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Kumaki D, Tensho K, Iwaasa T, Maezumi Y, Yoshida K, Koyama S, Shimodaira H, Hiriuchi H, Takahashi J. Postoperative patient-reported outcome measures after medial open-wedge high tibial osteotomy was improved by decreased joint line convergence angle. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38813913 DOI: 10.1002/ksa.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To evaluate the relationship between pre- and postoperative joint line convergence angle (JLCA) changes and patient-reported outcome measures related to medial open-wedge high tibial osteotomy (MOWHTO). METHODS Sixty-one patients (71 knees) who underwent MOWHTO were examined. Preoperative and 2-year postoperative radiographic parameters (hip-knee-ankle angle, weight-bearing line ratio, medial proximal tibial angle and JLCA) were measured, and knee injury and osteoarthritis outcome scores (KOOS) were assessed. Patients were divided into two groups: group D (decreased JLCA compared with preoperative status) included 44 knees with a ΔJLCA < 0° and group I (increased JLCA and no-change JLCA compared with preoperative status) included 27 knees with a ΔJLCA ≥ 0°. KOOS sub-scores and the proportion of patients whose improvement exceeded the minimum clinically important difference (MCID) were compared between both groups using Student's t tests, Mann-Whitney U tests and chi-square tests. Multiple regression analysis was performed to determine the factor that had an influential effect on the postoperative KOOS total. RESULTS Significant differences in 2-year postoperative KOOS were observed between the two groups, including total, symptom, pain and activities of daily living scores. Group D had significantly more patients who achieved MCID for both KOOS symptoms and pain scores than group I did. Multivariate analysis indicated that JLCA change and body mass index were significantly associated with the postoperative KOOS total. CONCLUSION Patients with decreased JLCA had better 2-year post-MOWHTO KOOS and better symptom and pain improvements. Therefore, strategies that reduce JLCA are crucial to improving clinical outcomes, and efforts should be made to improve JLCA in surgical techniques. LEVEL OF EVIDENCE Level Ⅳ, Case series.
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Affiliation(s)
- Daiki Kumaki
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tomoya Iwaasa
- Department of Orthopedic Surgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yusuke Maezumi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kazushige Yoshida
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Suguru Koyama
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroki Shimodaira
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroshi Hiriuchi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Nazir SNB, Rathore FA. Efficacy of Mulligan joint mobilizations and trunk stabilization exercises versus isometric knee strengthening in the management of knee osteoarthritis: a randomized controlled trial. BMC Sports Sci Med Rehabil 2024; 16:105. [PMID: 38715135 PMCID: PMC11075249 DOI: 10.1186/s13102-024-00893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Knee osteoarthritis (KOA) progression is often influenced by biomechanical factors. Biomechanical interventions, such as Trunk stabilization exercise (TSE) and Mulligan joint mobilization (MWM), may offer relief from KOA symptoms and potentially slow disease progression. However, the comparative efficacy of these therapies remains uncertain. This study aimed to compare the efficacy of TSE, Mulligan joint mobilization, and isometric knee strengthening (KSE) on disability, pain severity, and aerobic exercise capacity in patients with KOA. METHODOLOGY A randomized controlled trial (RCT) with three intervention groups was conducted between September 2020 to February 2021. The study enrolled adults aged between 40 and 60 years with a confirmed KOA diagnosis recruited from the physical therapy clinic of the Sindh Institute of Physical Medicine and Rehabilitation, Pakistan. Participants were randomly assigned to receive 24 sessions of either TSE, MWM, or KSE. The knee's functionality was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), pain on a visual analogue scale (VAS), and two objective functional tests-the 6-minute walk test (6MWT) and the 11-stair climb test (SCT). These assessments were conducted at baseline, the third week, and the sixth week. Changes in outcome measures were analyzed using a mixed-design ANOVA with Bonferroni post-hoc analysis, with statistical significance set at a p-value < 0.05. RESULT Of the 60 participants, 22 (36.7%) were females, and 38 (63.3%) were males. Within-group analysis revealed a significant improvement in all outcome measures at the third week (p < 0.05) and sixth week (p < 0.05). Notably, the TSE group exhibited a greater reduction in mean difference (M.D) in VAS scores than the MWM and KSE groups across various measures in the third week. At rest, during stair ascent, and descent, the TSE group showed significant improvements in VAS scores: MWM (-2.05; -1.94; -1.94), TSE (-2.38; -2.5; -2.5), KSE (-1.05; -0.63; -0.63). Additionally, during sub-maximal exercise capacity assessment, the TSE group showed greater improvement (MWM 12.89; TSE 22.68; KSE 7.89), as well as in Knee Injury and Osteoarthritis Outcome Score for activities of daily living (KOOS-ADL) (MWM 20.84; TSE 28.84; KSE 12.68), and KOOS-pain (MWM 24.84; TSE 27.77; KSE 5.77) at the third-week assessment (p < 0.05). The TSE group demonstrated significant improvements (p < 0.05) across various measures in the sixth week. Specifically, improvements were observed in VAS scores at rest (MWM - 4.15; TSE - 4.42; KSE - 3.78), during stair ascent (MWM - 3.89; TSE - 4.88; KSE - 3.56) and descent (MWM - 3.78; TSE - 4.05; KSE - 2.94). Furthermore, significant improvements were noted in the stair climb test (MWM - 7.05; TSE - 7.16; KSE - 4.21), 6-minute walk test (6MWT) (MWM 22.42; TSE 37.6; KSE 13.84), KOOS-pain (MWM 41.47; TSE 49.11; KSE 28.73), and KOOS-ADL (MWM 40.31; TSE 50.57; KSE 26.05). CONCLUSION In this study in patients with KOA, TSE had greater efficacy compared to MWM and KSE in enhancing functional levels, reducing pain, improving sub-maximal exercise capacity, and performance on the stair climb test. Importantly, mean scores between the groups, particularly in the TSE group, reached the minimally important level, particularly in key areas such as pain, functional levels, sub-maximal exercise capacity, and stair climb performance. Clinicians should consider the significant pain reduction, improved functionality, and enhanced exercise capacity demonstrated by TSE, indicating its potential as a valuable therapeutic choice for individuals with KOA. TRIAL NO ClinicalTrials.gov = NCT04099017 23/9/2019.
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Affiliation(s)
- Shaikh Nabi Bukhsh Nazir
- Institute of Physical Medical & Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan.
| | - Farooq Azam Rathore
- Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan
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Yang HY, Shin YG, Shin HH, Choi JH, Seon JK. Factors to improve odds of success following medial opening-wedge high tibial osteotomy: a machine learning analysis. BMC Musculoskelet Disord 2024; 25:323. [PMID: 38658876 PMCID: PMC11040853 DOI: 10.1186/s12891-024-07441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Although high tibial osteotomy (HTO) is an established treatment option for medial compartment osteoarthritis, predictive factors for HTO treatment success remain unclear. This study aimed to identify informative variables associated with HTO treatment success and to develop and internally validate machine learning algorithms to predict which patients will achieve HTO treatment success for medial compartmental osteoarthritis. METHODS This study retrospectively reviewed patients who underwent medial opening-wedge HTO (MOWHTO) at our center between March 2010 and December 2015. The primary outcomes were a lack of conversion to total knee arthroplasty (TKA) and achievement of a minimal clinically important difference of improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) at a minimum of five years postoperatively. Recursive feature selection was used to identify the combination of variables from an initial pool of 25 features that optimized model performance. Five machine learning algorithms (XGBoost, multilayer perception, support vector machine, elastic-net penalized logistic regression, and random forest) were trained using five-fold cross-validation three times and applied to an independent test set of patients. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC). RESULTS A total of 231 patients were included, and 200 patients (86.6%) achieved treatment success at the mean of 9 years of follow-up. A combination of seven variables optimized algorithm performance, and the following specific cutoffs increased the likelihood of MOWHTO treatment success: body mass index (BMI) ≤ 26.8 kg/m2, preoperative KOOS for pain ≤ 46.0, preoperative KOOS for quality of life ≤ 33.0, preoperative International Knee Documentation Committee score ≤ 42.0, preoperative Short-Form 36 questionnaire (SF-36) score > 42.25, three-month postoperative hip-knee-ankle angle > 1.0°, and three-month postoperative medial proximal tibial angle (MPTA) > 91.5° and ≤ 94.7°. The random forest model demonstrated the best performance (F1 score: 0.93; AUC: 0.81) and was transformed into an online application as an educational tool to demonstrate the capabilities of machine learning. CONCLUSIONS The random forest machine learning algorithm best predicted MOWHTO treatment success. Patients with a lower BMI, poor clinical status, slight valgus overcorrection, and postoperative MPTA < 94.7 more frequently achieved a greater likelihood of treatment success. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Hong Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro 322 Hwasun-gun, Chonnam, 58128, Republic of Korea
| | | | - Hyun Ho Shin
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro 322 Hwasun-gun, Chonnam, 58128, Republic of Korea
| | - Ji Hoon Choi
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro 322 Hwasun-gun, Chonnam, 58128, Republic of Korea
| | - Jong Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro 322 Hwasun-gun, Chonnam, 58128, Republic of Korea.
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Van Genechten W, Vanneste Y, van Beek N, Michielsen J, Claes S, Verdonk P. No clinical outcome difference between varus phenotypes after medial opening-wedge high tibial osteotomy at 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 2024; 32:1016-1025. [PMID: 38409956 DOI: 10.1002/ksa.12099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Clinical studies regarding medial open-wedge high tibial osteotomy (MOWHTO) often analyse a large group of mechanical varus knees rather than differentiating for its primary varus-inducing component. This study aims to compare the radiological and clinical outcomes of the most prevalent varus malalignment phenotypes using the coronal plane alignment of the knee (CPAK) classification. METHODS MOWHTO cases with minimal 2-year clinical follow-up were retrospectively selected from a knee osteotomy database (2016-2020). Based on the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA), subjects were allocated to the correct CPAK phenotype pre- and postoperatively. Clinical outcomes were the numeric rating scale (NRS), the knee injury and osteoarthritis outcome score (KOOS) and the therapeutic response rate (TRR) at 2-year follow-up. Inter-observer correlation coefficient (ICC) and unpaired student t test were performed for cross-phenotype comparison. RESULTS One hundred thirty-five (135) subjects were found eligible (53.0 years old ±9.6 [19-77], 72% male, 53% left-sided). The most prevalent preoperative phenotype was CPAK 1 (n = 70 (52%)) and the postoperative phenotype was CPAK 6 (n = 66 (49%)). All CPAK phenotypes improved significantly relative to baseline but cross-phenotype comparison yielded no significant differences in clinical outcome. The TRR at 2 years was 67% for CPAK 1, 69% for CPAK 2 and 87% for CPAK 4. The TRR for CPAK 6 was 64% compared with 80% for CPAK 9, which was not significantly different. CONCLUSION At 2-year follow-up, no clinically significant differences are observed between different CPAK phenotypes. Accurate MOWHTO corrections provide significant clinical improvement even in the femoral-driven varus knee and the constitutional varus knee dominated by intra-articular wear. The clinical indication for MOWHTO performance should not be reduced to the medial arthritic varus knee with underlying tibial varus alone. LEVEL OF EVIDENCE Level IV, retrospective comparative study.
