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Chan-Waï-Nam J, Fernandez M, Josse A, Dubrana F. Medial unilateral knee arthroplasty after high tibial osteotomy: A retrospective study of 41 cases. Orthop Traumatol Surg Res 2023; 109:103514. [PMID: 36513325 DOI: 10.1016/j.otsr.2022.103514] [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: 11/15/2021] [Revised: 05/01/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION When medial knee osteoarthritis continues to get worse after a high tibial osteotomy (HTO) procedure, a subsequent total knee arthroplasty (TKA) is typically warranted. Medial unilateral knee arthroplasty (UKA) is not recommended. The aim of this study was to evaluate the outcomes of patients who underwent medial UKA after HTO. HYPOTHESIS Good results can be obtained with this procedure, as long as the postoperative valgus is not excessive. MATERIALS AND METHODS This was a retrospective, single-center study of patients operated between January 2005 and June 2019. The primary endpoint was the Oxford Knee Scale (OKS). The Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), range of motion and complications were the secondary endpoints. The average follow-up was 79 months. RESULTS Forty-one knees in 38 patients were analyzed. Four revisions with implant exchange (10%) were needed. Thirty-seven knees had a mean OKS of 20/60±8 (12-39). The mean flexion and extension amplitude were 123°±8° (110-140) and -1.5°±4 (-15-0), respectively. Eight patients had flexion and/or extension contractures. DISCUSSION Good functional and clinical outcomes in the medium term were achieved for the patients in this study who underwent UKA after HTO. These findings reinforce the good results reported in recent studies of UKA after HTO. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Julie Chan-Waï-Nam
- Orthopedic Surgery Department, hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France.
| | - Marie Fernandez
- Orthopedic Surgery Department, hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France
| | - Antoine Josse
- Pediatric Surgery Department, Hospices civils de Lyon, hôpital mère-enfant, 3, quai des Célestins, 69002 Lyon, France
| | - Frédéric Dubrana
- Orthopedic Surgery Department, hôpital de la Cavale Blanche, boulevard Tanguy Prigent, 29200 Brest, France
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2
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Lee SH, Seo HY, Lim JH, Kim MG, Seon JK. Higher survival rate in total knee arthroplasty after high tibial osteotomy than that after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:1132-1142. [PMID: 34165632 DOI: 10.1007/s00167-021-06641-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to evaluate the survival rates and complications in TKA after UKA and HTO as compared with primary TKA using national health data. It was hypothesized that survival and complication rates would be worse in patients with a history of UKA or HTO compared to primary TKA. METHODS Based on a list of patients who underwent TKA from Korean National Health Insurance database, 315,071 underwent primary TKA (group A); 2177 TKA after HTO (group B); and 1284 TKA after UKA (group C). Revision rates were compared between the groups using log-rank tests and adjusted hazard ratios (HR) of groups B and C were compared with those of the reference group (group A). A total of 1000 TKA matched patients were assigned to groups B and C according to propensity score for comparing revision rates after TKA and perioperative complication rates between TKA after HTO and UKA. RESULTS The overall revision rate was 2.1% in group A, 2.0% in group B, and 4.2% in group C. The revision rate until 10 years after TKA was significantly higher in group B (p = 0.03) or C (p < 0.0001) than in group A. The hazard ratios for revision was significantly higher in group A than in groups B and C at 10 years after index TKA (1.4 in group B and 3.7 in group C). The result of the comparison using PSM between TKA after HTO and UKA showed that TKA after HTO had lower risk of revision than TKA after UKA (HR: 0.41 at 10 years). However, no statistically significant differences in the perioperative complication rate between the two groups were found. (NS, not significant) CONCLUSIONS: TKA after UKA or HTO showed a significantly higher risk of revision than primary TKA. While TKA after HTO showed lower risk of revision than TKA after UKA, no significant differences in complications between TKA after UKA and HTO were found. Thus, surgeons must be aware of the low survival rate in TKA after UKA or HTO, especially in TKA after UKA. LEVEL OF EVIDENCE III (Retrospective cohort study).
