Medial Compartment Osteoarthritis Research Articles

Early Results of a Randomized Controlled Trial of Partial Versus Total Knee Arthroplasty.

Debate still exists regarding the benefits of unicompartmental (UKA) versus total knee arthroplasty (TKA) for the treatment of medial compartment osteoarthritis. The purpose of this randomized trial is to compare the early outcomes of UKA versus TKA. One-hundred and seven candidates for UKA were randomized at two centers; 57 candidates received UKA and 50 received TKA. Six-week and 6-month outcome measures including Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR), Knee Society Score (KSS), Forgotten Joint Score (FJS), and VR-12 global health scores were obtained. No demographic or baseline patient reported outcome (PRO) differences were present suggesting successful randomization (P > .05). UKA demonstrated shorter operative times (UKA= 65minutes, TKA= 74minutes; P < .001) and length of stay (UKA= 0.7 nights, TKA= 1.2 nights; P < .01). At 6 weeks, there were no differences in KOOS, JR (P= .755), KSS (P= .754), FJS (P= .664), or PRO change from preoperative scores (P= .468). There were three surgical complications within 90 days in each group. The duration of opioid consumption (UKA= 33.8 days, TKA= 28.5 days; P= .290) and return to work (UKA= 57.1 days, TKA= 47.3 days; P= .346) did not differ between groups. Data suggest no clinically significant differences between UKA and TKA in the early postoperative period in regards to patient-reported outcome measures, duration of opioid use, or return to work. Patients undergoing UKA can anticipate a shorter length of stay and greater early range of motion. All-cause short-term complications may be more prevalent with TKA.

Functional Outcome and Pain Relief After Pulsed Radiofrequency of Saphenous Nerve in Medial Compartment Knee Osteoarthritis: A Randomised Double-Blind Trial

Background and aims: Pulsed radiofrequency (PRF) of saphenous nerve (SN) has shown effective pain relief in knee pain due to knee osteoarthritis (KOA). Since adductor canal (AC) contains other sensory nerves innervating the medial part of knee joint apart from SN. We compared the PRF of SN within and outside the AC for their quality and duration of pain relief in knee osteoarthritis of medial compartment (KOA-MC). Methods: We conducted a randomised prospective study in 60 patients with anteromedial knee pain due to KOA-MC. Patients in group A received PRF-SN and those in group B, PRF-AC. Primary objectives were, comparison of pain by visual analogue scale (VAS) score and changes in quality of daily living by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and OXFORD knee scores (OKS). Secondary objectives were, comparison of analgesic requirements using Medicine Quantification Scale (MQS) scale and block related complications. Intra group comparison was done by Analysis of variance (ANOVA). Inter group normally distributed data was assessed by student's t-test, non-normally distributed and ordinal data by Mann-Whitney U-test and categorical data by Chi-square test. A p value of &lt; 0.05 was considered significant. Results: VAS scores were significantly lower in Gr-B at 12 weeks. The WOMAC scores and OXFORD scores at 4, 8, 12 and 24 weeks were significantly lower in Gr-B compared to Gr-A. Conclusion: The PRF-AC provides better pain relief and functional outcome than PRF-SN however, duration of pain relief was not significantly different.

High Tibial Osteotomy Using the ‘Tomofix™’ Plating System: Short Term Outcomes in Young Adults

Proximal tibial valgus osteotomy is one of the treatment options for painful medial compartment osteoarthritis and varus deformity of the knee. The aim of our study was to determine and quantify how much osteotomy altered symptoms from medial compartment gonoarthrosis. In addition we aimed to establish whether the Tomofix plating system would permit early weight bearing and achieve union without the use of bone grafts. We prospectively analysed our experience with medial opening wedge high tibial osteotomy using the Tomofix plate.&#x0D; Thirty-five knees were included in the study. The mean age was 47 years (36-59 years). Mean duration of follow-up was 23 months (7-48 Months). All patients underwent medial opening wedge high tibial osteotomy using the Tomofix plating system. Data was recorded using the Oxford Knee score, the Knee Injury Osteoarthritis Outcome score and through review of pre and postoperative x-rays. Good outcomes were seen with statistically significant improvement of both scores.&#x0D; There were two delayed unions, the remainder united without requirement for graft. There was improvement, in Oxford and Knee injury osteoarthritis scores. Correction of mal-alignment was seen in all cases. Early weight bearing was found to be permissible without risk of adverse event.&#x0D; The Tomofix plate provided immediate stability and satisfactory healing of the osteotomy site without the need for bone graft. Good functional results were seen.

