Medial Aspect Of Tibia Research Articles

Clinical and instrumental characteristics of osteoarthritis in hyperuricemia

Objective: to investigate in a multicentre single-stage study the relationships between hyperuricemia (HU) and clinical, instrumental and laboratory parameters of osteoarthritis (OA).Material and methods. The study included 200 patients aged 40 to 75 years with a definite diagnosis of knee (KN) OA that met ACR criteria, with stage I–III OA by Kellgren–Lawrence. The mean age of the patients was 55.9±10.3 years and the body mass index (BMI) was 29.4±6.2 kg/m2. An individual chart was completed for each patient, including anthropometric parameters, medical history and clinical examination data, visual analogue scale (VAS) assessment of KN pain, WOMAC, patient's general health assessment (GHA) and information on comorbidities. All patients underwent standard radiography and magnetic resonance imaging (MRI) of the KN (WORMS), dual-energy X-ray absorptiometry of the lumbar spine and femoral neck, and laboratory examination.Results and discussion. HU was diagnosed in 57 (28.5) patients when the serum uric acid (UA) level was above 360 μmol/L. Patients were divided into two groups according to the presence or absence of HU. The age of the patients in the two groups was comparable, but they differed significantly in terms of disease duration, BMI, waist and hip circumference, which were greater in the HU group (p <0.05). Statistically significant differences were also found in the assessment of the severity of OA course: there were higher pain indices according to VAS, WOMAC total score and its components (pain and functional impairment, FI), GHA in the HU group. On MRI, osteitis was more common in the medial aspect of the tibia (odds ratio 5.75; 95% confidence interval 1.29–25.6; p=0.03). Patients with HU had higher concentrations of CRP, COMP, leptin, insulin, triglycerides and creatinine (p <0.05 for all values).Spearman correlation analysis confirmed the association between HU and duration and radiological stage of OA, the presence of osteitis in the medial aspect of tibia detected by MRI, pain according to VAS and WOMAC, FI according to WOMAC and GHA (p<0.05).Conclusion. At high UA levels, pain values according to VAS and WOMAC are higher, GHA is worse, and CRP and COMP levels are elevated. MRI shows more frequent osteitis in the medial aspect of the tibia in patients with HU. Deciphering the mechanisms that determine the relationship between HU and OA is important for the development of new methods for the prevention and treatment of these diseases.

Knee reserved operation for knee osteoarthritis: proximal fibular osteotomy and high tibial osteotomy using absorbable balance spacer

Purpose: A new combination of knee reserved operation, proximal fibular osteotomy with high tibial osteotomy (HTO) using an absorbable balance spacer implantation is proposed to treat medial compartment OA with serious varus deformities. Methods: Under epidural anesthesia, the patients were placed in the supine position with the lower limb tourniquet inflated. A 4 cm long lateral incision was made at the proximal third of the fibula. After exposing the fibula, a 2 cm long section of fibula was removed with oscillating saw. The fibula ends were sealed with bone wax. After the fibular osteotomy, a medial longitudinal incision then was made and the periosteum was striped. Retract the pesanserinu to expose the front and medial aspect of tibia. A guidewire was inserted beginning at the anteromedial tibia at the level of the superior border of the tibial tubercle, approximately 4-5 cm distal to the joint line. The guidewire direction was towards the tip of the fibular head. Partial osteotomy was performed with osteotomes. We originally designed a wedge-shape absorbable spacer with barbs on both surfaces aiming to prevent the spacer from escaping. The spacer was made of 70% PLGA (85/15) and 30% β-TCP. The spacer was then inserted into the osteotomy in order to achieve the planned degree of correction. The muscles, fascia and skin were sutured separately. Results: From Jul 2016 to Sep 2016, a total of 8 patients with an average of 61.8 years (range, 49 to 76) were enrolled into this study, including 7 females and 1 male. All patients were diagnosed with medial compartment KOA, all being grade 4 according to Kellgren-Lawrence Grading Scale. Anteroposterior and lateral weight-bearing radiographs were taken and the femorotibial angle (FTA) was measured. The Hospital for Special Surgery knee score (HSS) and the visual analog scale (VAS) score of the knee joint were evaluated preoperatively, 7thday postoperatively and at subsequent follow-ups. The FTA was 163.1° ± 1.7° measured on the preoperative anteoroposterior radiograph. The operations were performed uneventfully without intraoperative complications. The operative time was 81.3 ± 12.7 minutes. At 7th day postoperative follow-up, mean FTA was 175.5° ± 1.5°, which was significantly smaller than those measured preoperatively (P < 0.05). Mean VAS score and interquartile range were 1.5 and 1.0, significantly lower than the preoperative data (6.5 and 1.5, respectively; P < 0.001). The similar results were acquired in the 1-mouth postoperative follow-up for 3 patients and 2-mouth postoperative follow-up for 5 patients. Conclusions: The knee reserved operation, proximal fibular osteotomy and HTO using the originally designed wedge-shape absorbable spacer, was a minimally invasive, safe, simple, and effective procedure for the management of medial compartment OA of the knee joint.