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Affiliation(s)
- Wouter Van Genechten
- Orthopedic Department, University Hospital Antwerp, Edegem, Antwerpen, Belgium
- More Institute, Antwerp, Belgium
- Orthopedic Department, Herentals, Antwerpen, Belgium
| | - Yannick Vanneste
- Orthopedic Department, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | | | - Jozef Michielsen
- Orthopedic Department, University Hospital Antwerp, Edegem, Antwerpen, Belgium
| | - Steven Claes
- Orthopedic Department, Herentals, Antwerpen, Belgium
| | - Peter Verdonk
- Orthopedic Department, University Hospital Antwerp, Edegem, Antwerpen, Belgium
- More Institute, Antwerp, Belgium
- ORTHOCA, Antwerp, Belgium
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Dobelle E, Fabre-Aubrespy M, Mandon B, Flecher X, Ollivier M, Argenson JN, Jacquet C. Bicondylar tibial plateau fracture osteosynthesis with double-plate fixation: Similar complication rates and clinical results but improved radiographic outcomes with dual compared to single approach. Orthop Traumatol Surg Res 2024; 110:103655. [PMID: 37423296 DOI: 10.1016/j.otsr.2023.103655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 12/30/2022] [Accepted: 05/16/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Associating posteromedial and anterolateral approaches should improve fracture line visualization and optimize bicondylar tibial plateau fracture reduction compared to a single midline approach. The present study aimed to compare postoperative complications rates and functional and radiographic results after double-plate fixation via either a single or a dual approach. The study hypothesis was that double-plate fixation using a dual approach provides equivalent complications rates with improved radiographic results compared to a single approach. MATERIAL AND METHODS A retrospective 2-center study compared bicondylar tibial plateau fractures treated by double-plate fixation on a single versus a dual approach between January 2016 and December 2020. Comparison focused on major complications requiring surgical revision, radiographic measurements of medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA); change from their respective baseline values of 87° and 83° (deltaMPTA and deltaPPTA), and functional results on KOOS, SF12 and EQ5D-3L self-reported questionnaires. RESULTS Major complications occurred in 2 of the 20 single approach group patients (10%) [1 surgical site infection (SSI) (5%), and 1 skin complication (5%)], and in 3 of the 39 dual approach group patients (7.69%) (p=0.763), at an average 29 months' follow-up. In the sagittal plane, deltaPPTA was significantly lower with dual than single approach (respectively, 4.67° versus 7.43°; p=0.0104). There were no significant intergroup differences in deltaMPTA or functional results at last follow-up. CONCLUSION The present study suggests an absence of significant difference in major complications, between single and dual approach for double-plate osteosynthesis of bicondylar tibial plateau fractures. Using a dual approach enabled improved anatomic restoration in the sagittal plane, without significant differences observed in the frontal plane or functional scores at an average 29months' follow-up. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Emile Dobelle
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France.
| | - Maxime Fabre-Aubrespy
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Bastien Mandon
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Xavier Flecher
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Jean-Noël Argenson
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Christophe Jacquet
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
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van Hagen CCE, Huiberts AJ, Mutubuki EN, de Melker HE, Vos ERA, van de Wijgert JHHM, van den Hof S, Knol MJ, van Hoek AJ. Health-related quality of life during the COVID-19 pandemic: The impact of restrictive measures using data from two Dutch population-based cohort studies. PLoS One 2024; 19:e0300324. [PMID: 38498510 PMCID: PMC10947685 DOI: 10.1371/journal.pone.0300324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES We describe health-related quality of life during the COVID-19 pandemic in the general Dutch population and correlations with restrictive measures. METHODS Data were obtained from 18-85 year-old participants of two population-based cohort studies (February 2021-July 2022): PIENTER Corona (n = 8,019) and VASCO (n = 45,413). Per cohort, mean scores of mental and physical health and health utility from the SF-12 were calculated by age group, sex and presence of a medical risk condition. Spearman correlations with stringency of measures were calculated. RESULTS Both cohorts showed comparable results. Participants <30 years had lowest health utility and mental health score, and highest physical health score. Health utility and mental health score increased with age (up to 79 years), while physical health score decreased with age. Women and participants with a medical risk condition scored lower than their counterparts. Fluctuations were small over time but most pronounced among participants <60 years, and correlated weakly, but mostly positively with measure stringency. CONCLUSIONS During the Dutch COVID-19 epidemic, health utility and mental health scores were lower and fluctuated strongest among young adults compared to older adults. In our study population, age, sex and presence of a medical risk condition seemed to have more impact on health scores than stringency of COVID-19 non-pharmaceutical interventions.
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Affiliation(s)
- Cheyenne C. E. van Hagen
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Anne J. Huiberts
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Elizabeth N. Mutubuki
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Hester E. de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Eric R. A. Vos
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Janneke H. H. M. van de Wijgert
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Susan van den Hof
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Mirjam J. Knol
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
| | - Albert Jan van Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
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Dal Fabbro G, Grassi A, Agostinone P, Lucidi GA, Fajury R, Ravindra A, Zaffagnini S. High survivorship rate and good clinical outcomes after high tibial osteotomy in patients with radiological advanced medial knee osteoarthritis: a systematic review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05254-0. [PMID: 38430233 DOI: 10.1007/s00402-024-05254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION The role of valgus producing high tibial osteotomy (HTO) for the treatment of advanced knee osteoarthritis (OA) is still controversial. The aim of the current systematic review was to assess survivorship and patient-reported outcomes (PROMs) of high tibial osteotomy in patients with radiological advanced medial knee OA. METHODS A systematic search of PubMed, Cochrane and EMBASE database was performed in July 2023 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Inclusion and exclusion criteria were applied to identify studies investigating the survivorship rate and PROMs of valgus-producing high tibial osteotomy in patients with advanced knee OA at x-ray assessment in the medial compartment at minimum-two-years follow up. Advanced radiological OA was defined as Kellgren Lawrence (K-L) ≥ 3 or Ahlbäch ≥ 2. Survivorship was defined as percentage of patients free of total knee arthroplasty (TKA) at follow-up. Clinical interpretation of provided PROMs were performed according to minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) target values reported in literature. Survivorship data and PROMs scores were extracted, and studies were stratified based on selected study features. The quality of included studies was assessed with modified Coleman score. RESULTS A total of 18 studies, totalling 1296 knees with a mean age between 46.9 and 67 years old, were included. Average survivorship was of 74.6% (range 60 - 98.1%) at 10-years follow up. The subjective scoring systems showed good results according to MCID and PASS, and postoperative improvements were partially maintained until final follow-up. CONCLUSION HTO is worth considering as treatment choice even in patients affected by radiological advanced medial knee osteoarthritis. Long term survivorship and good patient reported clinical outcomes could be expected in this population. LEVEL OF EVIDENCE IV; systematic review of level III-IV studies.
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Affiliation(s)
- Giacomo Dal Fabbro
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy.
- Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Bologna, Italy.
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Piero Agostinone
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Gian Andrea Lucidi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Raschid Fajury
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Abhijit Ravindra
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
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Watanabe S, Matsushita T, Nishida K, Nagai K, Hoshino Y, Matsumoto T, Kuroda R. Knee Osteotomy Decreases Joint Inflammation Based on Synovial Histology and Synovial Fluid Analysis. Arthroscopy 2024; 40:830-843. [PMID: 37474081 DOI: 10.1016/j.arthro.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To examine the biological changes in the joints of patients with knee osteoarthritis (OA) before and after around-knee osteotomy (AKO), focusing on synovial fluid (SF) and synovial pathological changes. METHODS Patients who underwent AKO for medial compartment knee OA between 2019 and 2021 were examined. SF and synovium were obtained at the time of AKO and plate removal after bone union (mean, 16.8 months [range: 11-38 months] postoperatively). SF volume and interleukin (IL)-6 concentrations in SF were assayed using enzyme-linked immunosorbent assay. Synovitis was assessed histologically using a semiquantitative scoring system. Macrophage infiltration was assessed by immunohistochemistry using a semiquantitative score for F4/80 expression. The M1/M2 ratio was calculated using percentage of cells positive for CD80 and CD163. The expression of proinflammatory cytokines was assessed by the percentage of IL-1β- and IL-6-positive cells. The number of vascular endothelial growth factor-positive luminal structures was counted to assess angiogenesis. The change in each parameter was compared before and after AKO using the Wilcoxon matched-pairs signed-rank test. RESULTS Twenty-four knees of 21 patients were included. SF volume and IL-6 concentration significantly decreased postoperatively (12.6 ± 2.1 mL vs 4.2 ± 0.6 mL; P < .0001 and 50.5 ± 8.6 pg/mL vs 20.7 ± 3.8 pg/mL; P = .0001, respectively). A significant reduction in synovitis score (P = .0001), macrophage infiltration (P < .0003), M1/M2 ratio (P < .0007), angiogenesis (P < .0001), and the percentage of IL-1β- and IL-6-positive cells in the intima (P < .008 and P < .002, respectively) was found after AKO. CONCLUSIONS SF volume and IL-6 concentrations in the SF decreased and inflammatory synovium pathology improved after AKO. In addition to biomechanical changes, the biological environment of the joint can be improved after AKO. LEVEL OF EVIDENCE Level IV, retrospective therapeutic case series.
