Femoral-tibial Angle Research Articles

Medium and long term results of high tibial osteotomy for the treatment of knee joint osteoarthritis

To analyze the medium and long term results of high tibial osteotomy(HTO) for the treatment of knee joint osteoarthritis(OA). From January 2001 to December 2005, 45 patients(63 knees)with medial compartment OA were treated with HTO, including 10 males (15 knees) and 35 females (48 knees), ranging in age from 45 to 64 years old with an average of (55.76±5.54) years old. Preoperative normal anteroposterior and lateral X ray films of weight bearing knee were conducted, with an accurate measurement of the femoral tibial angle(FTA), and the mass of lateral tibial osteotomy was determined according to the preoperative FTA. Routine HTO was performed after epidural anesthesia. Most patients were treated with middle part fibulae osteotomy, and some patients were treated with the release of proximal tibiofibular joints. The functional exercise no weight bearing ambulation and weight bearing exercise began on the second day after operation 2 weeks after operation and 8 to 10 weeks after operation respectively. All the cases should be examined with X ray postoperatively on the second day, 8 to 10 weeks, 6 months, 1 year after operation and once a year. The VAS, HSS and KSS were used to evaluate knee pain, deformity, function, and range of motion preoperatively, 3 to 5 years postoperatively, 10 to 14 years postoperatively in all the patients. Forty three patients (61 knees) were followed up for more than 10 years. All the incisions were healed at the first stage. The bone healing was achieved 8 to 10 weeks after operation. The knee joint was evaluated according to the HSS standard 10 to 14 years after operation, and the average score was 76.24±5.27. Twenty seven patients got an excellent result, 25 good, 7 fair and 2 poor. The VAS, HSS and KSS scores of postoperative 3 to 5 years and 10 to 14 years were better than those of before operation. There were no obvious differences of scores between postoperative 3 to 5 years and postoperative 10 to 14 years. The long term curative effect of high tibial osteotomy in the treatment of knee OA(medial compartment arthritis) is satisfied, if the indications for surgical treatment are appropriate, and postoperative active exercises are performed.

CLINICAL OBSERVATION OF ROTATING-PLATFORM PROSTHESIS FOR VALGUS KNEE DEFORMITY

To investigate the effectiveness of rotating-platform prosthesis for valgus knee deformity in total knee arthroplasty (TKA). A retrospective analysis was made on the clinical date of 25 cases (28 knees) of valgus deformity undergoing primary TKA by using Gemini MK II rotating-platform prosthesis. There were 6 males (7 knees) and 19 females (21 knees), aged from 47 to 82 years, with an average age of 64.8 years. The unilateral knee was involved in 22 cases and the bilateral knees in 3 cases. The causes included osteoarthritis in 20 cases (22 knees), rheumatoid arthritis in 4 cases (5 knees), and traumatic arthritis in 1 case (1 knee). The disease duration was 2-22 years (mean, 10.4 years). The main clinical symptoms were arthralgia combined with limited movement. According to the Keblish grade, there were 13 knees of mild deformity, 11 knees of moderate deformity, and 4 knees of severe deformity. All incisions healed by first intension. No complications of infection, cutaneous necrosis, deep venous thrombosis, and pulmonary embolism occurred. The postoperative follow-up duration was 12-60 months (mean, 25.4 months). Medial instability and palsies of nervus peroneus communis occurred in 1 and 2 cases respectively, and all were cured after symptomatic treatment. No patellar and polysthylene insert dislocation, prosthetic loosening or infection was observed. The Hospital for Special Surgery (HSS) score, femoral tibial angle, maximun flexion and extension angles, knee range of motion, and patellar score were significantly improved at last follow-up when compared with preoperative ones (P<0.01). The rotating-platform prosthesis for valgus deformity can obtain satisfactory effectiveness, but it requires precise soft tissue balancing technology, and the long-term effectiveness remains further observation.

Do CAS measurements correlate with EOS 3D alignment measurements in primary TKA?

