Varus Gonarthrosis Research Articles

Evaluation of the effect of vascularized fibula graft harvesting on coronal plane alignment and functional outcomes of the lower limb

Recent studies on fibular osteotomy for varus gonarthrosis and possible subsequent biomechanical changes have attracted increasing attention to the topic. Existing studies have focused mainly on proximal fibular osteotomy with short follow-up periods. The aim of this study was to investigate changes in the alignment of the coronal plane of the ankle and knee joints in patients who underwent vascularized fibula graft harvest (VFGH). The evaluation was based on functional outcomes and radiological measurements.In the comparison between the VFGH side and the contralateral side, no significant differences in the knee inclination (KI) or talar inclination (TI) angle, knee medial clear space (K-MCS) or ankle medial clear space (A-MCS) distance were noted. However, a significant difference in the hip knee (HKA) angle was observed between the operated and nonoperated sides (0.3° ± 1.8° and 1.5° ± 1.9°, respectively [p = 0.019]). Statistically significant differences in both the knee society score (KSS) and the AOFAS scores were found between the ipsilateral donor limb and the contralateral healthy limb. Although the contralateral healthy side had better clinical scores than the VFGH side, the outcomes of the VFGH side were still satisfactory or excellent.

Fibular osteotomy for varus gonarthrosis—useful or nonsense?

Fibular osteotomy for varus gonarthrosis—useful or nonsense?

Midterm results of intra-articular stromal vascular fraction injection for the treatment of knee osteoarthritis.

This study aimed to evaluate the safety and efficacy of intra-knee stromal vascular fraction (SVF) injection in patients with symptomatic knee osteoarthritis at the midterm (3-year) follow-up. SVF injection was applied to 25 knees of 20 patients. Eighteen patients (90%) were female, and the means ± standard deviations of age was 61.9 ± 7.8 (range, 50-76) years. Patients who received conservative treatment for at least 6months and had radiographic Kellgren-Lawrence (K-L) grades 2 and 3 varus gonarthrosis were included in the study. SVF was obtained from the umbilical region by liposuction using local anaesthesia. Patients were followed-up for 36months. Their visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lysholm scores were evaluated before and at 6, 12, 24 and 36months post-SVF injection. A statistically significant improvement (p < 0.05) was observed in VAS, WOMAC and Lysholm scores at the first 2-year follow-up compared to baseline. However, no statistically significant difference (n.s.) was observed in VAS, WOMAC and Lysholm scores at the 3-year follow-up compared with baseline. Intra-articular SVF injection decreased pain and significantly improved the functional outcomes in the first 2years in knees with grade 2-3 osteoarthritis; however, these positive effects of the injection disappeared in the 3rd year. Although short-term successful results of SVF have been reported in the literature, prospective studies are needed for medium- and long-term results.

Quadriceps Muscle Atrophy in Patients with Varus Gonarthrosis

Quadriceps Muscle Atrophy in Patients with Varus Gonarthrosis

Comparison of patient outcomes with and without graft following modified high tibial osteotomy

Objectives. The aim of this study is to evaluate the early results of patients with and without grafting with the proximal tibia medial biplanar open wedge osteotomy technique used in the surgical treatment of varus gonarthrosis and to compare them with the literature. Materials and Methods. Thirty-six patients with medial gonarthrosis with varus alignment were included in the study. The proximal tibia medial biplanar open wedge osteotomy was performed on thirtysix knees. In eighteen of these patients, a tricortical graft was applied to the osteotomy site from the iliac wing being noted as Group 1. The other patients who did not receive grafts constituted Group 2. All patients were evaluated according to the Ahlbäck classification. Leg length radiographs were taken for all patients, and the osteotomy angle was calculated according to Paley's measurements. Results. Although the mean union-time at the osteotomy site was shorter in the Group 1, it was not statistically significant. No significant difference was observed in terms of HSS scores, and no reduction loss was observed in any patient. The hematoma was seen in three patients in Group 2 and one patient in Group 1. The donor site problems were observed in 10 patients in Group 1. Conclusions. With proximal tibia medial biplanar osteotomy, frontal plane and sagittal plane deformities can be corrected in patients with varus gonarthrosis, and good clinical results can be obtained without using grafts, thus avoiding donor site complications.