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Affiliation(s)
- Shu Watanabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Kim JH, Kim KI, Song SJ, Lee SH. Postoperative Decrease in Bone Marrow Lesion Associated With Better Clinical Outcomes Following Medial Open-Wedge High Tibial Osteotomy. Arthroscopy 2024:S0749-8063(24)00088-4. [PMID: 38331368 DOI: 10.1016/j.arthro.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To assess serial changes of preoperative bone marrow lesion (BML) following medial open-wedge high tibial osteotomy (MOWHTO) up to 2 years and evaluate whether postoperative change of BML affected patient-reported outcome measures (PROMs) at 2 years' follow-up. Factors related to the postoperative changes in BML also were evaluated. METHODS The current study retrospectively assessed prospectively collected data of consecutive patients between December 2016 and March 2018 who underwent MOWHTO for symptomatic knee osteoarthritis with varus malalignment (≥5°) and a minimum 2-year follow-up. Serial magnetic resonance imaging scans at preoperative and postoperative 3, 6, 18, and 24 months were performed, and the extent of BML was evaluated consecutively using 2 validated methods. Clinically, preoperative and postoperative PROMs and their achievement of minimal clinically important difference values were evaluated. The associations of the extent of BMLs with PROMs at each follow-up period over time were analyzed using a linear mixed model. Furthermore, factors related to the postoperative changes of BML were assessed. RESULTS Of 26 patients, 21 (80.8%) had preoperative BML at medial femoral and tibial condyles. The postoperative decrease in BML was noted in 17 (81.0%) and 18 (85.7%) at medial femoral and tibial condyles. The BML decreased at postoperative 3 months and, thereafter, the extent of BML gradually reduced until postoperative 24 months. The proportion of patients achieved minimal clinically important difference was 84.6% for total Western Ontario and McMaster Universities Osteoarthritis Index scores and 80.8%, 76.9%, and 84.6% for KOOS symptom, pain, and activity of daily living subscales. Postoperative decrease in BML was significantly associated with better PROMs over postoperative 24 months. Furthermore, normo-correction (2°-5° valgus) was a significant factor for decreased BML following MOWHTO. CONCLUSIONS Preoperative BML gradually decreased with time following MOWHTO, and the postoperative decrease in BML related with better PROMs over postoperative 24 months. Moreover, postoperative valgus alignment was a significant factor relating the postoperative decrease of BML. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea; Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea; Department of Orthopaedic Surgery, Kyung Hee University Medical Center, Seoul, Korea
| | - Sang-Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea; Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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10
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Higuchi T, Koseki H, Yonekura A, Imai C, Tomonaga I, Sunagawa S, Matsumura U, Osaki M. Comparison of short-term clinical outcomes between open-wedge high tibial osteotomy and tibial condylar valgus osteotomy. BMC Musculoskelet Disord 2024; 25:98. [PMID: 38281004 PMCID: PMC10821256 DOI: 10.1186/s12891-024-07205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND This study aimed to compare radiological features and short-term clinical outcomes between open-wedge high tibial osteotomy (OWHTO) and tibial condylar valgus osteotomy (TCVO), to provide information facilitating decision-making regarding those two procedures. METHODS Twenty-seven cases involving 30 knees that had undergone OWHTO (HTO group) and eighteen cases involving 19 knees that had undergone TCVO (TCVO group) for medial compartment knee osteoarthritis (OA) were retrospectively evaluated. Patient characteristics, severity of knee OA, lower limb alignment, joint congruity and instability were measured from standing full-length leg and knee radiographs obtained before and 1 year after surgery. Range of motion in the knee joint was measured and Knee Injury and Osteoarthritis Outcome Score (KOOS) was obtained to evaluate clinical results preoperatively and 1 year postoperatively. RESULTS Mean age was significantly higher in the TCVO group than in the HTO group. Radiological features in the TCVO group included greater frequencies of advanced knee OA, varus lower limb malalignment, higher joint line convergence angle, and varus-valgus joint instability compared to the HTO group before surgery. However, alignment of the lower limb and joint instability improved to comparable levels after surgery in both groups. Maximum flexion angles were significantly lower in the TCVO group than in the HTO group both pre- and postoperatively. Mean values in all KOOS subscales recovered similarly after surgery in both groups, although postoperative scores on three subscales (Symptom, Pain, and ADL) were lower in the TCVO group (Symptom: HTO, 79.0; TCVO, 67.5; Pain: HTO, 80.5; TCVO, 71.1; ADL: HTO, 86.9; TCVO, 78.0). CONCLUSIONS Both osteotomy procedures improved short-term clinical outcomes postoperatively. TCVO appears preferable in cases of advanced knee OA with incongruity and high varus-valgus joint instability. An appropriate choice of osteotomy procedure is important to obtain favorable clinical outcomes.
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Affiliation(s)
- Takashi Higuchi
- Department of Physical Therapy, Osaka University of Human Sciences, Settsu, Japan
| | - Hironobu Koseki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan.
- Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chieko Imai
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Iku Tomonaga
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinya Sunagawa
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Umi Matsumura
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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11
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Yu J, Wu P, Guo H, Chen P, Yuwen P, Wang J, Zhang Y. Proximal tibial osteotomy with absorbable spacer combined with fibular osteotomy has similar clinical outcomes to high tibial osteotomy in the treatment of knee osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2023; 47:2699-2708. [PMID: 37490078 DOI: 10.1007/s00264-023-05894-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Proximal tibia osteotomy with absorbable spacer combined with fibular osteotomy (TPOASI) is an emerging surgical technique for treating knee osteoarthritis (KOA); however, the efficacy of this procedure remains unknown. We hypothesize that TPOASI can achieve similar clinical outcomes to opening-wedge high tibial osteotomy (OW-HTO). The objective of this study is to compare the clinical results between these two procedures. METHODS Patients who underwent TPOASI or OW-HTO from July 2016 to September 2020 were included. The following outcome parameters were determined before and after the surgery: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale of pain, the Intermittent and Persistent Osteoarthritis Pain Scale, femorotibial angle, and post-operative complications. RESULTS In total, 209 cases were analyzed (102 in TPOASI group; 107 in OW-HTO group) with 3.1 years average follow-up. Both procedures achieved significant improvement in KOOS (62.0 to 24.4 in the TPOASI and 62.8 to 26.2 in the OW-HTO group, p < 0.001) and WOMAC score (68.9 to 24.1 in the TPOASI versus 69.9 to 26.1 in the OW-HTO group, p < 0.001). There were no significant differences in complications or femorotibial angle between the two groups but the only significant difference in the outcome parameters was the WOMAC stiffness score (19.6 in the TPOASI versus 26.5 in the OW-HTO group). CONCLUSION TPOASI achieves comparable results to OW-HTO in terms of clinical scores, radiographic results, and complications, but has the advantage of avoiding internal fixation removal.
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Affiliation(s)
- Jiahao Yu
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People's Republic of China
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, Hebei, People's Republic of China
| | - Penghuan Wu
- Department of Orthopaedics, Shaoguan First People's Hospital, Affiliated Shaoguan First People's Hospital, Southern Medical University, Shaoguan, Guangdong, China
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- The School of Medicine, Nankai University, Tianjin, China
| | - Haichuan Guo
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People's Republic of China
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, Hebei, People's Republic of China
| | - Pengzhao Chen
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People's Republic of China
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, Hebei, People's Republic of China
| | - Peizhi Yuwen
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People's Republic of China
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, People's Republic of China
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, Hebei, People's Republic of China
| | - Juan Wang
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People's Republic of China.
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, People's Republic of China.
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, Hebei, People's Republic of China.
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
| | - Yingze Zhang
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People's Republic of China.
- Hebei Orthopaedic Clinical Research Center, Shijiazhuang, Hebei, People's Republic of China.
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent Equipment, Ministry of Education, Shijiazhuang, Hebei, People's Republic of China.
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Machado A, Micicoi L, Ernat J, Schippers P, Bernard de Dompsure R, Bronsard N, Gonzalez JF, Micicoi G. Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4276-4284. [PMID: 37326635 DOI: 10.1007/s00167-023-07465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO. METHODS This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed. RESULTS The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = - 0.15, p = 0.04) and function IKS (R = - 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°. CONCLUSION Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Axel Machado
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Lolita Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Justin Ernat
- University of Utah Health, Salt Lake City, Utah, USA
| | - Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Régis Bernard de Dompsure
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Grégoire Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France.
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
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13
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Itou J, Itoh M, Kuwashima U, Okazaki K. Lateral joint tightness in flexion following cementless mobile-bearing total knee arthroplasty decreases patient-reported outcome measures and postoperative range of motion. J ISAKOS 2023; 8:332-337. [PMID: 37321294 DOI: 10.1016/j.jisako.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The purpose of this study was to clarify the association between clinical outcomes and the flexion joint gap following rotating concave-convex (Vanguard ROCC) total knee arthroplasty (TKA). METHODS This consecutive retrospective series included 55 knees that underwent ROCC TKA. All the surgical procedures were performed using a spacer-based gap-balancing technique. To evaluate the medial and lateral flexion gaps, axial radiographs of the distal femur were obtained using the epicondylar view with a distraction force to the lower leg at 6 months postoperatively. Lateral joint tightness was defined as the lateral gap being greater than the medial gap. To evaluate clinical outcomes, patients were asked to complete patient-reported outcome measures (PROMs) questionnaires preoperatively and during at least 1 year of follow-up postoperatively. RESULTS The median follow-up duration was 24.0 months. Overall, 16.0% of patients had postoperative lateral joint tightness in flexion. The postoperative range of motion and PROMs were lower in patients with lateral joint tightness than in those with a balanced flexion gap or lateral joint laxity. No serious complications, including bearing dislocations, occurred during the observation period. CONCLUSION Lateral joint tightness in flexion following ROCC TKA decreases PROMs and postoperative range of motion. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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14
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Lauwers R, van Beek N, Goossens D, Claes S, Bartholomeeusen S, Claes T. Clinical and radiological outcomes of medial opening-wedge monoplanar and biplanar high tibial osteotomy using a triangular allograft impaction technique: A retrospective single centre study. Knee 2023; 44:21-30. [PMID: 37487379 DOI: 10.1016/j.knee.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/08/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE The aim of the study was to research the clinical and radiological outcomes between monoplanar and biplanar medial opening-wedge high tibial osteotomy. We hypothesized that there would be no differences between both techniques when using a triangular allograft impaction technique. METHODS A single-centre, observational, retrospective study was conducted on 103 opening-wedge high tibial osteotomy patients from January 2017 to September 2019. Data collection, NRS and KOOS-PS, was performed preoperatively, 3 months and 12 months postoperatively. Radiological assessment (Kellgren-Lawrence, mechanical femoral-tibial angle, posterior tibial slope angle, lateral patellar tilt, patellar height) was performed on standing radiographs. RESULTS In total 32 patients were included in the biplanar group and 71 patients in the monoplanar group. NRS and KOOS-PS scores improved significantly (p < 0.001) in time for both groups from baseline to 3 m PO and further to 1 year postoperatively. Our results showed no differences in radiological outcomes such as patellar height, LPT and posterior tibial slope angle. The monoplanar group did have more Takeuchi I and III fractures and a higher mFTA angle without clinical repercussion. CONCLUSIONS Using a triangular allograft impaction technique for monoplanar and biplanar medial opening-wedge high tibial osteotomy gives no differences in clinical (NRS and KOOS) and radiological outcomes. Although a difference in Takeuchi fractures was found for monoplanar patients, no additional fixation was necessary, nor did clinical complications occur. We can conclude that triangular allograft impaction technique creates a stable construct and standardizes the healing procedure postoperatively for both monoplanar and biplanar medial opening-wedge high tibial osteotomy.