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Affiliation(s)
- Sun-Ho Lee
- Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Seoyang-ro 322, Hwasun-eup, 58128, Hwasun-gun, Republic of Korea
| | - Hyoung-Yeon Seo
- Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Seoyang-ro 322, Hwasun-eup, 58128, Hwasun-gun, Republic of Korea
| | - Jun-Hyuk Lim
- Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Seoyang-ro 322, Hwasun-eup, 58128, Hwasun-gun, Republic of Korea
| | - Min-Gwang Kim
- Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Seoyang-ro 322, Hwasun-eup, 58128, Hwasun-gun, Republic of Korea
| | - Jong-Keun Seon
- Center for Joint Disease, Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Seoyang-ro 322, Hwasun-eup, 58128, Hwasun-gun, Republic of Korea.
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Schuster P, Rathgeb F, Mayer P, Michalski S, Hielscher L, Buchholz J, Krüger L, Richter J. Double level osteotomy for medial osteoarthritis and bifocal varus malalignment has excellent short-term results while maintaining physiologic radiographic joint parameters. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07247-1. [PMID: 36494478 DOI: 10.1007/s00167-022-07247-1] [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: 10/16/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to prospectively evaluate the clinical and radiological results of double level osteotomy (distal femoral lateral closed wedge and proximal tibial medial open wedge) in medial osteoarthritis and varus malalignment due to bifocal deformity of femur and tibia. METHODS From 2017 to 2019 all cases of DLO in osteoarthritic varus malaligned knees with bifocal deformity (femoral and tibial deformity) were prospectively enrolled into this observational therapeutic study. Evaluation was performed preoperatively, at six, twelve, 18 and 24 months with regard to survival (not requiring arthroplasty), functional outcome [subjective International Knee Documentation Committee score (IKDC), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome score (KOOS) and Tegner Activity Scale], pain level (numeric rating scale), subjective satisfaction (rating 1-5), radiographic parameters on a pre-and postoperative full leg x-rays (mechanical axis, mechanical proximal tibial and distal femoral angles) and complications. For statistical evaluation student's t test, Mann-Whitney U test and Wilcoxon-signed-rank test were used. RESULTS Fifty-two consecutive cases in 48 patients were enrolled in the study. Three cases were excluded, resulting in a follow-up rate of 94%. No arthroplasties were performed within follow-up. All functional outcome scores substantially and significantly increased as early as six months after the index procedure and further increased until final follow-up (p < 0.001). Pain level significantly decreased (p < 0.001). At final follow-up all patients stated that they would retrospectively undergo the operation again, and rated the result with 4.5 ± 0.6 out of 5 (3-5). Radiographic parameters were within physiological limits postoperatively. No severe complications occurred. CONCLUSIONS Double level osteotomy has excellent short-term results while maintaining physiological radiographic parameters. Therefore, it should be an integral part and standard procedure in realignment surgery for monocompartimental osteoarthritis. LEVEL OF EVIDENCE IV (prospective observational therapeutic study).
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Affiliation(s)
- Philipp Schuster
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany. .,Clinic Nuremberg, Department of Orthopedics and Traumatology, Paracelsus Private Medical University, Nuremberg, Germany.
| | - Frida Rathgeb
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany.,Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Philipp Mayer
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
| | - Stefan Michalski
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
| | - Lotta Hielscher
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany.,Clinic Nuremberg, Department of Orthopedics and Traumatology, Paracelsus Private Medical University, Nuremberg, Germany
| | - Julia Buchholz
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany.,Clinic Nuremberg, Department of Orthopedics and Traumatology, Paracelsus Private Medical University, Nuremberg, Germany
| | - Lara Krüger
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jörg Richter
- Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany
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Morales-Avalos R, Perelli S, Raygoza-Cortez K, Padilla-Medina JR, Peña-Martínez VM, Guzmán-López S, Zavala JMD, Barrera FJ, Vilchez-Cavazos F, Monllau JC. Fixed-bearing unicompartmental knee arthroplasty provides a lower failure rate than mobile-bearing unicompartimental knee arthroplasty when used after a failed high tibial osteotomy: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3228-3235. [PMID: 34415370 DOI: 10.1007/s00167-021-06707-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
Despite the fact that the choice of bearing design has been thought to influence the functional outcomes and longevity of unicompartimental knee arthroplasty (UKA), there is a lack of clinical evidence supporting the decision-making process in patients who have undergone high tibial osteotomy (HTO). A systematic review of studies was carried out that reported the outcomes of fixed-bearing (FB) or mobile-bearing (MB) medial UKA in patients with a previous HTO. A random effect meta-analysis using a generalized linear mixed-effects model to calculate revision rates was done. Seven retrospective cohort studies were included for this study. Regarding the fixation method, 40 were the FB-UKA and 47 were MB-UKA. For both groups, the mean post-operative follow-up was 5.8 years. The survival rates were 92% for the FB-UKA with a mean follow-up of 10 years. For the MB-UKA, it ranged from 35.7 to 93%, with a mean follow-up of 4.2 years. For the FB, the time to revision was reported as 9.3 years, while 1.2, 2.5 and 2.91 years was reported for the MB. The results of the meta-analysis showed that the revision rate for the patients receiving a FB-UKA after failed HTO was 8%, compared to 17% in those who received an MB-UKA. The results of the review suggest that the use of the FB-UKA is associated with lower revision rates and a longer survival time than the MB-UKA and have similar functional ability scores.Level of evidence: III (systematic review of level-III studies).