High corrective osteotomy of the tibia using a pedicle graft for varus deformity of the knee joint

The method of valgus revascularizating tibia osteotomy using autoplasty of the clinoid defect by a pedicle graft is proposed for the treatment of patients with varus gonarthrosis. Nine patients with varus deforming arthrosis, decompensated form, stages 2 and 3, were operated on. Varus changes in the tibiofemoral angle ranged from 5 to 15. The mean consolidation term in the region of osteotomy was about 10 weeks. Follow up period was at least 2 years. The patients were clinically observed using screening monitoring system to control the disease severity and treatment efficacy. Draining effect and normalization of microcirculation were estimated by the measure of intraosseous pressure in subchondral zone. Dispersion analysis of the observation results has shown stable reduction of the average number ofpatient's condition severity from 27. 7 to 17 and the reduction of intraosseous pressure from 2.4 kPa to 0.9 kPa.

Planning Results for High Tibial Osteotomies in Degenerative Varus Osteoarthritis Using Standing and Supine Whole Leg Radiographs.

ObjectiveIn this study, we hypothesized that standing and supine X‐rays lead to different preoperative planning results.MethodsThe present study included 168 pictures from 81 patients who were treated surgically with high tibial osteotomy (HTO) for varus deformity between January 2017 and February 2018. Each patient underwent whole leg X‐ray examinations in both standing and supine position. On both images, the following parameters were measured: degree of axis deviation (DAD), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), width of medial (MJS) and lateral joint space (LJS), and the correction angle (CA). The results were correlated with the patients’ age and body mass index (BMI). To analyze intra‐observer reliability, the same researcher, blinded to the previous measurements, remeasured all X‐rays from 10 patients 8 weeks after the initial measurements were carried out.ResultsWhile mLDFA (P = 0.075), mMPTA (P = 0.435), and MJS (P = 0.119) did not show any differences between the two modalities, LJS (P = 0.016) and DAD (P < 0.001) differed significantly, leading to different correction angles (P < 0.001). The mean difference of the CA was 1.7° ± 2.2° (range, −2.6° to−15.4°). In 14 legs (17%), the standing X‐ray led to a correction angle that was at least 3° larger than the calculation revealed in the supine X‐ray; in 4 legs (5%), it was at least 5° larger. Increased BMI (r = 0.191, P = 0.088) and older age (r = 0.057 , P = 0.605) did not show relevant correlation with DAD differences. However, more severe varus malalignment in the supine radiograph did correlate moderately with differences of correction angles between supine and weight‐bearing radiographs (r = 0.414, P < 0.001). The analysis of the intra‐rater reliability revealed mediocre to excellent intercorrelation coefficients between the measurements of the observer.ConclusionThe use of supine and standing X‐ray images leads to different planning results when performing high tibial osteotomies for varus gonarthrosis. To avoid potential overcorrection, surgeons might consider increased lateral joint spaces on standing radiographs in osteoarthritic knees with varus deviation.

High Valging Tibial Osteotomy in the Complex Treatment of Anterior Cruciate ligament Ruptures in Patients With Varus Gonarthrosis of the Knee

MATERIALS AND METHODS. We observed 164 patients from 2013 to 2019 (mean age 39.8 ± 5.1 years) who underwent anatomical antegrade ACLR ВТВ autograft . Group 1 (43 people, 31.1%) and Group 2 (48 patients, 29.3%) included patients with isolated medial GA of 2-3 degree and/or varus deformity of at least 5º. Group 3 (73 people or 44.5%) included patients with normal articular cartilage and the correct axis of the limb. In Group 1, ACLR was supplemented with an “open wedge” HVTO. The assessment was carried out according to Lysholm Knee Scoring Scale, 2000 IKDC, KOOS.RESULTS. The simultaneous performance of HVTO and ACLR shows good clinical and radiological results in 93% in the first year, and three years after surgery keeps it in 88.4%. The results of treatment of patients of Group 1 turned out to be significantly better in comparison with Group 2 (p&lt;0.01). In Group 1, the anteroposterior and rotational hypermobility of the knee joint was 16.3%, less commonly we observed pain, synovitis, atrophy of the muscles of the thigh and contracture (p &lt;0.01), some dysfunctions (C according 2000 IKDC scale) were determined in 11.6% (p&lt;0.05), and significant impairment of the knee joint function (D according to 2000 IKDC scale) were not observed (p&lt;0.001). In the first 5 years after surgery, a much larger number of patients of the 1st group were able to fully return to their work, domestic and sports activities, compared with Group 2 (p&lt;0.05).CONCLUSION. The combined ACLR and HVTO allow reliable technology in the treatment of anterior instability in patients with GA (p&lt; 0.05%). This approach is effective in young active middle-aged patients, with anterior instability of the knee joint and varus GA or prerequisites for its development, as well as with revision ACLR, posterior tibial plateau tilt of more than 12º. Performing HVTO simultaneously with ACLR is not practical for patients with valgus deviation of the lower leg, failure of the posterolateral capsular ligamentous complex, or changes in the external joint.