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Affiliation(s)
- Ruben Lauwers
- University of Antwerp, Antwerp, Belgium; AZ Herentals, Herentals, Belgium.
| | | | | | - Steven Claes
- AZ Herentals, Herentals, Belgium; University of Leuven, Leuven, Belgium
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15
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Xie T, Brouwer RW, van den Akker-Scheek I, van der Veen HC. Clinical relevance of joint line obliquity after high tibial osteotomy for medial knee osteoarthritis remains controversial: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:4355-4367. [PMID: 37340220 PMCID: PMC10471655 DOI: 10.1007/s00167-023-07486-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE To systematically review the literature on the association between knee joint line obliquity (KJLO) and clinical outcome after high tibial osteotomy (HTO) for medial knee osteoarthritis and summarize the KJLO cut-off value used when studying this association. METHODS A systematic search was conducted in three databases (PubMed, Embase, and Web of Science) on September 2022, updated on February 2023. Eligible studies describing postoperative KJLO in relation to clinical outcome after HTO for medial knee osteoarthritis were included. Nonpatient studies and conference abstracts without full-text were excluded. Two independent reviewers assessed title, abstract and full-text based on the inclusion and exclusion criteria. The modified Downs and Black checklist was used to assess the methodological quality of each included study. RESULTS Of the seventeen studies included, three had good methodological quality, thirteen fair quality, and one had poor quality. Conflicting findings were shown on the associations between postoperative KJLO and patient-reported outcome, medial knee cartilage regeneration, and 10-year surgical survival in sixteen studies. Three good-quality studies found no significant differences in lateral knee cartilage degeneration between postoperative medial proximal tibial angle > 95° and < 95°. Joint line orientation angles by the tibial plateau of 4° and 6°, joint line orientation angle by the middle knee joint space of 5°, medial proximal tibial angles of 95° and 98°, and Mikulicz joint line angle of 94° were KJLO cut-off values used in the included studies. CONCLUSION Based on current evidence, the actual association between postoperative KJLO and clinical consequences after HTO for medial knee osteoarthritis cannot be ascertained. The clinical relevance of KJLO after HTO remains controversial. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tianshun Xie
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Assink N, Bosma E, Meesters AML, van Helden SH, Nijveldt RJ, ten Duis K, Witjes MJH, de Vries JPPM, Kraeima J, IJpma FFA. Initial and Residual 3D Fracture Displacement Is Predictive for Patient-Reported Functional Outcome at Mid-Term Follow-Up in Surgically Treated Tibial Plateau Fractures. J Clin Med 2023; 12:6055. [PMID: 37762994 PMCID: PMC10531969 DOI: 10.3390/jcm12186055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Conventional measures of fracture displacement have low interobserver reliability. This study introduced a novel 3D method to measure tibial plateau fracture displacement and its impact on functional outcome. METHODS A multicentre study was conducted on patients who had tibial plateau fracture surgery between 2003 and 2018. Eligible patients had a preoperative CT scan (slice thickness ≤ 1 mm) and received a Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A total of 362 patients responded (57%), and assessment of initial and residual fracture displacement was performed via measurement using the 3D gap area (mm2). Patients were divided into four groups based on the 3D gap area size. Differences in functional outcome between these groups were assessed using analysis of variance (ANOVA). Multiple linear regression was used to determine the association between fracture displacement and patient-reported outcome. RESULTS Functional outcome appeared significantly worse when initial or residual fracture displacement increased. Multivariate linear regression showed that initial 3D gap area (per 100 mm2) was significantly negatively associated with all KOOS subscales: symptoms (-0.9, p < 0.001), pain (-0.0, p < 0.001), ADL (-0.8, p = 0.002), sport (-1.4, p < 0.001), and QoL (-1.1, p < 0.001). In addition, residual gap area was significantly negatively associated with the subscales symptoms (-2.2, p = 0.011), ADL (-2.2, p = 0.014), sport (-2.6, p = 0.033), and QoL (-2.4, p = 0.023). CONCLUSION A novel 3D measurement method was applied to quantify initial and residual displacement. This is the first study which can reliably classify the degree of displacement and indicates that increasing displacement results in poorer patient-reported functional outcomes.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | - Eelke Bosma
- Department of Trauma Surgery, Martini Hospital, 9712 CP Groningen, The Netherlands;
| | - Anne M. L. Meesters
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | - Sven H. van Helden
- Department of Trauma Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands; (S.H.v.H.); (R.J.N.)
| | - Robert J. Nijveldt
- Department of Trauma Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands; (S.H.v.H.); (R.J.N.)
| | - Kaj ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
| | - Max J. H. Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | | | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
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17
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Kempenaers K, VAN Beek N, Lauwers R, Tengrootenhuysen M. Total knee arthroplasty: do newer CR implants yield better results? A single center prospective study. Acta Orthop Belg 2023; 89:477-483. [PMID: 37935232 DOI: 10.52628/89.3.11325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The aim of this study was to compare whether the newest TKA prosthesis (Persona) gives improved clinical outcomes due its more anatomical design in comparison to older prostheses (balanSys). This study included a total of 89 patients planned for TKA from June 2018 to September 2019. Outcomes such as Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion (ROM), numeric pain rating scale (NRS), analgesics and alignment were recorded next to patient characteristics and complications. Our results showed a significant improvement in NRS, ROM and functional scores postoperatively compared to preoperatively for both the Persona and the balanSys implants. Although the flexion ROM for the Persona group was higher at 6 and 12 months postoperative compared to the balanSys, this was mainly a regaining of the preoperative ROM. Throughout all timepoints, there were no statistically significant differences observed in NSAID and opioid usage between the balanSys and Persona groups. Both implants are safe and efficient to use in the treatment of knee osteoarthritis. Although Persona had an improved postoperative flexion, this did not have an impact on any of the patient-reported outcomes.
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18
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Itou J, Kuwashima U, Itoh M, Okazaki K. Open-wedge high tibial osteotomy with a slight valgus correction from neutral limb alignment achieves clinical improvements comparable with those for knees with varus deformity. J Exp Orthop 2023; 10:75. [PMID: 37515658 PMCID: PMC10386984 DOI: 10.1186/s40634-023-00640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
PURPOSE The effect of open-wedge high tibial osteotomy (OWHTO) on the preoperative neutral alignment of the knee is unknown. The purpose of this study was to clarify the clinical outcome of OWHTO with neutral alignment, defined as within 4 degrees of varus. METHODS This retrospective study included 72 knees with varus that underwent medial OWHTO. The knees were divided according to the preoperative hip-knee-ankle angle into a neutral alignment group (≤ 4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Forgotten Joint Score-12 (FJS-12) were evaluated preoperatively and during at least 2 years of follow-up postoperatively. RESULTS There were no significant differences between the preoperative FJS-12 (17.9 versus 23.7; p = 0.16) and postoperative FJS-12 (57.3 versus 60.6; p = 0.52) or KOOS subscale scores (p > 0.05) in the neutral alignment group or the varus alignment group. Each group had a mean change in the KOOS subscale scores that exceeded the minimum clinically important difference. CONCLUSION The short-term clinical results of OWHTO for neutral alignment were as favourable as those for varus malalignment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
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19
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Hamilton JL, Mills JA, Stebbins GT, Long JD, Fuller RLM, Sathe S, Roché M, Sampaio C. Defining Clinical Meaningfulness in Huntington's Disease. Mov Disord 2023. [PMID: 37147862 DOI: 10.1002/mds.29394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/10/2023] [Accepted: 03/15/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Minimal clinically important difference (MCID) represents the smallest within-person change on an outcome measure considered meaningful to the patient. Anchor-based MCID methods evaluate the relationship between changes in an outcome measure and the patient-reported clinical importance of that change. OBJECTIVE This study aims to estimate longitudinal MCID for clinically relevant outcome measures for individuals who have Stages 2 or 3 disease as measured by the Huntington's Disease Integrated Staging System (HD-ISS). METHODS Data were drawn from Enroll-HD, a large global longitudinal, observational study and clinical research platform for HD family members. We analyzed HD participants (N = 11,070) by staging group using time frames ranging from 12 to 36 months. The anchor was the physical component summary score of the 12-item short-form health survey. HD-relevant motor, cognitive, and functional outcome measures were independent, external criterion outcomes. Complex analysis was conducted using multiple, independent, linear mixed effect regression models with decomposition to calculate MCID for each external criterion by group. RESULTS MCID estimates varied by progression stage. MCID estimates increased as stage progression increased and as the time frame increased. MCID values for key HD measures are provided. For example, starting in HD-ISS stage 2, meaningful group change over 24 months equals an average increase of 3.6 or more points on the Unified Huntington's Disease Rating Scale Total Motor Score. CONCLUSIONS This is the first study to examine MCID estimation thresholds for HD. The results can be used to improve clinical interpretation of study outcomes and enable treatment recommendations to support clinical decision-making and clinical trial methodology. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jamie L Hamilton
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | - James A Mills
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
| | - Glenn T Stebbins
- Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeffrey D Long
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, USA
| | - Rebecca L M Fuller
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | - Swati Sathe
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | - Matt Roché
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | - Cristina Sampaio
- Clinical Department, CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
