knee with varus deformity has almost normal cartilage and joint space in the lateral side of the knee. The malalignment of the knee is corrected using valgus osteotomy and the weight bearing on the medial side is transfered to the lateral side. That is, high tibial osteotomy, a method of the correction of varus deformity, is necessary to be performed.<br>On the other hand, rheumatoid arthritis is the disease of which joints are gradually destructed by the chronic inflammation of the membrane of the joints. Therefore, the resection of the inflammed joint membrane, that is, the synovectomy, is done to prevent the destruction of the joints. The knees which have already destructed by rheumatoid inflammation cannot be fruitfully managed with only synovectomy. Not only medial but also lateral compartment of the knee are equally damaged in the majority of the rheumatoid knees, so that the destructed knee of RA has lately been treated using the total knee arthroplasty. The rheumatoid case, which cannot walk and is obliged to use a wheel chair, is able to walk again after the total knee arthroplasty.<br>Sometimes rheumatoid patients are managed in the many joints besides the knee by using the joint arthroplasty which is suitable to each joint. The acupuncture and moxibustion should be carefully carried out to the joint with the total arthroplasty.