ABSTRACT
10.3969/j.issn.2095-4344.2013.26.004
ABSTRACT
PURPOSE: To evaluate the clinical and radiological results and to analyze the survivorship after closing wedge proximal tibial osteotomy(PTO) using miniplate staple. MATERIALS AND METHODS: From November 1993 to August 2003, sixty closing wedge PTO using miniplate staple were performed in forty patients. The average follow-up period was 7.2 years(range, 2.8~12.5 years). According to the post- operative femorotibial angle(FTA), group I was defined as the cases whose FTA was less than 7 degrees of valgus(25 cases) and group II was defined as the cases whose FTA was more than 7 degrees of valgus(35 cases). The HSS score, FTA and survivorship were compared between group I and II. RESULTS: Average HSS score at the last follow up were 75.3 in group I and 85.9 in group II(p=0.006). Average FTA at the last follow up were 0.8 degrees in group I and 7.7 degrees in group II(p=0.006). The overall 7-year survivorship was 92.6% and 12-year survivorship was 75.5%. The 7-year survivorship and 12-year survivorship of group I were 86.7% and 54.2%, respectively. Group II have no failure at last follow up(p=0.0489). CONCLUSION: Our results suggest that the desirable postoperative FTA was more than 7 degrees of valgus, considering the long term satisfactory result and survivorship of the closing wedge PTO using miniplate staple for the osteoarthritic knees.
Subject(s)
Humans , Follow-Up Studies , Knee , Osteotomy , Survival RateABSTRACT
PURPOSE: To compare the fixation power of the newly devised RSP (rigid stepped plate) with the L-plate by mechanical study and to prove the efficacy of the RSP. MATERIALS AND METHODS: Lateral closing wedge proximal tibial osteotomy was performed on the 10-monthsold porcine tibiae, which were fixed by 15 L-plates and 15 RSP's. Each group of 5 pairs of the specimen were applied to the Instron apparatus and loaded by compression, valgus, and varus bending. The fixation power was compared by the stiffness of each construct. RESULTS: Specimen fixed by the RSP's showed larger stiffness than those fixed by the L-plate. Even though the difference was not statistically significant in compression (p=0.465), it was statistically significant in valgus (p=0.047) and varus (p=0.009) bending. CONCLUSION: The RSP can be applied with minimal skin incision, will provide firm initial fixation to the osteotomy site, and seems to enable early range of motion exercise. It will improve the outcome of proximal tibial osteotomy by preventing excessive soft tissue dissection and complications resulting from long-term immobilization of the knee joint.
Subject(s)
Immobilization , Knee Joint , Osteotomy , Range of Motion, Articular , Skin , TibiaABSTRACT
The rationale for proximal tibial osteotomy is to correct the abnormal loading stresses on the knee that are caused by an abnormal tibiofemoral axis in the coronal plane. Aithough there are many methods of fixation including cast, staple and external fixation, Coventry staple has been used widely. But Coventry staple has some disadvantages such as inadequate fixation, long term cast immobilization and rehabilitation. The purpose of this study is to demonstrate the superior performance of Miniplate staple which was designed by authors(Johnson & Johnson Orthopaedics, New Milton, UK) over the conventional Coventry staple. We have analyzed the clinical results including postoperative rehabilitation course of 3I cases who had proximal tibial osteotomy fixed with Miniplate staple. Preoperative diagnosis was osteoarthritis(OA) in 24 cases(77.4%) and physiologic genu varum in 7 cases(22.6%). 1. Hospital for Special Surgery knee score was average 72.2 points preoperatively, 90.1 points postoperatively in osteoarthritis and average 94.1 points preoperatively, 99.7 points postoperativeiy in physiologic genu varum. 2. The average tibiofemoral angle was varus 5.8 degrees preoperatively and valgus 8.7 degrees postoperati vely. 3. The active ROM exercise started at 5.3 days, standing at 13.3 days, crutches ambulation at 20.2 days and ambulation without crutches at 46.3 days after operation. In conclusion, more rigid fixation and rapid mobilization was possible with newly designed Miniplate staple in proximal tibial osteotomy.
Subject(s)
Axis, Cervical Vertebra , Crutches , Diagnosis , Genu Varum , Immobilization , Knee , Osteoarthritis , Osteotomy , Rehabilitation , WalkingABSTRACT
The proximal tibial osteotomy is a procedure usually employed for osteoarthritis of the knee with a predominant single compartment involvement accompanied by pain and angular deformity. It has as its objective the shift of the gravitational line of weight from an involved to a relatively uninvolved side of knee. We studied the results of proximal tibial osteotomy in 30 patients (33knees). The mean age was 55.7 years, degenerative osteoarthritis was 31 cases (93.9%) and posttraumatic osteoarthritis was 2 cases (6.1%). The results were as follows; The average distance of osteotomy between the proximal plane and distal plane was 10.3mm. The average preoperative tibiofemoral angle was varus 3.8degrees and average postoperative tibiofemoral angle was valgus 7.6 degrees. The amount of upward displacement of fibular head after proximal tibial osteotomy was from 3mm to 16mm (mean 7.5mm). The preoperative knee rating scale was 52.9 and the postoperative knee rating scale was 78. The complications of proximal tibial osteotomy were 3 cases of transient peroneal nerve palsy and 2cases of Coventry staple loosening, but the nerve palsy was completely recovered and there were no need of staple removal.