Patellofemoral cartilage defects are acceptable in patients undergoing high tibial osteotomy for medial osteoarthritis of the knee

BackgroundPatients suffering cartilage defects of the medial compartment with underlying varus deformity do benefit from high tibial osteotomy (HTO) even in the long term. Nonetheless, kinematic and geometric changes especially in the patellofemoral joint have been described.Purpose of the present study was to evaluate the influence of patellofemoral cartilage defects detected during the diagnostic arthroscopy and their influence on HTO’s postoperative outcome.MethodsNinety patients with a mean follow-up of 10.08 ± 2.33 years after surgery were included. Patients were divided into four groups according to their cartilage status in the patellofemoral joint (A = no defects, B = isolated lesions of the patella, C = isolated lesions of the trochlea, D = kissing lesions). Functional outcome was evaluated before surgery and about ten years thereafter by relying on the IKDC, Lysholm, and KOOS scores. Radiological parameters were assessed pre- and six weeks postoperatively.ResultsIn groups A to D, the HTO led to significant patellar distalisation in the sagittal view, with the mean indices remaining at or above the limit to a patella baja. All patients in all groups profited significantly from HTO (higher Lysholm score, lower VAS p < 0.001), patients in group D had the lowest outcome scores. Patella height negatively influenced outcome scores in group C (Blackburne-Peel-Index—VAS p = 0.033) and D (Caton-Deschamps-Index—Tegner p = 0.018), a larger valgus correction was associated with lower outcome scores in group D (Lysholm p = 0.044, KOOSpain 0.028, KOOSQOL p = 0.004).ConclusionLong-term results of HTO for varus medial compartment osteoarthritis remain good to excellent even in the presence of patellofemoral defects. Overcorrection should be avoided. Distal biplanar HTO should be considered for patients presenting trochlear or kissing lesions of the patellofemoral joint.Trial registrationDRKS00015733 in the German Registry of Clinical Studies.

Excellent outcomes with combined single stage Physica ZUK medial unicompartment knee replacement and anterior cruciate ligament reconstruction results in young, active patients with instability and osteoarthritis with a mean follow up of 5 years

Background (including the aim of the study)Young and more active patients with medial compartment osteoarthritis (OA) in conjunction with anterior cruciate ligament (ACL) deficiency are difficult to treat. The aim of this study was to explore the outcomes of combined fixed bearing Physica ZUK medial unicompartmental knee replacement (UKR) (Lima Corporate, Udine Italy) with ACL reconstruction for patients presenting with isolated medial compartment OA and symptomatic ACL deficiency. MethodsPatients who underwent simultaneous single stage ACL reconstruction and medial UKR between 2012 and 2020 by a single surgeon (GG) were included. Preoperative outcome measures including Lysholm, Tegner, Oxford Knee Score and VAS pain score were evaluated and were repeated postoperatively at the most recent follow up appointment. ResultsTwenty four patients underwent simultaneous combined ACL and ZUK Medial UKR with a mean follow up of 5.1 years. Significant improvements in Lysholm (p < 0.001), Tegner (p < 0.001), Oxford Knee Score (p < 0.001) and VAS pain scores (p < 0.001) were seen with this combined approach with all patients returning to sport. Two patients had a minor peri-operative complication, which was treated conservatively. There were no revision procedures, and no evidence of implant loosening, however one patient had deceased due to an unrelated illness. ConclusionUKR combined with ACL reconstruction can be an effective treatment option for selected patients suffering from medial unicompartmental knee osteoarthritis and symptomatic ACL deficiency. This allowed active patients to return to sports, addressing both instability and OA pain in a specific patient population.