PurposeObjective of this study was to compare intraoperative computer-assisted surgery (CAS) alignment measurements during total knee arthroplasty (TKA) with pre- and postoperative coronal alignment measurements using EOS 3D reconstructions.MethodsIn a prospective study, 56 TKAs using imageless CAS were performed and coronal alignment measurements were recorded twice: before bone cuts were made and after implantation of the prosthesis. Pre- and postoperative coronal alignment measurements were performed using EOS 3D reconstructions. Thanks to the EOS radiostereography system, measurement errors due to malpositioning and deformity during acquisition are eliminated. CAS measurements were compared with EOS 3D reconstructions. Varus/valgus angle (VV), mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were measured.ResultsSignificantly different VV angles were measured pre- and postoperatively with CAS compared to EOS. For preoperative measurements, mLDFA did not differ significantly, but a significantly larger mMPTA in valgus was measured with CAS.ConclusionResults of this study indicate that differences in alignment measurements between CAS measurements and pre- and postoperative EOS 3D are due mainly to the difference between weight-bearing and non-weight-bearing position and potential errors in validity and reliability of the CAS system. EOS 3D measurements overestimate VV angle in lower limbs with substantial mechanical axis deviation. For lower limbs with minor mechanical axis deviation as well as for mMPTA measurements, CAS measures more valgus than EOS. Eventually the results of this study are of clinical relevance, since it raises concerns regarding the validity and reliability of CAS systems in TKA.Level of evidenceIIb.

Posterior Cruciate Ligament Retention versus Posterior Stabilization for Total Knee Arthroplasty: A Meta-Analysis.

IntroductionAlthough being debated for many years, the superiority of posterior cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior-stabilized (PS) TKA remains controversial. We compare the knee scores, post-operative knee range of motion (ROM), radiological outcomes about knee kinematic and complications between CR TKA and PS TKA.MethodsLiterature published up to August 2015 was searched in PubMed, Embase and Cochrane databases, and meta-analysis was performed using the software, Review Manager version 5.3.ResultsTotally 14 random control trials (RCTs) on this topic were included for the analysis, which showed that PS and CR TKA had no significant difference in Knee Society knee Score (KSS), pain score (KSPS), Hospital for Special Surgery score (HSS), kinematic characteristics including postoperative component alignment, tibial posterior slope and joint line, and complication rate. However, PS TKA is superior to CR TKA regarding post-operative knee range of motion (ROM) [Random Effect model (RE), Mean Difference (MD) = -7.07, 95% Confidential Interval (CI) -10.50 to -3.65, p<0.0001], improvement of ROM (Fixed Effect model (FE), MD = -5.66, 95% CI -10.79 to -0.53, p = 0.03) and femoral-tibial angle [FE, MD = 0.85, 95% CI 0.46 to 1.25, p<0.0001].ConclusionsThere are no clinically relevant differences between CR and PS TKA in terms of clinical, functional, radiological outcome, and complications, while PS TKA is superior to CR TKA in respects of ROM, while whether this superiority matters or not in clinical practice still needs further investigation and longer follow-up.

Postoperative Mechanical Axis Alignment and Components Position after Conventional and Patient-Specific Total Knee Arthroplasty

Introduction: Accurate postoperative alignment and implant positioning are determinant factors for successful total knee arthroplasty (TKA). Patient-specific template (PST) is a technique that uses computer technology for the planning, deigning and production of cutting guides. This study aims to compare PST to conventional technique in terms of mechanical axis alignment and component positioning. Patients and method: 109 TKA were performed for 78 patients in 2 groups. Group A included 69 conventional TKA in 55 patients and Group B included 40 patient-specific TKA in 23 patient. Postoperative long-film X-rays were done for all patients to observe the mechanical axis, anatomical axis, lateral distal femoral mechanical angle and medial proximal tibial angle. Results: No statistically significant difference was found between the two groups regarding alignment or component positioning. Conclusion: Both techniques have shown similar results in restoring the mechanical axis and alignment after TKA. However, PST had the advantages of reduced blood loss and shorter operative time.

