Ten-year results of tibial osteotomy for medial gonarthrosis. The influence of overcorrection.

The results in relation to the correction achieved 1 year after surgery of a series of tibial osteotomies in 50 patients (52 knees) are presented with a total observation time of 10 years. Mean age at the time of osteotomy was 56 years. Overcorrected knees had a significantly better result after 10 years. Progress of gonarthrosis occurred in 6/34 overcorrected knees compared with 3/4 in the normo- and undercorrected group. One out of 34 overcorrected knees recurred in varus. Five knees were revised by knee arthroplasty or reosteotomy one of which was overcorrected.

Function after tibial osteotomy for medial gonarthrosis below aged 50 years.

Twenty-seven patients (28 knees), with a median age of 42 (27-50) years treated with a high tibial osteotomy for early medial gonarthrosis (Ahlbäck's Stage I) were examined after 11 (7-18) years. Twenty-four were men; 18 knees had had previous meniscus and ligament lesions. At follow-up, 22 knees were satisfactory and 9 patients managed high-activity sports or heavy work. In 25/28 knees, the arthrotic process had not progressed radiographically.

Ankle fractures treated with non-rigid internal fixation.

Two hundred and thirty-seven fractures of the ankle treated with non-rigid internal fixation were reviewed with regard to classification, congruency of joint surface, range of motion and the patients' subjective symptoms. The fractures were divided into either severe fractures consisting of two or more skeletal injuries or simple fractures consisting of only one skeletal injury. Successful operation, i.e. congruency of the joint, was seen in 50 per cent of the severe and in 73 per cent of the simple fractures (significant, P less than 0.001). Disability was significantly more frequent after severe fractures and with incongruent joints. This study shows that the operative technique using non-rigid internal fixation is not sufficient for treating severe fractures, as exact anatomical reconstruction of the joint was not obtained.

High tibial osteotomy: a seven-year clinical and radiographic follow-up.

A series of 107 knees were evaluated for mobility, stability and pain relief two and seven years after high tibial osteotomy for correction of deformity secondary to arthrosis; patients with rheumatoid arthritis were excluded from this series. Eighteen knees had lateral femorotibial arthrosis, or which only six had good results at seven year follow-up. As many as six knees required further surgery. Of the 89 knees with medial arthrosis, 45 had good results, 36 did not and the remaining eight required further surgery. Lasting pain relief was clearly associated with correction of the mechanical axis of the knee which was more difficult to achieve in severe stages of the disease. In 22 of the 24 corrected knees, the disease had not progressed further. Six of these showed radiographic signs of cartilage repair. By contrast, two-thirds of the undercorrected knees had further progress of the disease. The opposite compartment did not suffer from the increased load on the articular cartilage; only three overcorrected knees showed cartilage narrowing, and they were painless. High tibial osteotomy is a reliable method for definitive treatment of early medial type gonarthrosis provided that the radiographically defined mechanical axis is adequately corrected.

Tibial osteotomy in medial gonarthrosis. The importance of over-correction of varus deformity.

In a prospective series of 52 knees selected for high tibial osteotomy because of early medial arthrosis, special care was taken to obtain a final over-correction in valgus. The operative procedure and the pre- and post-operative radiographic examinations were standardized and the follow up was 1-3 years. 49 of the 52 knees had obtained a normal or over-corrected mechanical axis. 45 of these had improved painfree walking distance, and 31 were painfree. In 45 knees the arthrotic condition had not progressed, and in 5 of these there were signs of cartilage restitution. It is concluded that precise correction of medial gonarthrosis can be achieved, and this provides a rational basis for definitive treatment of early stages of this condition: for the majority an endoprosthesis operation should not be needed in the future.

Technical accuracy in high tibial osteotomy for gonarthrosis.

A preoperative roentgenological analysis of the whole leg in the standing position is presented as an aid in high tibial osteotomy for medial osteoarthritis of the knee. This analysis provides information about the mechanical condition of the knee, the extent of the deformity and the exact size of the wedge of bone to be excised during the operation. The initial experience with this method is encouraging. In 66 osteotomies four-fifths had a postoperative correction within +/- 3 degrees of the predicted angle and after 1 year two-thirds were still within this range.

Results of surgical treatment for non-union after high tibial osteotomy in osteoarthritis of the knee.

In a series of 280 high tibial osteotomies performed for osteoarthritis of the knee between 1969 and 1975, there were ten cases of pseudarthrosis, an incidence of 3.6 per cent. These ten knees (and an additional two that were referred to us) were reoperated on. In most cases the pseudarthrosis was resected and stabilized with the Charnley transfixation-compression method. Other procedures involved resection without compression (one knee), compression blade-plate fixation, and arthroplasty with a hinge endoprosthesis. All osteotomies healed eventually with the knee in satisfactory position. In spite of the initial non-union and repeated operation, all twelve patients eventually had satisfactory correction of the preosteotomy deformity, and none had a loss in walking ability. All but two patients had freedom from pain. We concluded that patients with non-union following high tibial osteotomy for osteoarthritis of the knee should undergo resection of the pseudarthrosis and transfixation compression as the treatment of choice. Endoprosthetic replacement then can be used as a salvage procedure if it is needed.

Meniscectomy. A comparison of two series treated as outpatients and inpatients.

A total of 129 patients were operated on for meniscus lesion in the knee joint. Of these, 64 were operated as outpatients and 65 as inpatients. The outpatients reported to the operation department in the morning and left the hospital in the evening of the same day, after the operations. The inpatients were admitted to the hospital the day before the operation and were discharged 1--3 days after the operation. Objective postoperative findings, sick-leave periods and the number of visits to the outpatient clinic show no differences between the groups. The end result in the two groups is the same. This investigation also shows that it is possible to operate on patients with meniscus injury as outpatients without increased discomfort for the individual and without medical risks. Thus expensive nursing resources are released for other groups requiring more nursing care.