The Ability to Achieve a Specific Target Angle on Weightbearing Radiographs After Valgus High Tibial Osteotomy for Medial Knee Arthritis Is Not Predictable

PurposeStanding radiographs are commonly used to plan angular correction in valgus tibial osteotomy for varus gonarthrosis. Most clinical studies have reported postoperative alignment as overall averages or means. The purpose of this study was to compare the preoperatively planned angle of correction measured on weight-bearing radiographs to the follow-up angle measured on weightbearing radiographs in individual patients 6 weeks after surgery and to analyze factors that could potentially affect achieving the planned degree of surgical correction. Our objective was to analyze factors potentially affecting the accuracy and ability to achieve the preoperatively planned correction angle (the target angle) in the individual patient.MethodsWe studied 35 tibial osteotomies (13 Coventry closing wedge osteotomies and 22 Maquet barrel vault osteotomies) performed for varus gonarthrosis between 1981 and 2019 to determine how accurately the target angle, based on preoperative standing weight-bearing radiographs, was achieved according to the postoperative radiographs in each individual. We reviewed 35 knees in 34 patients who had complete pre- and postoperative radiographs for review.ResultsOverall, only 14 of 35 (40%) of the patients were corrected to within ± 2° of the planned target angle. Valgus tibial osteotomy based on preoperative weightbearing radiographs is unpredictable in its ability to achieve the target angle on postoperative weightbearing radiographs when using either the Coventry or the Maquet surgical technique. The tendency was to undercorrect with either of the techniques. Larger (greater than 10°) preoperative varus alignment did not make it more difficult to achieve the target angle. Male or female sex and body mass index had no effect on the ability to achieve the target angle.ConclusionsValgus tibial osteotomy planning based on preoperative weightbearing is unpredictable in its ability to achieve the target angle on postoperative weightbearing radiographs. Overall, only 40% of our patients were corrected to within ± 2° of the planned target angle. The tendency was to undercorrect, with either the Coventry or the Maquet technique. Contrary to our hypothesis, larger preoperative varus alignment (greater than 10°) did not make it more difficult to achieve the target angle. The Coventry technique was as accurate as the Maquet technique.Level of EvidenceLevel IV.

Adjustiertes mechanisches Alignment: Operative Technik – Tipps und Tricks

Mechanical alignment (MA) is astandardized procedure that aims to achieve aneutrally aligned leg axis. An alignment of the prosthesis closer to the patient's anatomy can be an approach for better clinical outcomes. The surgical technique of adjusted mechanical alignment (aMA) presented here is amodified extension-gap-first technique that takes into account the natural ligamentous tension of the knee joint so that ligamentous releases can be avoided as far as possible. The aMA technique can be used for primary and secondary varus gonarthrosis of up to20° of varus. The aim of the operation is to achieve abalanced ligament tension through afemoral osseous correction rather than ligament releases. TEA and the sulcus line are marked to control the ligament-based femoral rotation. The osteophytes are removed to ensure areliable ligament tension. Aquantitative ligament tensioner is stretched with great care, and gap width as well as medial and lateral ligament tension are read off. In order to correct an extension gap asymmetry, instead of the typical medial soft tissue release, the asymmetry is compensated by aspecial femoral cutting block. Now, the flexion gap is assessed, whereby the transverse femoral rotation follows the soft tissue tension. The tensioner adjusts arectangular flexion gap with balanced ligament tension. After a final balancing of the gaps, the femoral preparation is completed and the trial components are inserted. Here, the rotation of the tibial component is set by repeated flexion-extension cycles. The technique presented combines ameasured-resection technique with individual ligament tension. The maximum deviation of the femoral alignment in the coronal plane from the neutral alignment is2.5°. In order to avoid problems, it is recommended, as with the described technique, to achieve acomponent alignment based on the patient anatomy by adjusting the femoral component. The measured-resection technique carries the risk of flexion instability. With the gap-balancing technique symmetrical ligament tension can be achieved, assuming precise proximal tibial cuts. When aligning the femoral component rotation, flexion gap stability and patella tracking should be considered. Long-term studies of high case numbers are necessary to evaluate the good short-term results of the presented surgical technique.