Proximal Fibular Osteotomy (PFO) for Medial Compartment Osteoarthritis of Knee with Varus Deformity - Preliminary Report

Proximal Fibular Osteotomy (PFO) for Medial Compartment Osteoarthritis of Knee with Varus Deformity - Preliminary Report

Is medial open wedge high tibial osteotomy is good option for unicondylar osteoarthritis of knee? A prospective study

Introduction: A recent World Health Organization report on the worldwide burden of disease suggests that knee Osteoarthritis (OA) alone is likely to become the 4th most important cause of disability in women and the 8th in men. High tibial osteotomy is an accepted surgical technique for the treatment of medial compartment osteoarthritis of the knee in younger patients, It will provide relief of pain and deformity and preserve normal anatomical structure in a selected patient. Aims and Objective: High tibial osteotomy and Unicondylar knee replacement (Or Total knee replacement) are the mainstay of treatment for Medial compartment OA knee. Here we analyzed the functional outcome of the High tibial osteotomy for the medial compartment OA knee. Methodology: Prospective study was conducted for 2 years (2019-2021) among 30 patients who meet our criteria, with a mean age group of 47.33 years (26-58), with mean BMI of 25.22kg/m2 (22-29), the selected patient underwent medial open wedge high tibial osteotomy with plate & screw fixation, with or without bone grafting, on follow up visits patients are evaluated at 6 weeks,3 months,6 months and 1 year clinically, radiologically & complications noted. Based on these data final outcome was assessed with a Knee society score. Results: All patients showed progressive improvement in Range of motions, pain relief, return to normal activities and improved assessment scores.At the end of 1 year mean knee society score improved to 185.67 from 98.83 (P value

Assessment of Medial Open Wedge High Tibial Osteotomy in Management of Medial Compartment Osteoarthritis of The Knee

Assessment of Medial Open Wedge High Tibial Osteotomy in Management of Medial Compartment Osteoarthritis of The Knee

Changes in sagittal and axial plane alignment in medial opening wedge high tibial osteotomy: a prospective observational study.

Deformity correction during high tibial osteotomy is generally based on coronal plane alignment. The aim of this study was to measure changes in sagittal and axial plane alignment following medial opening wedge high tibial osteotomy [mHTO], using pre- and postoperative computed tomography [CT] scans, and correlate them with changes in coronal plane. The secondary objective was to correlate changes in functional outcomes with changes in alignment in each plane. The null hypothesis was that sagittal and axial plane alignment does not change significantly following mHTO. This was a prospective, observational study including 30 patients of isolated medial compartment osteoarthritis of the knee joint, between 30 and 60years of age. Preoperative and postoperative computed tomography scan of bilateral lower limbs from hip to ankle was performed. Varus angle, mechanical axis deviation [MAD] of the lower limb, medial proximal tibial angle [MPTA], tibial torsion and posterior proximal tibial angle [PPTA] were measured. Visual Analogue Scale [VAS 0-10cm scale] was used for assessment of pain. Functional outcomes were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 12 Item Short Form Survey [SF 12] and Tegner Lysholm knee scoring scale. Mean age of patients was 44.59 ± 8.157years. Mean preoperative varus deformity was 11.13 ± 1.5 degrees, which got corrected to a mean valgus alignment of 3.8 ± 0.93 degrees postoperatively. The mechanical axis deviation was 4.32 ± 1.76mm lateral to the knee joint center postoperatively. Preoperatively, all knees had external tibial torsion [27.08 ± 2.18 degrees] which was corrected to a mean external tibial torsion of 19.80 ± 3.72 degree after the surgery [P < 0.001]. The overall decrease in sagittal alignment in the present study was 3.70 ± 3.14 degree, 3.97 ± 3.06 degree, 3.92 ± 2.33 degree, for medial, middle and lateral cuts, respectively. There was a significant correlation between change in varus/valgus angle and change in TT and PPTA. Significant positive correlation was seen between change in coronal alignment and functional outcome scores. This study has shown that mHTO significantly changes torsional and sagittal alignment. This is the first study to establish relation between correction in coronal plane and associated changes in sagittal and torsional alignments.