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Wang S, Li B, Yu X, Wu H, Liu L. Is Ankle Arthrodesis With an Ilizarov External Fixator an Effective Treatment for Septic Ankle Arthritis? A Study With a Minimum of 6 Years of Follow-up. Clin Orthop Relat Res 2023; 481:717-725. [PMID: 36136051 PMCID: PMC10013661 DOI: 10.1097/corr.0000000000002418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/30/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Septic ankle arthritis is a devastating clinical problem with a high potential for permanent disability and amputation. Successful treatment of septic ankle arthritis remains a challenge for the surgeon and patient. Ankle arthrodesis combined with radical debridement may be an effective option to eradicate infection and salvage the limb. Although numerous fusion methods have been proposed, there is controversy about the most effective technique. QUESTIONS/PURPOSES At a minimum follow-up of 6 years after ankle arthrodesis performed using an Ilizarov external fixator, we asked, (1) In what proportion of patients was bony fusion achieved? (2) What complications were observed, and what reoperations were performed in these patients? (3) How much did patient-reported outcomes improve from before surgery to the most recent follow-up in this group? METHODS Between April 2010 to March 2015, we treated 59 patients for septic ankle arthritis. Of those, we considered patients who were at least 18 years of age with irreversible destruction of the joint as potentially eligible. During that time period, all patients met the prespecified criteria and were treated with ankle arthrodesis using an Ilizarov external fixator. Two percent (one of 59) of patients were excluded because they died in the second year after surgery for reasons unrelated to the procedure, and another 7% (four of 59) of patients were excluded because they were lost before the minimum study follow-up interval of 6 years. Finally, 92% (54 of 59) of patients were analyzed at a mean follow-up time of 9 ± 1 years. A total of 61% (33 of 54) were men, and they had a mean age of 48 ± 12 years. Forty-six percent (25 of 54) of patients were smokers, and 13% (seven of 54) of patients had Type 2 diabetes mellitus. All patients received radical debridement and primary arthrodesis with an Ilizarov external fixator, followed by antibiotic therapy. Postoperatively, patients were instructed to perform lower extremity functional exercises and external fixator care; weightbearing ambulation as tolerated was encouraged as early as possible. Fusion was assessed with a radiographic review that was performed by an individual who was not involved in the surgical care of these patients. We defined bony fusion as continuous trabeculae and complete cortical bridging in the fusion interface achieved before 9 months; delayed union was defined as fusion achieved by 9 to 12 months; and nonunion was defined as patients in whom fusion was not achieved by 12 months. Complications and reoperations were tallied through a record review that was performed by an individual who was not involved in the surgical care of these patients. We defined complications as any deviation from the expected postoperative course. We used the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the VAS active pain score, and the SF-12 questionnaire (including the physical component summary [PCS] score and mental component summary [MCS] score) to assess patient-reported outcomes. The minimum clinically important difference (MCID) for the AOFAS score was 30 points of 100, the MCID for the VAS active pain score was 2 points of 10, and the MCID of PCS and MCS scores was 7 points and 9 points, respectively. RESULTS Primary bony fusion was achieved in 94% (51 of 54) of patients. Delayed union was found in 2% (one of 54) of patients. Nonunion was found in 6% (three of 54); one of these patients underwent autologous bone grafting during revision, and bony fusion was ultimately achieved. Final bony fusion was achieved in 96% (52 of 54) of patients. Recurrent infection was found in 2% (one of 54). The median (range) AOFAS score improved from 28 points (8 to 59) before surgery to 80 points (52 to 86) at the most recent follow-up (median difference 52; p < 0.001). The median (range) VAS active pain score decreased from 8 points (6 to 9) before surgery to 2 points (0 to 5) at the most recent follow-up (median difference -6; p < 0.001). For the Short Form 12-item score, the median (range) PCS score improved from 0 points (0 to 30) before surgery to 70 points (40 to 95) at the most recent follow-up (median difference 70; p < 0.001), and the median (range) MCS score improved from 46 points (21 to 75) before surgery to 75 points (50 to 92) at the most recent follow-up (median difference 29; p < 0.001). CONCLUSION Ankle arthrodesis with Ilizarov external fixation might eradicate an infection and restore foot function in patients with septic ankle arthritis. However, patients should be fully informed of the complications related to the external fixator, such as pin-tract infections, recurrent infection, and nonunion. Standardized and professional pin care is important. Additionally, because Ilizarov external fixators can be inconvenient to the patients' daily lives, future studies should explore how psychologic support affects patients who undergo ankle arthrodesis with these devices. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Bohua Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xiaojun Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Lei Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P. R. China
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MCID and PASS in Knee Surgeries. Theoretical Aspects and Clinical Relevance References. Knee Surg Sports Traumatol Arthrosc 2023; 31:2060-2067. [PMID: 36897384 DOI: 10.1007/s00167-023-07359-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
The application and interpretation of patient-reported outcome measures (PROM), following knee injuries, pathologies, and interventions, can be challenging. In recent years, the literature has been enriched with metrics to facilitate our understanding and interpretation of these outcome measures. Two commonly utilized tools include the minimal clinically important difference (MCID) and the patient acceptable symptoms state (PASS). These measures have demonstrated clinical value, however, they have often been under- or mis-reported. It is paramount to use them to understand the clinical significance of any statistically significant results. Still, it remains important to know their caveats and limitations. In this focused report on MCID and PASS, their definitions, methods of calculations, clinical relevance, interpretations, and limitations are reviewed and presented in a simple approach.
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Kuwasawa A, Okazaki K, Noda K, Fukushima T, Nihei K. Intra-articular injection of culture-expanded adipose tissue-derived stem cells for knee osteoarthritis: Assessments with clinical symptoms and quantitative measurements of articular cartilage volume. J Orthop Sci 2023; 28:408-415. [PMID: 35063331 DOI: 10.1016/j.jos.2021.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/13/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intra-articular administration of adipose tissue-derived stem cells (ADSC) is an alternative treatment option for knee osteoarthritis (OA) after conventional treatment fails; however, the clinical results related to the severity of OA grade and changes of cartilage volumes after the administration of ADSC is unknown. This study aimed to determine 1) clinical outcomes after the ADSC administration in knee OA with consideration of radiographic OA grades and 2) changes in cartilage volumes after ADSC administration. METHODS This observational study included 86 knees from 51 patients who underwent intra-articular administration of cultured ADSC; 47 patients (80 knees) completed follow-up for 6 months (follow-up rate: 93%). The Knee injury and Osteoarthritis Outcome Scores (KOOS) were reported at baseline and 1, 3, and 6 months after the administration. The efficacy rate in the Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) was evaluated using the KOOS. Cartilage volume of the knee joint was measured using quantitative 3-dimensional magnetic resonance imaging (3D-MRI) software at baseline and 6 months in 52 knees in 31 patients (follow-up rate: 61%). RESULTS All items on the KOOS except "sports/recreation" improved significantly at 6 months with more significance in knees with a Kellgren-Lawrence (KL) grade 2 or 3 compared with KL grade 4 knees. The OMERACT-OARSI responder at 6 months was significantly greater in knees with KL grade 2 or 3 (64%) than in knees with KL grade 4 (42%, p = 0.045). Cartilage volume changes varied among patients and were not related to the changes in KOOS after ADSC administration. CONCLUSIONS Intra-articular administration of ADSC in knee OA improved KOOS at 6 months. The effects were more significant in knees with KL grade 2 or 3 than with KL grade 4. Changes in KOOS were not related to change in cartilage volumes after ADSC administration.
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Affiliation(s)
- Ayano Kuwasawa
- Department of Orthopaedic Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi, Saitama, 333-0831 Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, 162-8666 Japan.
| | - Kuniko Noda
- Department of Orthopaedic Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi, Saitama, 333-0831 Japan
| | - Takashi Fukushima
- Department of Orthopaedic Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi, Saitama, 333-0831 Japan
| | - Kotaro Nihei
- Department of Orthopaedic Surgery, Saitama Cooperative Hospital, 1317 Kizoro, Kawaguchi, Saitama, 333-0831 Japan
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23
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Superior survivorship and plate-related results of TomoFix compared to Puddu plate fixation for opening-wedge high tibial osteotomy: A systematic review of the literature. Knee 2023. [PMID: 36863116 DOI: 10.1016/j.knee.2023.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE This systematic review aimed to compare survivorship and plate-related results of Puddu and TomoFix plates in opening-wedge high tibial osteotomy (OWHTO). METHODS PubMed, Scopus, EMBASE, and CENTRAL databases were searched from January 2000 until September 2021 for clinical studies involving patients with medial compartment knee disease and varus deformity undergoing OWHTO using the Puddu or TomoFix plating systems. We extracted survival data, plate-related complications, and functional and radiological outcomes. The risk of bias assessment had been carried out using Cochrane Collaboration's quality assessment tool for randomised controlled trials (RCTs) and Methodological Index for Non-Randomised Studies (MINORS). RESULTS Twenty-eight studies were included. The total number of knees was 2568 in 2372 patients. The Puddu plate was used in 677 knees, while the TomoFix plate was used in 1891. The follow-up ranged from 5.8 to 147.6 months. Both plating systems were able to delay conversion to arthroplasty at different follow-up intervals. However, osteotomies fixed by the TomoFix plate achieved higher survival rates, especially at mid-term and long-term follow-ups. In addition, fewer complications were reported with the TomoFix plating system. Although both implants achieved satisfactory functional outcomes, high scores could not be maintained throughout long-term intervals. Regarding radiological results, TomoFix plate was able to achieve and maintain larger degrees of varus deformity, while preserving the posterior tibial slope. CONCLUSIONS This systematic review demonstrated the superiority of the TomoFix over the Puddu system as a safer and more effective fixation device in OWHTO. Nevertheless, these results should be interpreted with caution due to the lack of comparative evidence through high-quality RCTs.
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Roth W, Hoch C, Gross CE, Scott DJ. First metatarsophalangeal arthrodesis outcomes for hallux rigidus versus hallux valgus. Foot Ankle Surg 2023; 29:50-55. [PMID: 36210270 DOI: 10.1016/j.fas.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compared radiographic and functional patient outcomes of 1st MTP arthrodesis between hallux rigidus (HR) and hallux valgus (HV) cohorts. METHODS A retrospective review was conducted at an academic medical center on patients who underwent 1st MTP arthrodesis during 2009-2021. In total, 136 patients (148 feet: HR=57, HV=47, combined=44) met the inclusion criteria of minimum three-month follow-up (mean=1.25 years, range=0.25-6.14 years). Data collection included patient-reported outcome measures (PROMs), radiographic markers, and complication and reoperation rates. RESULTS PROMs improved overall, with HV patients significantly improving the least. The HR group had a significantly smaller improvement in HV angle (HR=-3.6, HV=-17, Combined=-15 p < .001), intermetatarsal angle (H=-0.16, HV=-2.8, Combined=-2.6 p < .001), and 1st-5th metatarsal width (HR=-0.98, HV=-4.6, Combined=-4.6, p < .001). Complication and reoperation rates did not differ by group. CONCLUSION Outcomes of 1st MTP arthrodesis does not appear to differ between diagnostic indications of hallux rigidus, hallux valgus, or both. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Warren Roth
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Caroline Hoch
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Christopher E Gross
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA
| | - Daniel J Scott
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
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Tibial Derotational Osteotomy for Patellofemoral Instability: A Systematic Review. Adv Orthop 2022; 2022:8672113. [PMID: 36620474 PMCID: PMC9812606 DOI: 10.1155/2022/8672113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/15/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction The etiology of patellofemoral (PF) instability is multifactorial. Excessive external tibial torsion has been associated with recurrent patellar subluxation and persistent anterior knee pain. Several surgical techniques have been historically used to correct this, including medial patellofemoral ligament reconstruction, tibial tuberosity transfer (TTT), trochleoplasty, and tibial derotation osteotomy (TDO). The purpose of this systematic review is to investigate the safety and efficacy of TDO for PF instability and pain. Methods A thorough search of the literature was conducted on July 15, 2022. Seven studies met the inclusion criteria for this systematic review. Results Among the included studies, there were 179 total subjects and 204 operative knees. Mean follow-up time was 66.31 months (range 11-192). Complication rate was low (12.8%) in studies that reported complications. Average degree of anatomical correction in the transverse plane was 19.9 degrees with TDO. This increased to 34 degrees when combined with TTT. All PROMs assessed were significantly increased postoperatively (p < 0.05). Age greater than 25 years and advanced PF chondromalacia may negatively affect postoperative outcomes. Conclusion The primary findings of this review were as follows: (1) TDO results in significantly improved pain and PROM ratings in patients with PF pain and/or instability, (2) the likelihood of complication, including recurrent patella subluxation after TDO, is low but may be increased by aging, and (3) the successful anatomical correction of TDO may be augmented by concurrent TTT in some cases.