Primary Repair for Injury of Medial Collateral Ligament During Total Knee Arthroplasty

This study, we aim to determine whether intraoperative over-release of MCL that is treated with primary repair can achieve satisfactory clinical results when compared to those who did not have over-release of MCL. At the same time, we seek to look into the difference between two methods of primary repair (anchor suture and staple) in terms of clinical outcomes.Purposes:We determined whether, after TKA, patients with CIA versus patients with CACB demonstrated (1) decreased pain scores (2) greater ambulatory ability postoperatively (3) decreased daily opioid consumption and hospital length of stayMethods:3897 TKAs were performed from year 2003-2014. Sixty-five patients with MCL injury due to over-release during TKA who were repaired with suture anchor or staple (suture anchor: 36 vs. staple: 29) were studied whereas matched group of 65 patients without MCL injury were selected and served as the control group. Subjective feeling of instability and functional score were assessed using Knee Society Score (KSS) and Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Objective stability was evaluated through measurement of opening angles in extension and 30° of knee flexion on valgus stress radiographs. The clinical and stability results of repair between the suture anchor and staple were compared.Results:The KSS and WOMAC scores in patients with primary repair of MCL during TKA from 50.6±14.8 to 87.3±8.3 and 65.9±16.3 to 17.7±8.3, respectively. However, there were neither statistical nor clinical significant difference when comparing between the group with primary repair and the control group. Radiographic stability also showed no differences between repair and control groups in extension and 30° of flexion (p= .63 and p= .37). Regarding the subgroups, There were no significant differences between the suture anchor and staple in terms of the stability and clinical outcomesConclusion:Primary repair either with suture anchor or with staple for injury of the MCL in varus gonarthrosis during TKA provides a good stability and clinical outcomes as those of result with no MCL injury.

Dynamic deformation of femur during medial compartment knee osteoarthritis.

ObjectivesThe aim of this study was to evaluate the morphological changes of the femur in the coronal plane in progressing varus gonarthrosis and to explore the interrelation of each component.Patients and methodsFrom January to July 2017, radiographic images of 1538 knees of 883 consecutive patients were collected and analyzed. We drew the alignments and measured the orientation angles of the lower extremities and compared the results among age groups for each sex. Correlation and regression tests were used to analyze the measurements.ResultsThere were significant differences in the neck-shaft angle (NSA), femoral bowing angle (FBA) and anatomic medial distal femoral angle (aMDFA) by age group in females, whereas the differences were not significant in males. In females, a positive correlation was found between age and the FBA and aMDFA (r = 0.253, 0.141, p<0.01), and a negative correlation was found between age and the NSA while the FBA was controlled (r = -0.065, p<0.05). The FBA was positively correlated with the NSA (r = 0.312, p<0.01) and aMDFA (r = 0.233, p<0.01). The NSA, FBA, and aMDFA together affected 72.2% of the mechanical medial distal femoral angle (mMDFA) (β = 0.071, -0.528, 0.803, p<0.01).ConclusionAs knee osteoarthritis (KOA) progressed, dynamic deformation of the femur was found in females, while no obvious changes were found in males. Femoral mechanical axis varus (mMDFA decrease) was the result of changes in the NSA, FBA and aMDFA. The deformation was throughout the femur rather than in a local area, as femur bowing can lead to corresponding changes in both ends of the femur. We provided a theoretical basis for TKA and knee-salvage treatment, and more attention should be paid to aging patients, especially females, in the preoperative protocol for orthomorphia.

