Effect of body mass index on short-term effectiveness of high tibial osteotomy in treatment of varus knee arthritis / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effect of body mass index (BMI) on the short-term effectiveness of high tibial osteotomy (HTO) in the treatment of varus knee arthritis.@*METHODS@#The clinical data of 84 patients (84 knees) with varus knee arthritis treated with HTO between May 2016 and August 2020 were retrospectively analyzed. According to BMI, the patients were divided into normal group (32 patients in group A, BMI<25 kg/m 2), overweight group (27 patients in group B, BMI>30 kg/m 2), and obese group (25 patients in group C, BMI>30 kg/m 2). The BMI of groups A, B, and C were (23.35±0.89), (26.65±1.03), and (32.05±1.47) kg/m 2, respectively. There was no significant difference ( P>0.05) in gender, age, surgical side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, knee range of motion, and hip-knee-ankle angle (HKA) between groups. The operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation were recorded and compared between groups. The improvement of knee joint function and pain status were evaluated by knee joint HSS score, knee range of motion, and VAS score before and after operation, and measuring the HKA of patients on X-ray film. During the follow-up, the X-ray films of the knee joint were reexamined to observe the position of the internal fixator and the healing of osteotomy.@*RESULTS@#All patients completed the operation successfully and were followed up 8-40 months (mean, 19.3 months). There was no significant difference in follow-up time, operation time, intraoperative dominant blood loss, and the decrease of hemoglobin on the 3rd day after operation between groups ( P>0.05). No operative complications such as severe vascular or nerve injury occurred. After operation, deep venous thrombosis of lower extremities occurred in 1 case in groups A and B respectively, and fat liquefaction of surgical incision occurred in 2 cases in group C. There was no significant difference in the incidence of perioperative complications between groups (3.1% vs. 3.7% vs. 8.0%) ( P=0.689). During the follow-up, there was no bone nonunion, plate fracture or loosening. At last follow-up, HSS score, VAS score, knee range of motion, and HKA significantly improved in the 3 groups when compared with those before operation ( P<0.05), but there was no significant difference in the differences of the above indexes between groups before and after operation ( P>0.05).@*CONCLUSION@#BMI does not affect the short-term effectiveness of HTO in the treatment of varus knee arthritis. HTO can be selected for overweight and obese patients after standard medical treatment is ineffective.

Combination of measured resection and gap balancing technique used in femoral component rotation in total knee arthroplasty / 中国组织工程研究

BACKGROUND: Total knee arthroplasty is effective in managing end-stage knee disease. Measured resection and gap balancing are two different techniques. Both of two have advantages and disadvantages. A technique has been developed that combines the benefits of measured resection and gap balancing to optimize the clinical effect of total knee arthroplasty. OBJECTIVE: To evaluate the operation and early clinical effect in total knee arthroplasty about the combination of measured resection and gap balancing technique used in femoral component rotation. METHODS: Totally 30 patients were treated with the combination of measured resection and gap balancing technique in total knee arthroplasty from September 2016 to December 2018, including 4 males and 26 females, at the age of 46-81 years. There were 24 cases of osteoarthritis with varus and 2 cases of osteoarthritis with valgus. There were 4 cases of rheumatoid arthritis with valgus. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Effects were evaluated by Visual Analogue Scale, Hospital for Special Surgery score, femorotibial angle and range of motion before surgery and during final follow-up. RESULTS AND CONCLUSION: (1) The incision healed in the first stage after operation. No early complications occurred, such as infection, vascular nerve injury, deep venous thrombosis of the lower extremities and periprosthetic fracture. (2) Totally 30 patients were followed up for 6-30 months. (3) Visual Analogue Scale, Hospital for Special Surgery score, range of motion and femorotibial angle were improved during final follow-up compared with those before surgery (P < 0.05). (4) Surgeons should be familiar with measured resection and gap balancing technique in total knee arthroplasty, and then use the combination of two techniques based on the specific situation of patients to obtain better soft tissue balance and prosthesis position. The combination technique is easy to master and can be operated with traditional osteotomy tools. Thus, good short-term effect can be achieved.

Tibial Torsion and Knee Varus Angle: Are These Aetiologies of Hallux Valgus?