Comparison of Alignment Correction Angles Between Fixed-Bearing and Mobile-Bearing UKA

Good outcomes have been reported with both fixed-bearing and mobile-bearing unicompartmental knee arthroplasty (UKA). However, overcorrected alignment could induce the progression of arthritis on the non-arthroplasty side. Changes of limb alignment after UKA with both types of bearings (fixed bearing: 24 knees, mobile bearing: 28 knees) were investigated. The mean difference between the preoperative standing femoral-tibial angle (FTA) and postoperative standing FTA was significantly larger in mobile bearing UKA group. In fixed-bearing UKA, there must be some laxity in MCL tension so that a 2-mm tension gauge can be inserted. In mobile-bearing UKA, appropriate MCL tension is needed to prevent bearing dislocation. This difference in MCL tension may have caused the difference in the correction angle between the groups.

Method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing.

To discuss the method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing. Clinical data of 80 patients from October 2013 to December 2014 was selected with a retrospective method. All patients have undergone total knee arthroplasty. Then the X-rays plain film in weight loading was measured before and after operation and osteotomy was performed accurately according to the knee joint scores and the conditions of lower limb alignments. The average angle of tibial plateau osteotomy of postoperative patients was 4.3°, and the corrective angle of soft tissue balancing was 10.7°; the postoperative patients’ indicies including range of joint motion, knee joint HSS score, angle between articular surfaces, tibial angle, femoral-tibial angle and flexion contracture were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant; the postoperative patients’ flexion contracture and range of joint motion were distinctly better than the preoperative indicies (p<0.05) and the differences were statistically significant. The effective release of the soft tissue of the posterior joint capsule under direct vision can avoid excess osteotomy and get satisfactory knee replacement space without influencing the patients’ joint recovery.

Stifle arthrodesis using a locking plate system in six dogs.

To describe the use of the Fixin locking plate system for stifle arthrodesis in dogs and to retrospectively report the clinical and radiographic outcomes in six cases. Medical records of dogs that had arthrodesis with the Fixin locking plate system were reviewed. For each patient, data pertaining to signalment and implant used were recorded. Plate series and thickness, number of screws placed, number of cortices engaged, and screw diameters were also recorded. The outcome was determined from clinical and radiographic follow-ups. Radiographic outcomes assessed included the measurement of the postoperative femoral-tibial angle in the sagittal plane. Six dogs met the inclusion criteria for the study. Mean body weight was 13 kg (range: 3 - 34 kg). Radiographic follow-up (mean: 32 weeks, range: 3 - 52 weeks) was available for all dogs. In one case, an intra-operative complication occurred. In another case, a tibial fracture occurred 20 days after surgery. All arthrodeses healed and no implant complication was detected although all cases had mechanical lameness. Stifle arthrodesis can be performed successfully using a Fixin locking plate system.

TEMPORARILY BLOCKING OF BONE GROWTH AREAS FOR THE CORRECTION OF ANGULAR EPIMETAPHYSEAL DEFORMITIES OF THE KNEE JOINT IN CHILDREN

Objective: To present outcomes of applying of a method of tempo­rary blocking of long bones’ sprout area for treatment of frontal angular knee joint deformities (FAKJD) in children. Methods: From 2010 to 2014 at the clinic of the Institute we treated 14 patients (9 boys, 5 girls) with FAKJD (mean age 11 years 2 months). In 8 patients (57.1 %) we revealed varus, and in 6 (42.85 %) valgus deformity. Among children with varus FAKJD in 7 of them we diagnosed Erlacher-Blount disease, and in 1 we found postosteomyelitic deformation. In patients with valgus FAKJD in 5 cases we revealed dysplastic deformities, and in 1 — postosteomyelitic deformation. We performed clinical examination with measurement of tibial-femoral angle (TFA) and X-ray protocol proposed by D. Paley. The average value of clinical TFA in patients with varus FAKJD was 15° (10° to 24°), and with valgus — 13,25° (11° to 18°). In all patients we performed temporary blocking of long bones’ sprout area using the plate with two screws. Control examinations were performed every 3 months. We defined clinical TFA, radiological assessment of deformation conducted according to D. Paley. After reaching full correction of deformity we removed plates. Results: Full correction of FAKJD in 13 patients there was in a period of 7 to 16 months. In one child with varus FAKJD (age 10 years) correction for 14 months could not be reached because of the lack of growth of the patient. The average speed of correction of deformation was 0,9° per month. Complications during treatment were not recorded. Conclusions: Minimally invasive method presented is effective in treating FAKJD in children with Erlacher-Blount disease, and with deformities of dysplastic and postosteomyelitic etiology.