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Amemiya M, Nakamura R, Yoshimura M, Takagi T. Proximal tibiofibular joint (PTFJ) dislocation due to Ehlers-Danlos syndrome: posterolateral open-wedge high tibial osteotomy combined with medial closed-wedge distal femoral osteotomy can correct the severe valgus deformity with a markedly increased tibial posterior slope. BMJ Case Rep 2022; 15:15/11/e250308. [PMID: 36446469 PMCID: PMC9710336 DOI: 10.1136/bcr-2022-250308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Ehlers-Danlos syndrome (EDS) causes joint hypermobility and joint dislocation. Since there are no reports of proximal tibiofibular joint (PTFJ) dislocation caused by EDS, little is known about the long-term course of this disease. A woman in her 40s presented with a posterolaterally depressed tibial condyle and severe valgus deformity caused by a long-standing PTFJ dislocation due to EDS. Considering the pathology, posterolateral open-wedge high tibial osteotomy (PLOWHTO) and medial closed-wedge distal femoral osteotomy were performed according to the deformity analysis. A favourable short-term clinical outcome was obtained and the PTFJ dislocation was reduced over time. Although PLOWHTO has several pitfalls, it is a logical and useful surgical technique that can help treat posterolateral dysplasia of the tibial plateau concomitant with severe valgus deformity, regardless of joint laxity, if performed with attention to pitfalls.
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Affiliation(s)
- Masaki Amemiya
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Japan,Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuichi Nakamura
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, Japan
| | | | - Tomoharu Takagi
- Orthopaedic Surgery, Fukui-ken Saiseikai Hospital, Fukui, Japan
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Sung YG, Yoon H, Park DC, Kim MS, In Y. Clinical Usefulness of SPECT/CT for Assessing Postoperative Outcomes After Medial Opening-Wedge High Tibial Osteotomy. Orthop J Sports Med 2022; 10:23259671221121083. [PMID: 36250032 PMCID: PMC9561658 DOI: 10.1177/23259671221121083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Qualitative studies have explored changes in Tc-99m hydroxymethylene
diphosphonate (HDP) uptake on single-photon emission computed tomography and
computed tomography (SPECT/CT) as a result of offloading after medial
opening-wedge high tibial osteotomy (MOWHTO) in patients with medial
compartment knee osteoarthritis. However, whether changes in the Tc-99m HDP
uptake on SPECT/CT reflect the degree of clinical improvement in
postoperative outcomes, especially when using minimal clinically important
differences (MCIDs), has not been investigated. Purpose: To investigate the association between changes in Tc-99m HDP uptake on
SPECT/CT and MCID-based improvement on the Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC) score in patients who underwent
MOWHTO. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study included 35 knees in 31 patients who underwent MOWHTO. SPECT/CT was
performed preoperatively and 3 years postoperatively with clinical and
radiological assessments. On SPECT/CT, the knee joint was divided into 10
regions, and the radiotracer uptake amount of each region was divided by the
uptake amount of the reference zone. Patients were divided into 2 groups
based on whether they achieved the MCID of 16.1 points on the WOMAC at 3
years postoperatively, and changes in uptake amount on SPECT/CT were
compared between the groups. Results: At 3 years postoperatively, 22 patients achieved the MCID on the WOMAC
(62.9%; above-MCID group) and 13 patients did not (37.1%; below-MCID group).
In the above-MCID group, significant improvement was observed in the WOMAC
after MOWHTO (from 55.8 to 19.6; P < .05); however,
significant improvement was not observed in the below-MCID group (from 38.8
to 32.3; P = .100). Based on mean change of uptake on
SPECT/CT in each region, the above-MCID group showed significantly greater
reduction of uptake on SPECT/CT than the below-MCID group in the femoral
anteromedial compartment (P = .004), tibial anteromedial
compartment (P = .009), and tibial anterolateral
compartment (P = .031). Conclusion: Reduction in radiotracer uptake on SPECT/CT of the knee joint reflected
clinical improvement in patient-reported outcomes following MOWHTO.
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Affiliation(s)
- Yong Gyu Sung
- Department of Orthopaedic Surgery, Seoul St Mary’s Hospital, College
of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyukjin Yoon
- Division of Nuclear Medicine, Department of Radiology, St Vincent’s
Hospital, College of Medicine, The Catholic University of Korea, Suwon-si, Republic
of Korea
| | - Dong Chul Park
- Department of Orthopaedic Surgery, Seoul St Mary’s Hospital, College
of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St Mary’s Hospital, College
of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St Mary’s Hospital, College
of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Yong In, MD, PhD, Department of Orthopaedic Surgery, Seoul St
Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222,
Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (
)
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28
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Ahmed I, Dhaif F, Khatri C, Parsons N, Hutchinson C, Staniszewska S, Price A, Metcalfe A. The meniscal tear outcome (METRO) review: A systematic review summarising the clinical course and outcomes of patients with a meniscal tear. Knee 2022; 38:117-131. [PMID: 36041240 DOI: 10.1016/j.knee.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes. METHOD A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson's correlations were calculated between outcome timepoints. RESULTS 35 studies were included, 28 reported outcomes following APM; four following meniscal repair and three following meniscal transplant. Graphical plots demonstrated a sustained improvement for all treatment interventions. A moderate to very strong correlation was reported between baseline and three-month outcomes. In the medium term, there was small significant difference in outcome between APM and non-operative measures (SMD 0.17; 95 % CI 0.04, 0.29), however, this was not clinically significant. CONCLUSIONS Patients with a meniscal tear demonstrated a sustained initial improvement in function scores, which was true of all treatments examined. APM may have little benefit in older people, however, previous trials did not include patients who meet the current indications for surgery as a result the findings should not be generalised to all patients with a meniscal tear. Further trials are required in patients who meet current operative indications.
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Affiliation(s)
- Imran Ahmed
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
| | - Fatema Dhaif
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
| | - Chetan Khatri
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
| | - Nicholas Parsons
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV47AL, United Kingdom.
| | - Charles Hutchinson
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
| | - Sophie Staniszewska
- Warwick Medical School, University of Warwick, Coventry CV47AL, United Kingdom.
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Headington, Oxford OX3 7LD, United Kingdom.
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, Clinical Sciences and Research Laboratories, University Hospital Coventry and Warwickshire, Coventry CV22DX, United Kingdom.
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29
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Piovan G, Farinelli L, Screpis D, Iacono V, Povegliano L, Bonomo M, Auregli L, Zorzi C. Distal femoral osteotomy versus lateral unicompartmental arthroplasty for isolated lateral tibiofemoral osteoarthritis with intra-articular and extra-articular deformity: a propensity score-matched analysis. Knee Surg Relat Res 2022; 34:34. [PMID: 35851077 PMCID: PMC9290203 DOI: 10.1186/s43019-022-00164-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Lateral unicompartmental arthroplasty (UKA) and distal femoral osteotomy (DFO) represent surgical solutions in cases of valgus malalignment and isolated lateral osteoarthritis (OA) of the knee. The aim of the present study was to assess the clinical results, complications, and the overall postoperative alignment of a series of DFO and lateral UKA with a minimum 2-year follow-up in active middle-aged patients. Methods Patients with valgus knee and isolated lateral OA who underwent opening-wedge DFO or UKA from 2017 to 2019 were reviewed. Each patient was characterized by a joint line convergence angle (JLCA) > 3° and mechanical lateral distal femoral angle (mLDFA) < 87°. We excluded patients who underwent meniscus or osteochondral allograft during DFO. The Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), complications, and postoperative alignment were assessed. Propensity score matching was used to identify comparable patients. Results The DFO and lateral UKA groups consisted of 29 patients each. No statistically significant differences in gender, age, body mass index (BMI), length of follow-up, or limb deformity were reported between the two groups. In the DFO group, OKS was reported to improve from 27.51 to 38.59 (p < 0.05) and KOOS from 51.14 to 67.2 (p < 0.05). Similarly, in the UKA group, OKS improved from 26.23 to 35.43 (p < 0.05) and KOOS from 50.12 to 65.91 (p < 0.05). However, the improvement in OKS and KOOS (delta) did not differ between groups (p = 0.35 and p = 0.95). The DFO and UKA groups were characterized by similar postoperative hip-knee-ankle (HKA) angle measurements of −3.26 and −3.00, respectively (p = 0.65). No patients in the UKA group underwent revision or other knee surgeries during follow-up. No infections were detected in either group. In the DFO group, no cases of nonunion or delayed union were reported. However, 40% of DFO patients underwent plate removal. One patient in each group was characterized by progression of medial OA with Kellgren-Lawrence (KL) grade > 3. Conclusion UKA and DFO represent an effective treatment in lateral knee OA with intra-articular and extra-articular deformity. Both surgeries were able to provide a significant and comparable clinical improvement. Level of evidence: III, comparative retrospective cohort study.