Knee Salvation Procedure (Arthroscopic Debridement Combined with LP-PRP Intraarticular Injection and Proximal Fibular Osteotomy) vs Proximal Fibular Osteotomy Alone in the Management of Medial Compartment Knee Osteoarthritis: A Comparative Study of 60 Cases

Objective: The study was performed to compare the outcomes of Knee salvation procedure (KSP) and Proximal Fibular Osteotomy (PFO) in medial compartment osteoarthritis (OA) of knee joint. Knee salvation procedure includes Arthroscopic lavage and debridement combined with Leucocyte poor platelet rich plasma [LPPRP] application and Proximal fibular osteotomy. Material and Methods: 60 patients with medial compartment osteoarthritis of knee joint were selected prospectively and randomly allocated into knee salvation procedure (KSP) group( 30 patients, observation group ) and PFO group ( 30 patients, control group ). The follow up period was 1 year and outcomes were compared between the two groups. Results: VAS score improved in patients postoperatively and was settled to lower values by the end of 1 year of follow up (P &lt; 0.005). The mean Knee score rating of patients Pre operatively was 53.1 ± 6 and 75.4 ± 10.16 at the end of 1 year postoperative follow up. The mean function score pre operatively was 46.5 ± 13.84 which improved to 71.50 at the end of 1 year. The majority of patients who were with normal Body mass index had good to excellent results. The mean ratio MJS/LJS Post operatively improved for KSP and PFO group (P- value &lt;0.0001) Conclusion: In medium to long term KSP has superior effects than PFO in improving the VAS score and KSS while PFO has better effects in immediate postoperative to short term. BMI also has implication in outcome of procedures with better results in normal BMI patients in KSP group. Keywords: osteoarthritis (OA), Proximal Fibular Osteotomy (PFO), LP-PRP, Knee Salvation Procedure, Visual Analogue Scale (VAS), Medial Joint Space (MJS), Lateral Joint Space (LJS), Knee Society Score (KSS), Body mass index (BMI).

Accuracy of Intraoperative Mechanical Axis Alignment to Long-Leg Radiographs following Robotic-Arm-Assisted Unicompartmental Knee Arthroplasty.

Improper alignment and implant positioning following unicompartmental knee arthroplasty (UKA) has been shown to lead to postoperative pain and increase the incidence of revision procedures. The use of robotic-arm assistance for UKA (RAUKA) has become an area of interest to help overcome these challenges. The accuracy of intraoperative alignment compared with standing long-leg X-rays postoperatively following medial RAUKA has been in question. Therefore, the purpose of this study was to (1) determine final mean intraoperative coronal alignment in extension utilizing an image based intraoperative navigation system, and (2) compare final intraoperative alignment to 6-week weight-bearing (WB) long-leg X-rays. Patients who underwent RAUKA for medial compartmental osteoarthritis were identified from January 1, 2018, to August 31, 2019, through our institution's joint registry. The query yielded 136 (72 right and 64 left) patients with a mean age of 72.02 years and mean body mass index (BMI) of 28.65 kg/m2 who underwent RAUKA. Final intraoperative alignment was compared with WB long leg X-rays 6 weeks postoperatively by measuring the mechanical alignment. Statistical analysis was primarily descriptive. Pearson's correlation coefficient was used to determine the relationship between intraoperative alignment to 6-week alignment. A p-value of <0.05 was considered statistically significant. Mean intraoperative coronal alignment after resections and trialing was 4.39 varus ± 2.40 degrees for the right knee, and 4.81 varus ± 2.29 degrees for the left knee. WB long-leg X-rays 6 weeks postoperatively demonstrated mechanical axis alignment for the right and left knees to be 3.01 varus ± 2.10 and 3.7 varus ± 2.38 degrees, respectively. This resulted in a change in alignment of 1.36 ± 1.76 and 1.12 ± 1.84 degrees for the right and left knees, respectively (p < 0.05). Pearson's correlation coefficient demonstrated a correlation of 0.69 between intraoperative to long-leg-X-ray alignment. RAUKA demonstrates excellent consistency when comparing postoperative WB long-leg X-rays to final intraoperative image-based non-WB alignment.

High Tibial Osteotomy: An Update for Radiologists.

High tibial osteotomy (HTO) is a surgical procedure to treat symptomatic unicompartmental osteoarthritis (OA) associated with knee malalignment. There has been a recent resurgence of interest in HTO in patients who prefer joint-preserving surgery because HTO shifts the knee's mechanical axis from the arthritic compartment to a neutral position, thereby reducing knee pain, slowing progression of OA, and delaying the need for a total knee arthroplasty. The ideal candidates for HTO are patients who are young, active, and nonobese who have isolated varus deformity of the knee resulting from medial compartment OA. Radiography is critical in the preoperative evaluation for HTO and can help expand surgical indications to include a wider variety of patients. Radiography is also routinely obtained in postoperative assessment and is typically the first test to indicate complications. This review describes the radiologic aspects of HTO, including preoperative imaging assessment and normal and abnormal postoperative imaging appearances. Surgical techniques and osteotomy fixation devices are described, with a focus on the medial opening wedge approach. Given the growing interest in HTO, radiologists should become familiar with the basics of the procedure and the role of imaging in preoperative and postoperative evaluation.