Good survivorship of all-polyethylene tibial component UKA at long-term follow-up.

To determine the long-term survival rate of an all-polyethylene tibial unicompartmental knee arthroplasty (UKA) in a large series of consecutive patients and to investigate the possible factors that could influence the outcome. A retrospective evaluation of 273 patients at 6-13 years of follow-up was performed. Clinical evaluation was based on KSS and WOMAC scores. Subjective evaluation was based on a visual analogue scale for pain self-assessment. Radiographic evaluation was performed to assess femoral-tibial angle (FTA), posterior tibial slope (PTS) and tibial plateau angle (TPA). A Kaplan-Meier survival analysis was performed assuming revision for any reason as primary endpoint. The 10-year implant survivorship was 87.6%. Twenty-five revisions (9.2%) were performed, and aseptic loosening of the tibial component was the most common failure mode (11 cases, 4%). The comparison of survival rate according to age at surgery did not show significant difference. Age at surgery, FTA, TPA and PTS were not related to higher risk of revision. No correlations were found between BMI, age at surgery and clinical scores. Finally, no statistical differences of radiographic measurements were found between revisions and non-revisions. The present study has demonstrated on a large series of patients that UKA with an all-polyethylene tibial component, with an accurate technique and a proper patient selection, can provide a satisfactory clinical and functional outcome and a good overall survivorship of the implant at long-term follow-up. These advantages could be achieved at a lower cost. Retrospective Therapeutic Study, Level IV.

A new method to measure anatomic knee alignment for large studies of OA: data from the Osteoarthritis Initiative

To develop and validate a new and improved software method to rapidly determine femur-tibia angle (FTA). Three readers, two skilled and one unskilled, without any formal medical training, measured FTA in 142 subjects from the Osteoarthritis Initiative (OAI). The reader reliability was assessed using the intra-class correlation coefficient (ICC), root mean square standard deviation (RMSSD), and Bland-Altman plots, comparing the existing and new FTA methods. Gender-specific linear regression assessed the relationship of FTA with the hip-knee-ankle angle (HKA). The ICC (RMSSD) for intra- and inter-reader reproducibility of the existing FTA method was 0.96 (0.77°) and 0.92 (1.38°), respectively, and for the new technique was 0.98 (0.25°) and 0.98 (0.37°), with similar results for all three readers. Bland-Altman 95% limits of agreement were greater than ±2° for the existing, and ±1° for the new method. The r-value for the relation of FTA to HKA was 0.68 and 0.72 for the existing and new methods, respectively. Varus (HKA ≤ -2°)/neutral (-2° < HKA < 2°)/valgus (HKA ≥ 2°) alignment based on predicted HKA agreed moderately with measured HKA (weighted kappa = 0.53), and had moderate sensitivity (73%) and specificity (84%) for varus malalignment. The new FTA was related to HKA using a linear equation with a slope of 0.98 and an offset of 4.0°. Since it is largely automated and uses unambiguous anatomical landmarks, the new method is highly reproducible and can be made on a standard posteroanterior (PA) knee radiograph by a relatively unskilled reader.