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Affiliation(s)
- Gianluca Piovan
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Daniele Screpis
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Venanzio Iacono
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Lorenzo Povegliano
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Marco Bonomo
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Ludovica Auregli
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Claudio Zorzi
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
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30
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Itou J, Kuwashima U, Itoh M, Okazaki K. High tibial osteotomy for medial meniscus posterior root tears in knees with moderate varus alignment can achieve favorable clinical outcomes. J Exp Orthop 2022; 9:65. [PMID: 35796797 PMCID: PMC9263016 DOI: 10.1186/s40634-022-00504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Favorable clinical results have been reported following high tibial osteotomy (HTO) for medial meniscus posterior root tear (MMPRT) in knees with varus alignment. However, the effect on the preoperative neutral alignment of the knee is not known. This study sought to evaluate the clinical outcomes of medial open-wedge HTO for MMPRT with neutral alignment. Methods We retrospectively reviewed 119 medial open-wedge HTOs and analyzed 22 knees with MMPRT. The knees were divided according to the preoperative hip-knee-ankle angle into a moderate varus alignment group (≤4° of varus alignment) and a varus alignment group (> 4° of varus alignment). The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score-12 (FJS-12) values were evaluated preoperatively and at the latest follow-up. The healing status of MMPRT at the time of second-look arthroscopy, performed at a mean of 15.4 ± 4.2 months, was compared with that after the primary HTO. Results There were 11 knees in the moderate varus alignment group and 11 in the varus alignment group. In terms of perioperative patient-reported outcome measures, there was no significant difference in the preoperative or postoperative KOOS subscale score or FJS-12 score between the moderate varus and varus alignment groups. The healing rate was significantly higher in the moderate varus alignment group. Conclusion Favorable clinical results were obtained by medial open-wedge HTO in knees with MMPRT and moderate varus alignment in the short term. Surgeons should consider the indications for medial open-wedge HTO, even with moderate varus alignment, when planning treatment for MMPRT with persistent knee pain. Level of evidence IV Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00504-9.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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31
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Liu G, Chen J, Xiang Z. Five-year outcomes of trauma-specific function in patients after acute blunt popliteal artery injury: a matched cohort analysis. J Orthop Surg Res 2022; 17:256. [PMID: 35525991 PMCID: PMC9077808 DOI: 10.1186/s13018-022-03145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/26/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Few studies focus on the trauma-specific functional outcomes after surgical revascularization and risk factors contributing to poor outcomes in patients with acute blunt popliteal artery injury (PAI). The objective of this study was to investigate the long-term trauma-specific functional outcomes in patients with acute blunt PAI and identify the associated risk factors. METHODS There were 36 patients with acute blunt PAI who require surgical revascularization at a national trauma center of West China Hospital of Sichuan University between March 2010 and April 2019. After propensity matching, each patient was matched to one patient who did not have a concomitant vascular injury in control cohort. Functional outcomes were assessed with trauma-specific functional scores, physical examination of range of motion, nerve functional status and knee stability. A logistics regression model was established to determine the independent risk factors. RESULTS The 5-year (range 2-10 years) follow-up showed that 22 patients (22/36, 61.1%) had functional deficit due to limited activity or chronic neurological symptoms. Patients in vascular cohort had significantly decreased FIM score and AHFS score compared with matched patients without vascular involvement (P = 0.003 and P < 0.001), whereas there was no statistically significant difference in KSS (P = 0.136). Spearman correlation analysis of functional scores in vascular cohort showed that the FIM score was positively correlated with AHFS score (r = 0.926, P < 0.001), but not correlated with the KSS (r = - 0.007, P = 0.967). Additionally, there was significant difference in the range of motion of ankle between two groups (P < 0.001 and P = 0.034). Logistic regression analysis further demonstrated nerve injuries and compartment syndrome were risk factors for poor ankle function after surgery (OR 22.580, P = 0.036 and OR 12.674, P = 0.041). CONCLUSION Most patients who sustained blunt PAI had significant functional deficit associated with limited activity and chronic neurological symptoms of ankle and foot, and poor functional outcomes were related to nerve injury and compartment syndrome. Therefore, early and effective decompression for compartment syndrome remains the only potentially modifiable risk factor for improving functional outcomes following PAI.
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Affiliation(s)
- Gang Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Jialei Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Zhou Xiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
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32
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Herbst E, Günther D, Ackermann J, Lattermann C, Mathis D, Schüttler KF, Wafaisade A, Eggeling L, Akgün D, Rössler P, Laky B, Kopf S. Empfehlung für Fragebögen zur klinischen und subjektiven Untersuchung der Kniegelenksfunktion vom Research-Komitee der AGA. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00538-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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33
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Bae JK, Kim JH, Kim KI, Lee SH, Seo DW. Serial Improvement of Medial Meniscus Extrusion Following Medial Open-Wedge High Tibial Osteotomy Does Not Correlate With Clinical Outcomes and Arthroscopic Articular Cartilage Improvement. Arthroscopy 2022; 38:928-935. [PMID: 34324963 DOI: 10.1016/j.arthro.2021.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess serial change up to 2 years in medial meniscus extrusion (MME) following medial open-wedge high tibial osteotomy (MOWHTO) and to determine whether postoperative changes in MME correlated with clinical outcomes and arthroscopic articular cartilage status. METHODS This study included 26 patients from December 2016 to March 2018 who underwent MOWHTO for primary medial osteoarthritis with varus malalignment. Second-look arthroscopy with plate removal was performed at postoperative 2 years. MME was consecutively measured using coronal magnetic resonance imaging at preoperative and postoperative 3 months, 6 months, 1.5 years, and 2 years. We also assessed which preoperative parameters could reflect the postoperative changes in MME and evaluated whether postoperative clinical outcomes and arthroscopic articular cartilage improvement would be influenced by the MME changes. RESULTS Regarding the postoperative serial changes in MME values, significant improvement in MME was noted from postoperative 6 months (P = .003), and thereafter, mean MME was further improved with time until postoperative 2 years (P < .001). Regarding the correlation between preoperative parameters and MME changes, preoperative medial proximal tibial angle (MPTA) showed significant correlations in univariate and multivariate analysis (P = .004 and P = .004, respectively). Meanwhile, changes in MME were not correlated with postoperative clinical outcomes or arthroscopic articular cartilage improvement. CONCLUSION After MOWHTO, MME improved with time and was significantly correlated with preoperative MPTA. However, the changes in MME after MOWHTO did not reflect postoperative clinical and arthroscopic articular cartilage improvement. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Jung-Kwon Bae
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea; Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea; Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Dong-Won Seo
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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34
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Seiferth NL, Faber SO, Angele P, Kniffler H, Loer I, Schauf G, Spahn G, Zinser W, Niemeyer P. Effect of Previous Knee Surgery on Clinical Outcome After ACI for Knee Cartilage Defects: A Propensity Score-Matched Study Based on the German Cartilage Registry (KnorpelRegister DGOU). Am J Sports Med 2022; 50:994-1005. [PMID: 35373607 DOI: 10.1177/03635465211070536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is an established procedure for the treatment of cartilage damage in the knee joint. At present, it is still unclear how previous surgery influences outcome after ACI. PURPOSE To evaluate the effect of previous knee surgery related or nonrelated to the treated cartilage defect on clinical outcome after ACI for knee cartilage defects. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS An overall 730 patients with ACI who underwent previous unspecific knee surgery, whether related to the defect being currently treated or not, were identified from a cohort of 5961 patients registered in the German Cartilage Registry. Propensity score matching was used to match these patients to 690 patients with analogous characteristics but without previous surgery. Subsequently, 317 patients with previously failed cartilage treatment at the defect site were identified and compared with a matched collective of 254 patients without previous cartilage treatment. In a subgroup analysis, the type of previous cartilage surgery was additionally investigated. Outcome was evaluated by Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain, rate of reintervention, and patient satisfaction up to 36 months. A chi-square test was used to compare categorial variables and an unpaired t test to compare continuous variables. RESULTS Patients with previous knee surgery not related to the cartilage defect showed a lower KOOS at 6 months (68.3 vs 70.8; P = .026), while patients with previous cartilage surgery showed significantly lower KOOS values at all follow-up time points when compared with patients without any previous knee or cartilage surgery (all P < .05). A comparison of KOOS values in patients with previous therapy at the cartilage defect with ACI versus bone marrow stimulation did not show any significant differences at any follow-up. CONCLUSION Previously failed cartilage treatment at the defect site represents a negative prognostic factor up to 3 years after ACI. However, this influence appears to be independent of the type of previous treatment at the defect site and applies equally to failed bone marrow stimulation as well as previous ACI. In contrast, a negative effect of previous surgery to the knee unrelated to the cartilage defect could not be shown in the 3-year follow-up.
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Affiliation(s)
- Nick L Seiferth
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany.,Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Svea O Faber
- OCM
- Orthopaedische Chirurgie München, Munich, Germany
| | - Peter Angele
- University Medical Center Regensburg, Regensburg, Germany.,Sporthopaedicum Regensburg/Straubing, Regensburg, Germany
| | | | - Ingo Loer
- Orthopaedie in Essen, Essen, Germany
| | | | - Gunter Spahn
- Praxisklinik für Unfallchirurgie und Orthopaedie Eisenach, Eisenach, Germany
| | - Wolfgang Zinser
- Praxisklinik für Unfallchirurgie und Orthopaedie Eisenach, Eisenach, Germany
| | - Philipp Niemeyer
- Department of Orthopedics and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert Ludwig University of Freiburg, Freiburg, Germany.,OCM
- Orthopaedische Chirurgie München, Munich, Germany
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35
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Lopresti AL, Smith SJ, Jackson-Michel S, Fairchild T. An Investigation into the Effects of a Curcumin Extract (Curcugen ®) on Osteoarthritis Pain of the Knee: A Randomised, Double-Blind, Placebo-Controlled Study. Nutrients 2021; 14:nu14010041. [PMID: 35010916 PMCID: PMC8746505 DOI: 10.3390/nu14010041] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 02/06/2023] Open
Abstract
Curcumin, a phytochemical from the spice turmeric, has anti-inflammatory properties and has been shown to have pain-relieving effects. In this 8-week, randomised, double-blind, placebo-controlled study, 101 adults with knee osteoarthritis received either 500 mg twice daily of a standardised curcumin extract (Curcugen®) or placebo. Outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS), knee pain ratings, Japanese Orthopaedic Association Score for Osteoarthritic Knees (JOA), PROMIS-29, and performance-based testing comprising the 40-m fast-paced walk test, 6-min walk test, timed up-and-go test, and 30-s chair stand test. Compared to the placebo, curcumin significantly reduced the KOOS knee pain score (p = 0.009) and numeric knee pain ratings (p = 0.001). Curcumin was also associated with greater improvements (p ≤ 0.05) than the placebo on the timed up-and-go test, 6-min walk test, and the JOA total score; but not the 30-s chair stand test or 40-m fast-paced walk test. Pain-relieving medication was reduced in 37% of participants on curcumin compared to 13% on placebo. The findings support the potential efficacy of curcumin for the treatment of osteoarthritis of the knee but studies of longer duration, varying treatment doses, differing curcumin extracts, and the use of other objective outcome measures will be helpful to expand on these findings.