10-Year Survival Rates After High Tibial Osteotomy Using Angular Stable Internal Plate Fixation: Case Series With Subgroup Analysis of Outcomes After Combined Autologous Chondrocyte Implantation and High Tibial Osteotomy.

Background:Good-to-excellent midterm results after high tibial osteotomy (HTO) to treat medial compartment cartilage defects or osteoarthritis (OA) have been published, but little is known about long-term survival rates in terms of conversion to total knee arthroplasty (TKA) using angular stable internal plate fixation.Purpose:To determine TKA-free survival rates and functional and radiological outcomes at 10 years after HTO. A subgroup analysis of patients who underwent combined HTO and autologous cartilage implantation (ACI) was also performed.Study Design:Case series; Level of evidence, 4.Methods:Included were 125 patients with a mean follow-up of 9.90 ± 2.25 years; 90 patients underwent HTO for medial OA, and 35 patients underwent ACI and HTO for medial focal cartilage defects. Functional outcome measures included visual analog scale (VAS) for pain, Lysholm, International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and KOOS4 (average of 4 KOOS subscales: Pain, Symptoms, Sport, and Quality of Life). Radiological outcomes included lateral distal femoral angle, medial proximal tibial angle, and joint line convergence angle.Results:Overall, 16 patients required conversion to TKA at a mean 86.75 ± 25.73 months (10-year survival rate, 87.2%). Only 2 patients in the HTO+ACI subgroup required a conversion to TKA (10-year survival rate, 94.3%). The complication rate for all patients was 8.8%. In both the HTO and HTO+ACI subgroups, VAS pain levels decreased and Lysholm scores increased significantly from pre- to postoperatively (P < .001). A higher preoperative Tegner score led to a significantly lower risk for conversion to TKA (P = .001), and a preoperative body mass index of ≥35 was associated with a significantly higher risk (P = .019), as was female sex (P = .046). Radiological parameters remained within physiological ranges. The postoperative joint line conversion angle did correlate with postoperative functional outcome but not with TKA conversion.Conclusion:Long-term results of HTO for medial compartment OA or cartilage defects with underlying varus deformity were good to excellent. In particular, patients who underwent HTO+ACI presented excellent long-term survival rates. HTO, therefore, delays or prevents TKA implantation, especially in young, active patients with medial compartment damage.

Prognostic factors for medial open-wedge high tibial osteotomy with spacer implantation in patients with medial compartmental knee osteoarthritis

BackgroundTo identify medial open-wedge high tibial osteotomy (MOWHTO) prognostic factors with wedge-shaped spacer implantation (spacer-type MOWHTO) for varus medial compartment knee osteoarthritis.MethodsPatients who underwent spacer-type MOWHTO between August 2018 and September 2019 were prospectively enrolled in this study. Patients were divided into effective group and invalid group based on the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) score one year postoperatively. The variables assessed at baseline and one year postoperatively including age, sex, body mass index (BMI), Kellgren–Lawrence (K–L) grade, hip–knee–ankle angle (HKAA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), Blackburn–Peel index (BPI), duration of symptoms, and WOMAC score were compared. Prognostic factors were analyzed using logistic regression, and the corresponding odds ratios were also calculated.ResultsA total of 104 patients were enrolled in the study protocol at one year postoperatively. The WOMAC score decreased from 72.39 ± 12.95 at baseline to 20.06 ± 12.96 at one year postoperatively. Univariate analysis revealed that the significant predictors of the WOMAC score were age > 70 years, BMI > 30 kg/m2, K–L grade IV, and pre-HKAA > 10° (P < 0.1 for all). Multivariable logistic regression analysis revealed that age > 70 (OR = 4.861) and K–L grade IV (OR = 6.590) were significantly associated with the higher WOMAC score at one year postoperatively.ConclusionsSpacer-type MOWHTO is an effective treatment for osteoarthritis with varus deformity. The prognostic factors for spacer-type MOWHTO are age and K–L grade.