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Affiliation(s)
- Rodolfo Morales-Avalos
- Knee Unit, Department of Orthopedic Surgery and Traumatology, University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México.,Department of Human Anatomy, Col. Mitras Centro, School of Medicine, Universidad Autonoma de Nuevo León (U.A.N.L.), Av. Francisco I. Madero and Av. Dr. Eduardo Aguirre Pequeño, s/n, C.P. 64460, Monterrey, Nuevo León, México.,Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain
| | - Simone Perelli
- Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.,Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain
| | - Karina Raygoza-Cortez
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | - José Ramón Padilla-Medina
- Knee Unit, Department of Orthopedic Surgery and Traumatology, University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - Víctor M Peña-Martínez
- Knee Unit, Department of Orthopedic Surgery and Traumatology, University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - Santos Guzmán-López
- Department of Human Anatomy, Col. Mitras Centro, School of Medicine, Universidad Autonoma de Nuevo León (U.A.N.L.), Av. Francisco I. Madero and Av. Dr. Eduardo Aguirre Pequeño, s/n, C.P. 64460, Monterrey, Nuevo León, México.
| | - José M Diabb Zavala
- Facultad de Ingeniería Mecánica Y Eléctrica (FIME), Universidad Autónoma de Nuevo León (U.A.N.L.), San Nicolás de los Garza, Nuevo León, México
| | - Francisco J Barrera
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | - Félix Vilchez-Cavazos
- Knee Unit, Department of Orthopedic Surgery and Traumatology, University Hospital "Dr. José Eleuterio González", Universidad Autonoma de Nuevo León (U.A.N.L.), Monterrey, Nuevo León, México
| | - Juan Carlos Monllau
- Knee and Arthroscopy Unit, Institut Catalá de Traumatologia I Medicina de L'Esport (ICATME), Hospital Universitari Quiron Dexeus, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain.,Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain
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5
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Legnani C, Parente A, Parente F, Ventura A. Medial unicompartmental knee replacement is a viable treatment option after failed high tibial osteotomy: a systematic review. EFORT Open Rev 2022; 7:569-575. [PMID: 35924648 PMCID: PMC9458945 DOI: 10.1530/eor-21-0133] [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] [Indexed: 11/22/2022] Open
Abstract
Purpose Methods Results Conclusions
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Affiliation(s)
- Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sports Traumatology and Minimally Invasive Articular Surgery Center, Milan Italy
| | - Andrea Parente
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | - Franco Parente
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | - Alberto Ventura
- IRCCS Istituto Ortopedico Galeazzi, Sports Traumatology and Minimally Invasive Articular Surgery Center, Milan Italy
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Unicompartmental vs. total knee replacement in patients with failed high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:2051-2056. [PMID: 34351470 DOI: 10.1007/s00402-021-04093-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The influence of a previous high tibial osteotomy (HTO) on the outcome and survival of a knee arthroplasty is a debated issue. The purpose of this study is to compare subjective, radiographic, and functional outcomes of unicompartmental knee replacement (UKR) and total knee replacement (TKR) after failed open wedge HTO. METHODS 26 post-HTO UKRs (group A) with an average follow-up of 7.8 years (range 2-13), and 33 post-HTO TKRs (group B) with an average follow-up of 11.2 years (range 4-16) operated between 2001 and 2017, were retrospectively reviewed. Assessment included Knee Society Score (KSS), University of California at Los Angeles Activity Score (UCLA), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Standard knee X-rays, and long-standing X-rays were performed pre-operatively and at follow-up to evaluate prosthesis survival, coronal alignment, and patellar height. RESULTS Improvements regarding KSS, UCLA and WOMAC scores were noted at follow-up in both groups compared to pre-operatory status (p < 0.001). No statistically significant differences in clinical and functional postoperative scores were reported between groups (p = n.s.) at follow-up. Group B presented a more neutral mean mechanical axis of 0.5° compared to 2.7° in Group A (p < 0.001). CONCLUSIONS Performing UKR after previous failed HTO is a safe and effective procedure which leads to clinical, radiological and functional outcomes comparable to TKR after HTO.