Differences between opening versus closing high tibial osteotomy on clinical outcomes and gait analysis

BackgroundHigh tibial osteotomy (HTO) for medial knee osteoarthritis (OA) is mainly performed via two procedures: closing wedge HTO (CW) and opening wedge HTO (OW). In this study, differences between these procedures were assessed by serial clinical evaluation and gait analysis before and after surgery. MethodsTwenty-one patients underwent HTO for medial knee OA in 2011 and 2012, with 12 patients undergoing CW and nine undergoing OW. The severity of OA was classified according to the Kellgren–Lawrence classification. The Japanese Orthopedic Association score for assessment of knee OA (JOA score), the Numeric Rating Scale (NRS), and the femoral tibial angle (FTA) on X-ray were evaluated. For gait analysis, gait speed, varus moment, varus angle and lateral thrust were calculated. ResultsThe JOA score and NRS were improved significantly oneyear postoperatively in both groups. The FTA was maintained in both groups at oneyear. Varus angle and varus moment were significantly improved in both groups at each postoperative follow-up, when compared preoperatively. Lateral thrust was significantly improved at threemonths postoperatively in both groups. However, the significant improvement in lateral thrust had disappeared in the CW group sixmonths postoperatively, whereas it was maintained for at least oneyear in the OW group. ConclusionsThis study found that clinical outcomes were well maintained after HTO. OW reduced knee varus moment and lateral thrust, whereas CW had little effect on reducing lateral thrust. Level of evidenceLevel IV

Physical exercise attenuates inflammation via suppression of systemic macrophage activation

Physical exercise attenuates inflammation via suppression of systemic macrophage activation

Short-term follow-up of bilateral total knee arthroplasty following previous high tibial osteotomy in both knees

BackgroundClosing wedge high tibial osteotomy (HTO) as a treatment for medial compartment osteoarthritis has a long history. As a result of improvements in operative methods and in the quality of the implants used for total knee arthroplasty (TKA), the use of HTO has decreased considerably in recent years. The clinical results of HTO deteriorate with time despite the initial satisfactory results. The aim of this study was to assess the clinical and radiological results as well as patient satisfaction following knee arthroplasties for failed HTO and to identify the various variables affecting the results.Patients and methodsTwenty-eight bilateral TKAs were performed in patients who had previously undergone a closed wedge HTO. Different radiological assessments were performed and the American Knee Society Scores were recorded preoperatively and at the latest follow-up. Moreover, patients were asked whether they were satisfied with their operation. The average follow-up was 2.5 years and the average age of the patients was 60.5 years.ResultsThe average femoral-tibial angle was corrected from varus 6.5° to valgus 5.75°. The mean improvement in the postoperative arc of flexion was 25°. Preoperatively, the average American Knee Society Score was 45 points and at the final follow-up, it was 82; the improvement was significant.ConclusionIn conclusion, TKA after HTO improves knee function, but it is a technically demanding operation with altered anatomy and significant balancing problems, and a meticulous surgical technique may lead to satisfactory results in such cases.

Arthroscopic cartilage regeneration facilitating procedure for osteoarthritic knee

BackgroundThe effectiveness of arthroscopic treatment for osteoarthritic knee is a controversy. This study presents the technique of a novel concept of arthroscopic procedure and investigates its clinical outcome.MethodAn arthroscopic procedure targeted on elimination of focal abrasion phenomenon and regaining soft tissue balance around patello-femoral joint was applied to treat osteoarthritis knees. Five hundred and seventy-one knees of 367 patients with osteoarthritis received this procedure. There were 70 (19%) male and 297 (81%) female and the mean age was 60 years (SD 10). The Knee Society score (KSS) and the knee injury and osteoarthritis outcome score (KOOS) were used for subjective outcome study. The roentgenographic changes of femoral-tibial angle and joint space width were evaluated for objective outcomes. The mean follow-up period was 38 months (SD 3).ResultsThere were 505 knees in 326 patients available with more than 3 years follow-up and the mean follow-up period was 38 months (SD 3). The subjective satisfactory rate for the whole series was 85.5%. For 134 knees with comprehensive follow-up evaluation, the KSS and all subscales of the KOOS improved statistically. The femoral-tibial angle improved from 1.57 degrees (SD 3.92) to 1.93 degrees (SD 4.12) (mean difference: 0.35, SD 0.17). The joint space width increased from 2.02 millimeters (SD 1.24) to 2.17 millimeters (SD 1.17) (mean difference: 0.13, SD 0.05). The degeneration process of the medial compartment was found being reversed in 82.1% of these knees by radiographic evaluation.ConclusionsBased on these observations arthroscopic cartilage regeneration facilitating procedure is an effective treatment for osteoarthritis of the knee joint and can be expected to satisfy the majority of patients and reverse the degenerative process of their knees.