Short-term outcomes of Oxford unicompartmental knee arthroplasty with coronal subluxation of the knee: a retrospective case\u2013control study

BackgroundThe goal of this study was to assess short-term outcomes in single compartment osteoarthritis patients associated with the coronal tibiofemoral subluxation (CTFS) of the knee joint after Oxford unicompartmental knee arthroplasty (OUKA), and to establish the potential impact of the degree of CTFS on operative outcomes.MethodsData pertaining to 183 patients with medial compartment osteoarthritis that underwent OUKA treatment between February 2016 and June 2019 were retrospectively analyzed. The presence and degree of severity of CTFS were assessed using preoperative weight-bearing anteroposterior X-ray images of the knee. Patients were stratified into three subgroups based upon the observed degree of subluxation: a normal group, a mild subluxation group (CTFS < 0.5 cm), and a severe subluxation group (CTFS ≥ 0.5 cm). Anterior and posterior X-ray examination of the knee was conducted at the time of most recent follow-up for each patient to assess the degree of CTFS correction following OUKA. Clinical function was assessed using Oxford knee score (OKS) and Hospital for Special Surgery score (HSS) values, while pain was rated using visual-analog scale (VAS) scores. The mechanical femoral tibial angle (mFTA), range of motion (ROM), and complication rates in these three groups were additionally compared.ResultsThe average follow-up duration for patients in this study was 24.1 months (range: 17–32 months). There were no significant differences in patient age, sex, body mass index (BMI), follow-up duration, mFTA, ROM, OKS, HSS, or VAS scores among these three groups (P > 0.05). After surgery, OKS and HSS scores declined significantly, but no differences in these scores were observed among groups (P > 0.05). Of these patients, 135 (73.8%) were satisfied with the operation, of whom 80 (43.7%) were very satisfied. There were no significant differences in ROM or VAS scores among groups (P > 0.05). The degree of CTFS for patients in the mild and severe subluxation groups was significantly improved following OUKA relative to preoperative values such that the degree of postoperative CTFS did not differ significantly among these groups (P > 0.05). Postoperative mFTA was also significantly improved in these three patient subgroups (P < 0.05). No patients experienced operative complications over the follow-up period.ConclusionsOUKA can successfully improve clinical symptoms in patients with single compartmental osteoarthritis. Moreover, OUKA can effectively correct CTFS of the knee in these patients, and the degree of preoperative CTFS has no impact on surgical efficacy.Level of evidenceIII.

Effectiveness of intraoperative tibia fibular angle and femoral fibular angle in predicting coronal lower limb alignment after medial open-wedge high tibial osteotomy

To explore the prediction of postoperative coronal lower limb alignment by the tibia fibular angle (TFA) and femoral fibular angle (FFA) after osteotomy in medial open-wedge high tibial osteotomy (MOWHTO). A clinical data of 20 patients with medial compartment osteoarthritis, who were treated with MOWHTO between September 2019 and September 2020, was retrospectively analyzed. Among them, there were 9 males and 11 females; the age ranged from 46 to 69 years, with an average of 56.0 years. The body mass index (BMI) was 21.3- 35.7 kg/m 2, with an average of 26.7 kg/m 2. Osteoarthritis involved 11 cases of left knee and 9 cases of right knee; the disease duration was 2-6 years, with an average of 3.8 years. According to the Kellgren-Lawrence classification, there were 7 cases of grade Ⅰ, 9 cases of grade Ⅱ, and 4 cases of grade Ⅲ. The angle and height for open-wedge was planned preoperatively by osteotomy master software, and the TFA and FFA were measured by software after simulated osteotomy. The intraoperative angle for open-wedge was adjusted according to TFA and FFA after simulated osteotomy.The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), mechanical femorotibial angle (mFTA), weight-bearing line (WBL) ratio, TFA, and FFA were measured before operation and at 2 days after operation. The difference (X) between the intraoperative measurement value and the preoperative plan value of TFA/FFA, and the difference (Y) between the postoperative WBL ratio and the target alignment (62.5%) were calculated, and the correlation between the two indicators was analyzed by Pearson's test. According to the median BMI of patients (25.81 kg/m 2), the patients were allocated into high BMI group (>25.81 kg/m 2, n=10) and low BMI group (≤25.81 kg/m 2, n=10), and the influencing factors of WBL ratio was analyzed by linear regression. There was no significant difference between pre- and post-operation in LDFA and JLCA ( P>0.05); while there were significant differences between pre- and post-operation in MPTA, mFTA, and WBL ratio ( P<0.05). The TFA was (89.5±4.0)° during operation and (87.7±4.7)° after operation, showing significant difference ( t=2.991, P=0.008). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of TFA and the difference (Y) between the postoperative WBL ratio and the target alignment ( r=0.595, P=0.006). The FFA was (86.9±4.3)° during operation and (85.7±4.4)° after operation, showing significant difference ( t=1.760， P=0.094). There was a positive correlation between the difference (X) between the intraoperative measurement value and the preoperative plan value of FFA and the difference (Y) between the postoperative WBL ratio and the target alignment ( r=0.536, P=0.015). After BMI stratification, X was an influential factor of Y in the low BMI group ( P<0.05), but X was not an influential factor of Y in the high BMI group ( P>0.05). Intraoperative FFA and TFA can predict coronal limb alignment after MOWHTO. FFA and TFA can predict more preciselyfor patients with BMI≤25.81 kg/m 2.