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Kim KI, Kim JH, Lee SH, Song SJ, Jo MG. Mid- to Long-Term Outcomes After Medial Open-Wedge High Tibial Osteotomy in Patients With Radiological Kissing Lesion. Orthop J Sports Med 2022; 10:23259671221101875. [PMID: 35859646 PMCID: PMC9289913 DOI: 10.1177/23259671221101875] [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: 02/03/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Although medial open-wedge high tibial osteotomy (MOWHTO) is the treatment of
choice for patients with mild to moderate osteoarthritis with varus
malalignment, concerns about inferior outcomes in patients with preoperative
radiological kissing lesion (RKL) remain. Purpose: To compare the mid- to long-term clinical and radiological results and
survivorship after MOWHTO in patients with versus without preoperative
RKL. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 122 knees in patients who underwent MOWHTO with a medial locked
plate and had minimum 5-year follow-up data. The mean age at surgery was
55.9 years (range, 38-65 years), and the mean follow-up was 7.5 years
(range, 5-12.8 years). All patients had undergone second-look arthroscopy
around 2 years after MOWHTO. The knees were divided into an RKL group (n =
17) and no-RKL group (n = 105) based on preoperative standing radiographs.
The authors compared postoperative American Knee Society (AKS) knee and
function scores, range of motion, and improvements in AKS scores between
groups, as well as hip-knee-ankle angle, medial proximal tibial angle, and
joint-line convergence angle from preoperatively to postoperatively. Also
compared were the degree of cartilage regeneration between first- and
second-look arthroscopy and the survival rate after index surgery. Results: Preoperative AKS scores were significantly lower in the RKL group versus the
no-RKL group (AKS knee, 79.6 ± 7.5 vs 83.8 ± 3.9, P = .037;
AKS function, 68.8 ± 9.3 vs 76.0 ± 5.1, P = .006).
Likewise, postoperative AKS scores were significantly lower in the RKL group
versus the no-RKL group (AKS knee: 91.3 ± 4.2 vs 94.4 ± 1.6, respectively,
P = .008; AKS function: 90.0 ± 10.0 vs 97.6 ± 4.5,
respectively, P = .007). However, all patients had
excellent postoperative AKS knee and function scores (>80). Moreover,
there were no between-group differences in pre- to postoperative improvement
in AKS scores, postoperative radiological changes, or grade of cartilage
regeneration. The survival rates in the RKL and no-RKL groups were 100% and
97.1%, respectively (P ≥ .999). Conclusion: Although the latest clinical scores were lower in the RKL group than in the
no-RKL group, comparable results in postoperative clinical improvement,
cartilage regeneration, and survivorship were observed in patients with RKL
at mid- to long-term follow-up.
