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BACKGROUND: Closed osteotomy of distal femur has a good effect in the treatment of genu valgus osteoarthritis, but the angle of osteotomy cannot be measured directly during the operation. It is necessary to correct the force line through repeated fluoroscopy and adjustment of osteotomy amount. Improper operation may cause iatrogenic rotation deformity. OBJECTIVE: To compare the effect of 3D printing assisted osteotomy of distal femur with conventional osteotomy of distal femur in the treatment of knee osteoarthritis. METHODS: From January 2014 to February 2018, 28 patients (37 knees in total) with osteoarthritis caused by genu valgus aged 28-60 years were enrolled from the First Hospital of Putian City. All patients were randomly divided into two groups. Patients in the control group (11 cases, 16 knees) were treated with conventional closed osteotomy of distal femur combined with locking compression plate implantation. Patients in the experimental group (17 cases, 21 knees) were treated with 3D printing module assisted with closed osteotomy of distal femur combined with locking compression plate. The operation time and times of fluoroscopy were recorded. The KOOS score, femorotibial angle, lateral angle of distal femur and fracture healing time were compared between the two groups before and after treatment. The experiment was approved by the Ethics Committee of the First Hospital of Putian City. RESULTS AND CONCLUSION: (1) Operation time and the times of fluoroscopy in the experimental group were less than those in the control group (P 0.05). (3) Femorotibial angle and lateral angle of distal femur in both groups were larger than those before operation (P 0.05). (4) There was no significant difference in the healing time between the two groups (P > 0.05). (5) The results showed that closed osteotomy of the distal femur can achieve good results in the treatment of genu valgus osteoarthritis. 3D printing technology can simplify the osteotomy operation, reduce the operation time, and the times of fluoroscopy.
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Objective To evaluate the correlation between osteophytes size and lower limb alignment in the knees of patients with Kaschin-Beck disease (KBD).Methods A total of 300 clinically diagnosed patients with KBD were X-rayed on knee-joints which ranged from the distal half of femur to proximal half of tibia.Meanwhile some related parameters in the X film with the anteroposterior position (including osteophytes length,femorotibial angle,femorotibial joint space ratio of inner side to outer side) were measured by DICOM 2.0,a software of medical graphic measuring,then followed by calculating the osteophyte spur index.The association between femorotibial angle,femorotibial joint space ratio and osteophytes spur index was evaluated by Pearson correlation test.Results The average of femorotibial angle of all the tested knee-joints was (165.97 ± 4.02)°,which positively correlated with both the osteophyte spur index of the medial femoral condyle [(6.54 ± 3.12)％,correlation coefficient (r) =0.524,P＜0.01] and the osteophyte spur index of medial tibil plateau [(7.14 ± 3.40)％,r =0.578,P ＜0.01].The femorotibial joint space ratio was 0.61 ± 0.13,which positively correlated with both the osteophyte spur index of medial femoral condyle (r =0.531,P ＜0.01) and that of the medial tibil plateau (r =0.563,P ＜0.01).Conclusions The results of this study indicate that there is a positive correlation between lower limb alignment and osteophyte size of both the medial femoral condyle and the medial tibial plateau.This finding may be evidenced by the fact that the changes of lower limb biomechanics may contribute to formation and development of osteophytes in the kneejoint.
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Objective To investigate the effect of total knee arthroplasty ( TKA) following high tibial osteotomy ( HTO) and to analyze the factors that may influence the operation .Methods A total of 16 patients (19 knees) who had undergone a previous HTO were treated with TKA between 2000 and 2010.The American Knee Society Scores ( KSS), femorotibial angle ,quadriceps angle ,posterior slope angle of tibial plateau ,Insall Salvatti Ratio and knee range of motion ( ROM) were evaluated for each patient pre-and post-operatively and the results were evaluated .Results The KSS scores improved from 73.20 ±3.56 scores preoperatively to 153.00 ±3.39 scores postoperatively (P <0.05).The femorotibial angle was corrected from 160.57°±3.30°preoperatively to 169.85°±1.34°postoperatively(P<0.05).The quadriceps angle was corrected from 24.57°±2.07°preoperatively to 17.28°±1.11°postoperatively (P<0.05).The posterior slope angle of tibial plateau was corrected from 2.25°±0.50°preoperatively to 3.75°±0.95°postoperatively (P<0.05).The Insall Salvatti Ratio improved from 0.80 ±0.08 preoperatively to 1.05 ±0.12 postoperatively ( P <0.05).The knee ROM improved to 38.25°±8.88°postoperatively from 96.25°±4.34°preoperatively(P<0.05).Conclusion TKA following HTO demands adequate soft tissue balancing , good limb alignment and appropriate prosthesis .
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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.
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Humans , Follow-Up Studies , Knee , Osteotomy , Survival RateABSTRACT
[Objective]To analyze the reasons of complications in high tibial valgus osteotomy in the varus osteoarthritic knee and its management.[Method]We studied the results of valgus-producing high tibial osteotomies in patients who had medial unicompartmental osteoarthritis and varus malalignment.We performed the operation for 126 patients from January 2000 to October 2004.Twenty-one patients had complications,including four men and seventeen women,with average age of 61 years(ranged:48～64 years).The femorotibial angle was measured on the standing anteroposterior film of knee preoperatively in order to get high accuracy in preoperative planning.A lateral closing-wedge osteotomy was performed,the osteotomy site was stabilized by Giebel blade plate or stepped staple.[Result]The mean duration of follow-up was 7.5 months(ranged,6 to 12 months).There were twenty-three complications(21 patients,16.7%):tibial fracture in four cases,deep-vein thrombosis in five cases,peroneal nerve palsy in three cases,recurrence of varus deformity in six cases,internal fixation failure in four cases(recurrence of varus deformity developed in two patients),a superficial wound infection developed in one patient.[Conclusion]To reduce the incidence of complications in high tibial valgus osteotomy,we should make familiarication with anantomy and take more accuracy in preoperative planning,improve surgical skill as well as appropriate perioperative management.