Intra-articular osteotomies for medial compartment osteoarthritis: Is adding an extra-articular osteotomy worthwhile?

Background and Aims: Medial compartment osteoarthritis (MCOA) of the knee presents with varus deformity arising from the upper tibia or lower femur. High tibial osteotomies relieve pain by correcting the varus and improving the mechanical axis deviation (MAD). Closing wedge, opening wedge, and dome osteotomies are popular choices in the upper tibial metaphysis. These are all extra-articular osteotomies (EAO). Recently, attention has turned to detection and treatment of intra articular deformity arising from the knee to treat MCOA. Tibial condylar valgus osteotomy (TCVO) is an intra-articular osteotomy (IAO) which corrects the varus malalignment by elevating the medial tibial condyle and is usually fixed with a plate (Tibial condylar valgus osteotomy-plating [TCVO-P]). A second distal extra articular osteotomy, fixed with an Ilizarov fixator (tibial condylar valgus osteotomy-Ilizarov [TCVO-I]) is performed in some patients for better correction of the mechanical axis. The two groups were treated with different surgical approaches based on preoperative analysis of deformity. Hence this is a level IV study. We aimed to study the improvement in radiological parameters after TCVO in MCOA. We also compared the results between TCVO-P and TCVO-I. Patients and Methods: We performed 64 osteotomies in 55 patients over the last 7 years. 30 (33 tibiae) had a TCVO-P. 25 (31 tibiae) had a TCVO-I. The mean age in TCVO-P was 55 years, and in TCVO-I was 48 years. Results: The mean preoperative (bo) MAD was more in TCVO-I at –37.4% and improved to a mean postoperative MAD of 53.8%. TCVO-P had a lesser mean bo MAD of –7.4%, which corrected to 46.4%. MAD was better corrected by TCVO-I (P = 0.0058). Correction of medial proximal tibial angle, hip knee ankle angle, ankle joint line orientation improved significantly in both groups. The knee joint line orientation was improved by TCVO-I (P = 0.001), but not by TCVO-P (P = 0.075). Joint line convergence angle (JLCA), spine edge angle, and spine vertical distance were all significantly improved in both groups. Condylar plateau angle was not changed significantly in either group. Conclusion: TCVO is an Intra articular osteotomy which effectively corrects the varus deformity arising from the knee joint in MCOA. An isolated TCVO-P slightly under-corrects the mechanical axis. TCVO-I is better at restoring mechanical axis to beyond neutral and is better for younger patients and with intorsion deformities.