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Affiliation(s)
- Adrian L. Lopresti
- Clinical Research Australia, Perth, WA 6023, Australia;
- College of Science, Health, Engineering and Education, Murdoch University, Perth, WA 6150, Australia;
- Correspondence: ; Tel.: +61-8-94487376
| | - Stephen J. Smith
- Clinical Research Australia, Perth, WA 6023, Australia;
- College of Science, Health, Engineering and Education, Murdoch University, Perth, WA 6150, Australia;
| | | | - Timothy Fairchild
- College of Science, Health, Engineering and Education, Murdoch University, Perth, WA 6150, Australia;
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36
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Tawy G, Shahbaz H, McNicholas M, Biant L. The Relationships between Coronal Plane Alignments and Patient-Reported Outcomes Following High Tibial Osteotomy: A Systematic Review. Cartilage 2021; 13:132S-146S. [PMID: 33884908 PMCID: PMC8808848 DOI: 10.1177/19476035211007903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This systematic review aimed to determine whether coronal angular corrections correlate with patient reported outcomes following valgus-producing high tibial osteotomy (HTO). DESIGN Ovid MEDLINE, Embase, and Web of Science were systematically searched. Studies that reported hip-knee-ankle angles (HKA) or femorotibial angles (FTA), and the Oxford Knee Score (OKS), visual analogue scale (VAS) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), or EQ-5D before and after valgus-producing HTO were eligible. Correlation analyses were performed where appropriate to investigate the relationships between variables. PROSPERO ID: CRD42019135467. RESULTS This study included 39 articles including 50 cohorts. VAS was reported in 22 studies, OKS in 9, KOOS in 12 and EQ-5D in 2. The HKA angle was corrected from 7.1° ± 1.7° varus to 2.3° ± 1.7° valgus at final follow-up. The FTA changed from 3.0° ± 2.0° varus to 7.7° ± 1.3° valgus. Outcome scores improved with clinical and statistical significance postoperatively. Spearman correlations for nonparametric data revealed greater changes in knee alignment were moderately associated with larger improvements in VAS scores (r = 0.50). Furthermore, those who experienced greater changes in alignment showed larger improvements in the KOOS Activity and Quality of Life domains (r = 0.72 and r = 0.51, respectively). CONCLUSION On average, patients did not achieve the "ideal correction" of 3° to 6° valgus postoperatively. Nevertheless, statistical and clinical improvements in patient-reported outcome measure scores were consistently reported. This suggests that the "ideal correction" may be more flexible than 3° to 6°.
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Affiliation(s)
- Gwenllian Tawy
- Division of Cell Matrix Biology &
Regenerative Medicine, School of Biological Sciences, The University of Manchester,
Manchester, UK,Gwenllian Tawy, Division of Cell Matrix
Biology & Regenerative Medicine, School of Biological Sciences, The
University of Manchester, 1.541 Stopford Building, Oxford Road, Manchester, M13
9PG, UK.
| | - Hamza Shahbaz
- Division of Medical Education, School
of Medical Sciences, The University of Manchester, Manchester, UK
| | - Michael McNicholas
- Division of Cell Matrix Biology &
Regenerative Medicine, School of Biological Sciences, The University of Manchester,
Manchester, UK,Department of Orthopaedics, Aintree
University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool,
UK
| | - Leela Biant
- Division of Cell Matrix Biology &
Regenerative Medicine, School of Biological Sciences, The University of Manchester,
Manchester, UK,Manchester Orthopaedic Centre, Trafford
General Hospital, Manchester University NHS Foundation Trust, Manchester, UK,Centre for Health Sciences Research,
University of Salford, Manchester, UK
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37
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Said MKM, Said HG, Elkady H, Said MKM, Ramadan IKA, El-Radi MA. Does arthroscopic patellar denervation with high tibial osteotomy improve anterior knee pain? J Exp Orthop 2021; 8:104. [PMID: 34750692 PMCID: PMC8575725 DOI: 10.1186/s40634-021-00411-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Patellofemoral (PF) joint osteoarthritis (OA) is a major cause of anterior knee pain. Combined PF and medial tibiofemoral (TF) OA is common in older adults. We evaluated the effect of arthroscopic patellar denervation (PD) in patients with combined TF and PFOA after malalignment correction. METHODS Forty-five patients [females/males, 27/18; age, 30-59 years (45.5 ± 8.50); mean body mass index, 25.15 ± 3.04 kg/m2] were treated in our department from March 2017 to March 2019. The patients were randomised into 2 groups: group A included 22 patients who underwent open-wedge high tibial osteotomy (OWHTO) and arthroscopic PD and group B included 23 patients who underwent OWHTO without denervation. The effect of denervation was statistically and clinically evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Kujala (anterior knee pain score) score. RESULTS After 24 months, 40 patients were available for the final follow-up. The final values of KOOS and the Kujala score were significantly different between the groups (p < 0.001). For group A, the average KOOS improved from 42.73 to 72.38 (p < 0.001) and the Kujala score improved from 42 to 74.1 (p < 0.001), whereas in group B, the average KOOS improved from 39.22 to 56.84 (p < 0.001) and the Kujala score improved from 39.7 to 56.4 (p < 0.001). CONCLUSION Adding arthroscopic PD to OWHTO relieves anterior knee pain in patients with combined TF and PFOA and improves knee joint function and quality of life. LEVEL OF EVIDENCE Level I prospective randomised control clinical trial.
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Affiliation(s)
| | - Hatem G Said
- Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Hesham Elkady
- Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
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Lee SM, Bin SI, Kim JM, Lee BS, Suh KT, Song JH. Joint Space Width Increases Medially and Decreases Laterally at Different Time Points After Medial Open-Wedge High Tibial Osteotomy. Arthroscopy 2021; 37:3316-3323. [PMID: 33933572 DOI: 10.1016/j.arthro.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the serial changes in the joint space width (JSW) of the medial and lateral compartments after medial open-wedge high tibial osteotomy (MOWHTO) and its associated factors. METHODS The medial and lateral weight-bearing JSWs were measured on serial radiographs and analyzed preoperatively and postoperatively within 2 weeks, as well as at 3 months, 6 months, 1 year, and 2 years. Associations between the medial and lateral JSWs and age, body mass index, mechanical axis, correction angle, lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle (JLCA), JLCA on stress radiographs, and arthroscopic cartilage status were examined. Clinical outcome was measured according to the Knee Society objective and functional scores. RESULTS Seventy-one patients who underwent MOWHTO with locking-plate fixation were analyzed. The respective mean medial and lateral JSWs on serial radiographs were as follows: 3.08 mm and 5.14 mm preoperatively, 3.10 mm and 4.63 mm postoperatively, 3.37 mm and 4.57 mm at 3 months, 3.40 mm and 4.59 mm at 6 months, 3.44 mm and 4.57 mm at 1 year, and 3.42 mm and 4.64 mm at 2 years. At 3 months, the medial JSW increased (P < .001), whereas the lateral JSW decreased immediately (P < .001). JSW showed no significant differences at other time points. Preoperative and postoperative JLCAs and medial femoral and tibial cartilage grades were associated with medial JSW changes (P = .021). However, no significant parameters were associated with decreases in the lateral JSW (P > .05). The postoperative Knee Society objective and functional scores improved and were maintained. CONCLUSIONS After MOWHTO, the medial JSW increased at 3 months postoperatively and the lateral JSW decreased immediately. The preoperative and postoperative JLCAs and the medial femoral and tibial cartilage grades were associated with the change in the medial JSW. However, no significant parameters were associated with the decrease in the lateral JSW. LEVEL OF EVIDENCE Level IV, case series of therapeutic study.
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Affiliation(s)
- Sang-Min Lee
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan, Republic of Korea; Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kuen Tak Suh
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Yangsan, Republic of Korea; Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Ju-Ho Song
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
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Kim MS, Koh IJ, Choi KY, Sung YG, Park DC, Lee HJ, In Y. The Minimal Clinically Important Difference (MCID) for the WOMAC and Factors Related to Achievement of the MCID After Medial Opening Wedge High Tibial Osteotomy for Knee Osteoarthritis. Am J Sports Med 2021; 49:2406-2415. [PMID: 34115533 DOI: 10.1177/03635465211016853] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many approaches have been used to determine the minimal clinically important difference (MCID) in patients undergoing total knee arthroplasty, but the MCID for outcome measures after medial opening wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis (OA) has not been reported. PURPOSE To define the MCID for the Western Ontario and McMaster Universities Arthritis Index (WOMAC) after MOWHTO and to identify risk factors for not achieving the MCID. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Among patients with medial compartment knee OA who underwent MOWHTO, 174 patients who were followed for 2 years were included in the study. The MCID and substantial clinical benefit (SCB) for the WOMAC were determined using the anchor-based method with a 15-item questionnaire. Preoperative OA severity was measured by the Kellgren-Lawrence (K-L) grading system, and the acceptable range of the postoperative weightbearing line ratio was 50% to 70%. Patients were divided into 2 groups based on whether the MCID and SCB were achieved, and then factors related to failure to achieve the MCID and SCB were analyzed using multivariate logistic regression analysis. RESULTS The MCID for the WOMAC was 4.2 points for the pain subscale, 1.9 points for the stiffness subscale, 10.1 points for the function subscale, and 16.1 points for the total. Additionally, the SCB for the WOMAC was 6.4 for pain, 2.6 for stiffness, 16.4 for function, and 25.3 for the total. Overall, 116 (66.7%), 99 (56.9%), 127 (73.0%), and 128 (73.6%) patients achieved the MCID for the WOMAC pain, stiffness, function, and total, respectively, after MOWHTO. The odds of not achieving the MCID for the WOMAC total were 1.09 times greater (95% CI, 1.05-1.13; P < .001) in patients with a low preoperative WOMAC total score (cutoff values: 10.5 for pain, 3.5 for stiffness, 34.5 for function, and 51.0 for the total), 11.77 times greater (95% CI, 3.68-37.70; P < .001) in patients with K-L grade 4 OA compared with K-L grades 2 or 3 OA, and 8.39 times greater (95% CI, 2.98-23.63; P < .001) in patients with undercorrection or overcorrection. A low preoperative WOMAC score, K-L grade 4 OA, and undercorrection or overcorrection were also associated with not achieving the SCB for the WOMAC total (all P < .05). CONCLUSION Patients treated with a MOWHTO require a 16.1-point improvement in the WOMAC total score to achieve a MCID from the procedure. Low preoperative WOMAC scores, severe OA, and undercorrection or overcorrection were related to failure to achieve the MCID.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Young Choi
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Gyu Sung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Chul Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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