Outcome analysis of surgical treatment of Blount disease in Nigeria

The objective was to evaluate the results of surgery of Blount diseases using the postoperative metaphyseal-diaphyseal angle (MDA) at 2-year follow-up. The goal of surgery in Blount disease is to restore the normal configuration of the articular surface of the proximal end of the tibia in proper relationship to the mechanical axis of the limb. Our hypothesis is that patients will demonstrate significant clinical improvements following surgery and predictive models can be developed. All patients who had surgery for Blount disease from January 2002 till December 2007 at the National Orthopaedic Hospital Lagos Nigeria and follow-up for 2 years were included. Data extracted were gender, affected limb, Blount's type, age when deformity was noted, and age at presentation, preoperative femoral tibial angle (TFA), Langenskiold score, preoperative MDA, and postoperative MDA. Linear regression was used to assess the predictive effect of selected clinical and radiographic measures on post-MDA. The model was adjusted for confounders: age deformity noted, age at presentation, affected limb, Blount's type, and gender. Variables in the adjusted model achieving significance at P < 0.05 were included in a multiple regression analysis. Eighty-six knees in 57 patients were included. The mean preoperative and postoperative MDA at 2 years was 34.6° ± 8.9° and 10.6° ± 4.3°, respectively. Seventy-three knees (84.9%) have correction of ≤10° with recurrence in 13 (15.1%) knees at 2 years (P < 0.001). The postoperative MDA was graded into good outcome if ≤10°. There was a significant improvement between preoperative MDA and postoperative MDA (P < 0.001). The multilinear analysis demonstrated that the preoperative MDA was a significant predictor of the postoperative MDA. The postoperative MDA was predicted with a standard error of 0.92 with the following formula: post-MDA = 1.027 + 0.404 pre-MDA. The mean postoperative MDA of 84.9% of the knees operated at 2 years was 9.4° ± 3.1° with recurrence rate of 15.1%. Postoperative MDA is a good outcome measure for surgical treatment of Blount disease and surgical correction should aim at producing post MDA ≤10°.

Polyethylene thickness is a risk factor for wear necessitating insert exchange

PurposeThe aim of this observational study was to investigate the optimal minimal polyethylene (PE) thickness in total knee arthroplasty (TKA) and identify other risk factors associated with revision of the insert due to wear.MethodsA total of 84 TKA were followed for 11–16 years. All patients received the same prosthesis design (Interax; Howmedica/ Stryker) with halfbearings: separate PE-inserts medially and laterally. Statistical analysis comprised Cox-regression to correct for confounding.ResultsEight knees (9.5%) had been revised due to thinning inserts and an additional patient is scheduled for revision. PE thickness, diagnosis, BMI and weight are risk factors for insert exchange. For each millimetre decrease in PE thickness, the risk of insert exchange increases 3.0 times, which remains after correction for age, gender, weight, diagnosis and femoral-tibial angle. Insert exchange was 4.73 times more likely in OA-patients compared to RA-patients. For every unit increase in BMI and weight the risk for insert exchange increases 1.40 times and 1.14 times, respectively.ConclusionsIn conclusion we therefore advise against the use of thin PE inserts in modular TKA and recommend PE inserts with a minimal 8-mm thickness.