Functional Outcome Following Concurrent Medial Meniscus Posterior Horn Root Repair during High Tibial Osteotomy in Early Medial Compartment Osteoarthritis

Background: Meniscal root tears cause biomechanical changes comparable to a total meniscectomy. The resultant compromise in hoop stress, leads to decreased tibiofemoral contact area and increased contact pressure. This will lead to early arthritis. The meniscus root tear causes more detrimental changes in people with varus alignment of the lower limb. This increases the chances of progression to arthritis, causing joint pain and functional limitation, eventually necessitating early replacement surgery. Surgical management with repair of the meniscus, with corrective osteotomy restoring the normal anatomy, has been reported to improve clinical and functional outcomes and delay the replacement surgery. This study aimed to evaluate the functional outcome following concurrent Medial meniscus posterior horn root (MMPHRTs) repair during open medial wedge high tibial osteotomy (HTO) with medial osteoarthritis. Methods: We performed posterior horn root repair with open medial wedge HTO in 9 patients, between 2016 and 2021. The mean follow-up of patients was 2 years. The mean Lysholm and IKDC scores showed significant improvement (7 had excellent and 2 had satisfactory scores). Patients returned to their expected activity of daily living. Conclusion: Concurrent MMPHRT repair along with medial open wedge HTO for medial compartmental osteoarthritis with varus alignment gives good results and has shown good clinical and radiological outcome on short term follow-up. Keywords: Meniscal root tear, Medial open wedge HTO, Preoperative planning, Outcome.

High Tibial Osteotomy versus Proximal Fibular Osteotomy in Medial Compartmental Osteoarthritis of Knee: A Longitudinal Study

Introduction: Osteoarthritis (OA) is a chronic degenerative intra-articular disorder of cartilage and bone. Knee joint is most commonly involved due to its pivotal role in weight bearing as it is constantly exposed to wear and tear. Osteotomy procedures can achieve normal alignment of the weight bearing axis of the lower limbs. Aim: To evaluate and compare the functional outcome of High Tibial Osteotomy (HTO) and Proximal Fibular Osteotomy (PFO) in medial compartmental osteoarthritis of knee joint. Materials and Methods: This prospective longitudinal study was conducted in a tertiary healthcare centre, IPGMER and SSKMH, Kolkata,West Bangal, India from October 2019 to November 2021 for a duration of 26 months, in which 40 osteotomies were performed around the knee. Considering the inclusion and exclusion criteria 20 proximal fibular osteotomies and 20 high tibial osteotomies were operated avoiding the patients with advanced stage or tricompartmental OA. The scoring system considered for evaluation of the functional outcome was Oxford Knee Score (OKS) and Visual Analouge Scale (VAS) Score. The analysis was done through paired t-test with determining of p-value where value ≤0.05 was considered for statistically significant. Results: Majority of the patients in the present study were more than 45 years of age. The most frequent age group was 46-50 years followed by 51-55 years. The follow-up period was at least 15 months where the OKS score was 39.35±3.51 and 41.20±4.50 with p-value of 0.1556 and VAS score was 5.50±1.10 and 3.80±1.10 with p value of &lt;0.0001 for PFO and HTO respectively. Only two of the patients developed surgical site infection in both cases. Conclusion: In long term follow-up the final functional status of both treatment modalities were comparable although HTO was considered superior with significant improvement in pain relief perspective than PTO.

A study of functional outcome of proximal fibular osteotomy in medial compartmental osteoarthritis of knee

Objective: To evaluate the effectiveness of proximal fibular osteotomy (PFO) to produce symptomatic relief from pain and improvement of medial joint space and function in patients with medial compartmental osteoarthritis of the knee. Materials and Methods: A prospective study from October 2019 to October 2021 at Rajah Muthiah Medical College, in 15 patients with clinical and radiological evidence of osteoarthritis of knee (Kellgren and Lawrence score 2 or more) who surgically managed with proximal fibular osteotomy were used in this study. Preoperative and Postoperative weight-bearing x-rays were obtained, to measure tibiofemoral angle, medial and lateral joint space of knee and to analyse the alignment of lower extremity. Pain relief was measured using a visual analogue scale and functional recovery was assessed by using the oxford knee score preoperatively and postoperatively. Results: PFO provides short-term relieving from knee pain and improvement in walking postoperatively in almost all patients. Postoperative weight-bearing radiographs showed an increase in medial joint space and obvious correction of alignment of the lower extremity. Conclusion: PFO is a technically easy and simple procedure in treating unicompartmental osteoarthritis of the knee, provides significant pain relief and functional restoration of the joint. PFO can emerge as an alternative for younger patients with medial compartmental arthritis and patients unable to undergo TKR due to comorbidities. This surgery delays the need for a TKR, even may obviate it. Care should be taken to avoid common peroneal nerve injury.