Morphological factors of medial compartment knee osteoarthritis

Objective To evaluate the factors contributing to medial compartment knee osteoarthritis and the possible correlations between them. Methods Radiographic images were collected for analysis of 840 patients who had sought medical attention from January to July 2017 for 1,422 sides of knees varus at Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University. They were aged from 17 to 87 years(average, 61.0 years), involving 323 knees in males and 1,099 knees in females. The alignments and parameters of lower extremity were measured, including hip-knee-ankle angle (HKA), mechanical medial distal femoral angle (mMDFA), medial proximal tibial angle (MPTA) and joint line convergence angle (JLCA). The measurements were compared between HKA values and genders for correlation analysis. Results HKA, mMDFA, MPTA and JLCA were respectively 172.85°±4.27°, 90.99°±2.59°, 84.78°±2.82° and 2.83°±2.33° for males, and 172.13°±4.63°, 91.11°±2.74°, 84.58°±3.30° and 3.48°±2.58° for females. The females had significantly smaller HKA and significantly larger JLCA than males (P 0.05). Pearson correlation test showed that there were significant correlations between HKA and mMDFA, MPTA and JLCA (rmale1=0.526, rmale2=0.545, rmale3=-0.562; rfemale1=0.547, rmale2=0.610, rmale3=-0.485; P<0.01). mMDFA (βmale=0.491, βfemale=0.464, P<0.01) and MPTA (βmale=0.487, βfemale=0.560, P<0.01) had significantly positive influences on HKA; the influence of JLCA was negative (βmale=-0.463, βfemale=-0.450, P<0.01). Conclusions Femoral mechanical axis varus, increased JLCA and collapse of medial tibial plateau all significantly contribute to the varus gonarthrosis. The effects of mMDFA, MPTA and JLCA on HKA may be almost the same. Key words: Knee joint; Knee osteoarthritis; Knee varus; Radiology; Morphology

Complication analysis after angle-stable CW and OW high tibial osteotomy

High tibial osteotomy (HTO) is agood joint-preserving alternative to joint replacement in the treatment of isolated medial varus gonarthrosis. It is, however, accompanied by anumber of complications, which can compromise the outcome of the treatment. Analysis and comparison of the complication structure after angle-stable navigated closed wedge (CW) HTO and conventional angle-stable open wedge (OW) HTO, as well as determination of influence factors. 281 HTO (187 CW- and 94OWHTO) were analyzed retrospectively. Age, sex, BMI, time of surgery and radiological parameters were included as possible influence factors. A statistical analysis was performed with binary logistic regression. An overall complication rate of 21.4% was revealed (25.1% after CW- and 13.8% after OWHTO, p = 0.02); the major complications occurred after 13.9% CW- and 10.6% OWHTO (p = 0.27); minor complications were observed after 11.2% CW- and 3.2% OWHTO (p = 0.03). This difference results from complications specific to CWHTO (peroneal lesions and pseudarthrosis fibulae). The incidence of pseudarthrosis tibiae was equal in both procedures (7.5%). Age ≥ 52years and body mass index (BMI) ≥ 30 kg/m2 were the relevant predictors for mechanical complications after CWHTO; these were not relevant for OWHTO. The correct patient selection is essential to avoid postoperative complications after HTO. The overall complication rates are lower after OWHTO, mainly through the avoidance of complications typical for CWHTO. OWHTO offers a wider choice with respect to the selection of patients.

Good correlation between bone tracer uptake in SPECT/CT and intraoperative findings of chondral lesions graded with the ICRS scoring.

The question if bone tracer uptake in SPECT/CT reflects the intraoperative cartilage status of the knee is still unanswered. In this study, thirty-three consecutive patients (male:female = 11:22; mean age ± standard deviation 61 ± 15) with bi- or tri-compartmental knee osteoarthritis who underwent SPECT/CT before total knee arthroplasty (TKA) were collected. The knee was graded in eleven different anatomical regions. In each region, the maximal relative bone tracer uptake (mrBTU) was measured twice by two observers with a six weeks interval. The intraclass correlation coefficients (ICC) showed excellent correlations and mean values were used. Intraoperatively every region was assessed with the macroscopic International Cartilage Repair Society (ICRS) scoring. A factorial analysis and a non-parametrical Spearman's correlation were calculated among the 11 knee regions on both mrBTU and ICRS scores and significant correlations were seen between regions belonging to the same knee compartment (p < 0.05). A non-parametrical Spearman's correlation was also performed to investigate the correlation between rmBTU in SPECT/CT and intraoperative ICRS cartilage grading. Significant correlations were seen on the medial compartment, on the proximal femoral trochlea and on the medial patellar facet (p < 0.05). A significant correlation between SPECT/CT and intraoperative findings was so demonstrated in several regions. The low accuracy of the macroscopic ICRS scoring system on grade I-II lesions could have affected the missing correlations on the lateral compartment since the selected presented mainly a varus gonarthrosis. The use of an objective measure as the rmBTU could overcome the limit of the subjectivity of MRI findings in early osteoarthritis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:522-528, 2019.