OBJECTIVE: The purpose of this study is to evaluate that knee deformity (varus or valgus) due to osteoarthritis of the knee and tibial torsion could be aetiologies of hallux valgus. METHODS: Forty-nine patients (43 females, six males; mean patient age, 69.88±6.12 years) before total knee arthroplasty for advanced primary osteoarthritis were recruited. All deformities were of the left knee. Preoperative torsional computed tomography, anteroposterior (AP) and lateral weight-bearing foot radiographs, AP and lateral weight-bearing knee radiographs, and long-leg standing AP views were obtained for each patient. The correlations between foot angle and knee varus angle or tibial torsion angle were examined. RESULTS: There was no significant correlation between knee varus angle and foot angle. Similarly, there was no significant relationship between tibial torsional angle and foot angle, except talocalcaneal angle (TCA)-lateral (r=0.28). No significant relationships were found between TCA-AP and (1–2 intermetatarsal angle [IMA] and hallux valgus angle [HVA]), or between TCA-lateral and (1–2 IMA and HVA). CONCLUSION: No significant correlations were found between the knee anatomical axis (knee varus angle) and foot angle or between the tibial torsional angle and foot angle. Tibial torsion and knee varus angle were not aetiologies for hallux valgus.

Comparison of Complete Distal Release of the Medial Collateral Ligament and Medial Epicondylar Osteotomy during Ligament Balancing in Varus Knee Total Knee Arthroplasty

BACKGROUND: During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed. METHODS: This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. RESULTS: There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. CONCLUSIONS: Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.

One-Staged Open-Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the clinical and radiological results of one-staged open-wedge high tibial osteotomy (HTO) and arthroscopic anterior cruciate ligament (ACL) reconstruction for patients with complete rupture of the ACL and concomitant varus malalignment of the lower limb. MATERIALS AND METHODS: Twenty-five patients were prospectively assessed before and 1 year after their simultaneous operation as a single procedure. The clinical assessment included the Lysholm score, the Tegner activity level scale and a physical examination. The radiological data was used to calculate the mechanical axis, the joint space, the tibial slope and the arthrometric stress test. The postoperative complications were also assessed. RESULTS: The Lysholm knee score and the Tegner activity level scale improved from a mean of 72.1 to 93.8 and from 1.45 to 4.65, respectively (p0.05). The severity and rate of the postoperative complications were both low. CONCLUSION: One-staged open-wedge HTO and ACL reconstruction produced satisfactory correction of the mechanical axis alignment and, it improved knee function. Further, the procedure had a low complication rate. It is also cost effective due to, reducing the frequency of operation and avoiding overlap of rehabilitation.

Short-term Follow-up Results of Medial Epicondylar Osteotomy for the Varus Knee in TKA

PURPOSE: We wanted to evaluate the results of medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty. MATERIALS AND METHODS: We reviewed 32 cases of medial epicondylar osteotomy for treating varus deformity, and these cases underwent operation from December 2004 to December 2007. The average age of the patients was 71.0-years-old and the average follow-up period was 23.5 months. The clinical outcomes were measured, including the Knee Society score (KSS), the function score (FS) and the range of the motion (ROM). The radiological outcomes were measured by anteroposterior simple radiographs for assessing the union state of the osteotomy site, and the valgus stress radiographs and the whole extremity radiographs were used for assessing the femorotibial angle, the mechanical axis angle and the alignment. RESULTS: The KSS improved from 46.5+/-7.6 to 89.1+/-5.9 points (p<0.001) and the FS increased from 39.5+/-9.2 to 84.2+/-8.5 points (p<0.001). The range of motion increased from 101.5+/-28.2degrees to 116.0+/-10.8degrees (p=0.006). Bony union occurred in 22 knees and fibrous union occurred in 10 knees. The femorotibial angle was corrected from varus 8.2+/-5.0degrees to valgus 5.6+/-1.5degrees (p<0.001) and the mechanical axis angle was revised from varus 13.9+/-4.5degrees to varus 0.7+/-1.6degrees (p<0.001). There were 27 neutral, 4 varus and 1 valgus alignment. On the valgus stress radiographs, the difference compared with the opposite side was 1.0+/-0.6degrees and there was no significant difference between the bony union group and the fibrous union group (p=0.175). CONCLUSION: Medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty could be a useful ligament balancing technique for achieving medial stability of the knee.