Distal Femoral Varus Osteotomy: Unloading the Lateral Compartment: Long-term Follow-up of 45 Medial Closing Wedge Osteotomies

Distal femoral medial closing wedge osteotomy is useful for mechanical axis realignment to unload the lateral compartment of the valgus knee. The primary indication for unloading the lateral compartment is lateral unicompartmental osteoarthritis. Alternative treatment options include lateral unicompartment or total knee arthroplasty (TKA). Prerequisites for the osteotomy include a 90° arc of motion, age younger than 60 years, and an active patient capable of an extensive period of rehabilitation. Surgery is carried out through a midline skin incision and uses a subvastus approach. The medial femoral closing wedge osteotomy is fixed with a 90° dynamic compression blade plate. A critical technical point is the need to insert the blade plate parallel to the joint line. The right angle plate corrects the tibialfemoral angle to 0°. A benefit of the closing wedge over an opening wedge osteotomy is reduced risk of nonunion. Survivorship and functional outcome of 41 patients with 45 distal femoral varus osteotomies at a mean follow-up of 13.3 years were retrospectively analyzed. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5% respectively. Mean Modified Knee Society Score was 36.1 preoperatively, 74.4 at 1-year postoperatively, and 60.5 at last follow-up. Distal femoral varus osteotomy is effective at unloading the lateral compartment in unicompartmental arthritis in the valgus knee. It may be indicated in the young, high activity demand, and overweight patient. By 20 years after the osteotomy most patients require conversion to TKA.

A meta-analysis into the effect of lateral-wedged insoles with subtalar strapping versus traditional insoles in adults with medial knee osteoarthritis.

To systematically identify, collate, and analyze the current available evidence for the effectiveness of lateral-wedged insoles, with subtalar strapping, on reducing pain, improving function and improving the femoral-tibial angle (FTA), in adults with medial knee osteoarthritis compared to traditional insoles without subtalar strapping.Six computerised databases, namely Cochrane Library, CiNAHL, PEDro, BIOMED central, PubMed and ScienceDirect were searched. The included articles were then all rated using the PEDro scale to determine their meth-odological quality. Homogeneous data were pooled in a meta-analysis using Review Manager (REVMAN) software. Where statistical pooling of the results was not possible, findings were summarised in narrative form. Three randomised controlled trials were selected for this review. The average PEDro score was 5.7. A meta-analysis demonstrated that lateral-wedged insoles with subtalar strapping significantly reduced pain in the short-term (p=0.004). The review found that lateral-wedge insoles with subtalar strapping significantly decreased pain in the short-term and seemed to have a positive effect on the FTA in the long-term, when compared to traditional insoles without subtalar strapping. The lateral-wedge insole with subtalar strapping may provide a financially feasible adjunctive self-management treatment for knee OA and should be considered before invasive procedures such as surgery.

Bioactive Glass S53P4 and Autograft Bone in Treatment of Depressed Tibial Plateau Fractures - A Prospective Randomized 11-year Follow-Up

The clinical and radiological outcomes of bioactive glass (BAG)-S53P4 and autograft bone (AB) used as bone-graft substitutes in depressed tibial plateau fractures were evaluated in a prospective randomized 11-year follow-up study. All patients (n = 29) had sustained tibial plateau fractures with a joint-line depression of >3 mm. Fifteen patients (5 patients the BAG group, 10 patients in the AB group) participated in this long-term follow-up. X-rays were taken preoperatively, postoperatively, and at the long-term follow-up, and computed tomography (CT) scans were made at the long-term follow-up for evaluation of the bone substitute, osteoarthritis, the tibial-femoral angle, and deviation of mechanical axes. No material-dependent adverse effects were seen in any patient. The means of the articular surface depression on X-rays at the long-term follow-up were 1.4 mm (range: 0-2 mm) in the BAG group and 1.4 mm (range: 0-4 mm) in the AB group, and on CT scans the means were 2.2 mm (range: 2-3 mm), and 2.1 mm (range: 0-3), respectively. No significant difference in the tibial-femoral angle or deviation of mechanical axes was observed between the two groups. BAG-S53P4 can be used as a bone substitute in depressed lateral tibial plateau fractures with good functional and radiological long-term results.