Épargne sanguine : l’acide tranexamique est efficace dans l’ostéotomie tibiale de valgisation

IntroductionThere has been paucity in literature regarding the blood sparing effect of TXA after high tibial osteotomy (HTO). The purpose of this study is to determine the efficacy of tranexamic acid (TXA) with regard to its blood-sparing effects in open-wedge HTO, and to assess thromboembolic complications in patients undergoing open-wedge HTO with or without the use of TXA. HypothesisThe intravenous TXA would reduce postoperative blood loss and transfusion requirements without increasing thromboembolic complications in open-wedge HTO. Materials and methodsFrom March 2011 to December 2016, medial open-wedge HTO was performed in 150 consecutive knees with varus gonarthrosis. The mean age at the time of surgery was 55.3±5.0years. TXA was intravenously used in the latter 75knees (TXA group), and the group was retrospectively compared with the former 75 knees without use of TXA (control group). Outcome measures were postoperative hemoglobin drop, drain amount, total estimated blood loss, transfusion requirements, and incidence of thromboembolic complications. ResultsThe use of TXA led to a significant decrease in hemoglobin drop (p<0.001) and drain amount (p=0.025). Total estimated blood loss was lower in the TXA group than in the control group (p<0.001). Two knees in the control group had postoperative blood transfusion, compared to none in the TXA group (p>0.05). There were no thromboembolic complications such as symptomatic deep vein thrombosis and pulmonary embolism in both groups. ConclusionThe use of TXA reduced perioperative hemoglobin drop, drain amount, and total estimated blood loss without thromboembolic complications in patients undergoing open-wedge HTO. Therefore, the use of TXA is a safe and viable option for perioperative blood management in open-wedge HTO. Level of evidenceIII, Case control study.

The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity

ObjectiveTo evaluate the microfracture intervention with tibial valgus osteotomy associated in the treatment of varus gonarthrosis. MethodsFrom November 2005 to May 2013, 129 patients with medial gonarthrosis, varus deformity (8°–12°), and range of movement greater than 90° were evaluated. Patients with advanced gonarthrosis (Alhbäck 3, 4, and 5), Outerbridge lesion inferior to IV, previous knee surgery, body mass index greater than 35kg/m2, and/or cruciate ligament injuries were not included. All patients were treated with videoarthroscopy followed by tibial valgus osteotomy. In the group osteotomy associated with microfracture (n=56, mean age=39.3), tibial valgus osteotomy and microfracture techniques to address chondral defects were used. In the isolated osteotomy group (n=73, mean age=41.4), only this procedure was performed. Post-surgical follow-up was 24 months, with four evaluations in the first 6 months, proceeding to biannual twice-a-year evaluation in the subsequent period. The Lysholm scale was used for functional monitoring. ResultsThere was a significant improvement in the pain, limping, and squatting domains of the Lysholm scale but only in the isolated osteotomy group. A greater variance of results was observed in the osteotomy group associated to microfracture, in addition to an increased risk of functional deterioration (OR=8.64). ConclusionThe association of microfractures and tibial valgus osteotomy was correlated to lower functional outcomes than tibial valgus osteotomy alone, and may be related to the risk of worsening in the first two postoperative years.

Tranexamic acid is effective for blood management in open-wedge high tibial osteotomy

IntroductionThere has been paucity in literature regarding the blood-sparing effect of TXA after high tibial osteotomy (HTO). The purpose of this study is to determine the efficacy of tranexamic acid (TXA) with regard to its blood-sparing effects in open-wedge HTO, and to assess thromboembolic complications in patients undergoing open-wedge HTO with or without the use of TXA. HypothesisThe intravenous TXA would reduce postoperative blood loss and transfusion requirements without increasing thromboembolic complications in open-wedge HTO. Materials and methodsFrom March 2011 to December 2016, medial open-wedge HTO was performed in 150 consecutive knees with varus gonarthrosis. The mean age at the time of surgery was 55.3±5.0 years. TXA was intravenously used in the latter 75 knees (TXA group), and the group was retrospectively compared with the former 75 knees without use of TXA (control group). Outcome measures were postoperative hemoglobin drop, drain amount, total estimated blood loss, transfusion requirements, and incidence of thromboembolic complications. ResultsThe use of TXA led to a significant decrease in hemoglobin drop (p<0.001) and drain amount (p=0.025). Total estimated blood loss was lower in the TXA group than in the control group (p<0.001). Two knees in the control group had postoperative blood transfusion, compared to none in the TXA group (p>0.05). There were no thromboembolic complications such as symptomatic deep vein thrombosis and pulmonary embolism in both groups. ConclusionThe use of TXA reduced perioperative hemoglobin drop, drain amount, and total estimated blood loss without thromboembolic complications in patients undergoing open-wedge HTO. Therefore, the use of TXA is a safe and viable option for perioperative blood management in open-wedge HTO. Level of evidenceIII, Case control study.

“Horizontal butterfly” technique in repair of radial meniscus tears: A biomechanical study

IntroductionRadial meniscus tears are seen in young patients, especially with anterior cruciate ligament ruptures. Repair of complete radial meniscus tear is necessary for the meniscus functions. The most important factor for success of the meniscus repair is primary stability, but it is still unknown which technique is ideal repair technique. AimWe developed a new suture technique named Horizontal Butterfly (HB). In this novel technique the contact between meniscal tissue and suture is more than Horizontal Loop (HL) that routinely used today. So, we think that this technique will provide better fixation than HL. We aimed to compare 2 repair techniques (HB vs. HL) using human lateral menisci biomechanically with cyclic loading and load to failure tests. Material-methodWe used 22 intact lateral meniscus obtained from patients that operated (total knee replacement) for varus gonarthrosis in our clinic. All menisci were cut radially. In the first group (n:11) menisci were repaired with standard horizontal loop technique, and in the second group (n:11) horizontal butterfly technique were used for repair. All specimens were tested with load to failure test after cyclic loading test (500 cycle X 5–30 N). ResultsBoth groups have similar failure load (71,4 ± 17,52 N vs. 77,9 ± 28,49 N; p:0,559) and stiffness (24,46 ± 19,19 N vs. 24,48 ± 15,87 N; p:0,818). HB group has less peak displacement (6,26 ± 1,24 mm vs. 8,4 ± 1,92 mm; p:0,010). ConclusionThis novel repair technique decreases the amount of displacement according to standard technique while as strong as standard technique routinely used. In this way; we believe that it will increase the rate of healing in clinical use.

Evaluation of functional outcome of high tibial osteotomy in medial compartment osteoarthritis of knee fixed with orthofix and puddu plate: A comparative study

Introduction: Osteoarthritis of knee joint is the most common form of arthritis, affecting a huge population of about 237 million (3.3% of the population). Among those over 60 years old, about 10% of males and 18% of females are affected. Medial compartment is a common disease, caused by additional force on the medial compartment as a result of varus malalignment. The high tibial osteotomy (HTO) is one possibility for the treatment of varus gonarthrosis. Especially for younger and active patients this method can produce long-term relief, which often significantly delays the need for knee arthroplasty. Various techniques for valgus HTOs are described. High tibial osteotomy (HTO) is a widely performed procedure to treat medial knee arthrosis.Materials and Methods: This was a prospective study of 30 patients in the age group between 50 years and 70 years of medial compartment osteoarthritis of knee joint treated by opening wedge osteotomy fixed with orthofix and puddu plate. The study was conducted in the Department of Orthopaedics, SRMS IMS, Bareilly in between September 2016 to march 2018.Patients were randomly allocated in two groups by a computer generated selection system. Their functional results were analysed using knee soceity score.Results: Statistical analysis was performed to compare the demographic characteristics between two groups. The groups were compared with regards to age and sex, grade of osteoarthritis, time of consolidation and functional outcome. Majority of patients were males accounting to 73.33% n=22). Mean age of patients was 61.5years. Minimum age in this series was 52 years and maximum age in this series was 70 years. An unilateral Osteotomy was done in a single setting even when bilateral procedures were required. In our study bilateral osteotomy was done in 12 (40%) patients out of 30 patients. 18 Patients were treated unilaterally (60%).Among unilaterally treated patients majority of these were treated on right knee.Conclusion: Shorter follow-up period is the main shortcoming of our study. However, early results obtained indicate that medial open-wedge osteotomies in medial compartment osteoarthritis of knee fixed using Puddu plates and ortho fix could be done safely and effectively with considerable success with encouraging outcomes, and this technique could be a good alternative for unicompartmental total knee arthroplasty.