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Affiliation(s)
- Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang-Hak Lee
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Myeong-Guk Jo
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Bode L, Eberbach H, Brenner AS, Kloos F, Niemeyer P, Schmal H, Suedkamp NP, Bode G. 10-Year Survival Rates After High Tibial Osteotomy Using Angular Stable Internal Plate Fixation: Case Series With Subgroup Analysis of Outcomes After Combined Autologous Chondrocyte Implantation and High Tibial Osteotomy. Orthop J Sports Med 2022; 10:23259671221078003. [PMID: 35224123 PMCID: PMC8873560 DOI: 10.1177/23259671221078003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/08/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Good-to-excellent midterm results after high tibial osteotomy (HTO) to treat
medial compartment cartilage defects or osteoarthritis (OA) have been
published, but little is known about long-term survival rates in terms of
conversion to total knee arthroplasty (TKA) using angular stable internal
plate fixation. Purpose: To determine TKA-free survival rates and functional and radiological outcomes
at 10 years after HTO. A subgroup analysis of patients who underwent
combined HTO and autologous cartilage implantation (ACI) was also
performed. Study Design: Case series; Level of evidence, 4. Methods: Included were 125 patients with a mean follow-up of 9.90 ± 2.25 years; 90
patients underwent HTO for medial OA, and 35 patients underwent ACI and HTO
for medial focal cartilage defects. Functional outcome measures included
visual analog scale (VAS) for pain, Lysholm, International Knee
Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome
Score (KOOS) subscales and KOOS4 (average of 4 KOOS subscales:
Pain, Symptoms, Sport, and Quality of Life). Radiological outcomes included
lateral distal femoral angle, medial proximal tibial angle, and joint line
convergence angle. Results: Overall, 16 patients required conversion to TKA at a mean 86.75 ± 25.73
months (10-year survival rate, 87.2%). Only 2 patients in the HTO+ACI
subgroup required a conversion to TKA (10-year survival rate, 94.3%). The
complication rate for all patients was 8.8%. In both the HTO and HTO+ACI
subgroups, VAS pain levels decreased and Lysholm scores increased
significantly from pre- to postoperatively (P < .001). A
higher preoperative Tegner score led to a significantly lower risk for
conversion to TKA (P = .001), and a preoperative body mass
index of ≥35 was associated with a significantly higher risk
(P = .019), as was female sex (P =
.046). Radiological parameters remained within physiological ranges. The
postoperative joint line conversion angle did correlate with postoperative
functional outcome but not with TKA conversion. Conclusion: Long-term results of HTO for medial compartment OA or cartilage defects with
underlying varus deformity were good to excellent. In particular, patients
who underwent HTO+ACI presented excellent long-term survival rates. HTO,
therefore, delays or prevents TKA implantation, especially in young, active
patients with medial compartment damage.
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Affiliation(s)
- Lisa Bode
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Helge Eberbach
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Anna-Sophie Brenner
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Ferdinand Kloos
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- OCM Clinic, Munich, Germany
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Department of Orthopaedic Surgery, University Hospital Odense, Odense, Denmark
| | - Norbert P. Suedkamp
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Gerrit Bode
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Sporthopaedicum, Straubing, Straubing, Germany
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9
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Parente A, Legnani C, Bargagliotti M, Marullo M, Romagnoli S. Medial Unicompartmental Knee Arthroplasty After Failed Open-Wedge High Tibial Osteotomy. J Arthroplasty 2021; 36:2746-2751. [PMID: 33810918 DOI: 10.1016/j.arth.2021.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Controversy exists whether or not a previous high tibial osteotomy (HTO) influences the outcome and survival of a unicompartmental knee arthroplasty (UKA). The aim of this retrospective study was to evaluate clinical, radiological, and functional outcomes of UKA after failed open-wedge HTO compared with UKA with no previous HTO. METHODS Between 2001 and 2017, 24 post-HTO UKAs (group A) with an average follow-up of 8.1 years (range: 5 to 13) were compared with a control group of 30 patients undergoing simple UKA (group B) with an average follow-up of 9.5 years (range: 2 to 16). All patients were evaluated preoperatively and postoperatively using Knee Society Score, University of California at Los Angeles Activity Score, Western Ontario and McMaster University Osteoarthritis Index, and through objective evaluation. Mechanical coronal alignment and Caton-Deschamps index were measured both preoperatively and postoperatively. RESULTS In both groups, Knee Society Score, University of California at Los Angeles Activity Score, and Western Ontario and McMaster University Osteoarthritis Index scores significantly improved at follow-up (P < .001). In addition, statistically significant greater improvements in clinical and functional scores were reported in group B compared with group A (P < .001). No statistically significant differences concerning postoperative mechanical axis were observed between groups (2.7° and 3.2°, respectively, P = .27) and with regard to Caton-Deschamps index (1.0° and 1.1°, respectively, P = .44). CONCLUSION This study demonstrated improvements in clinical and functional outcomes compared with preoperatory status in both groups irrespective of a previous HTO. A prior HTO was a determinant for having reduced postoperative clinical and functional outcomes after UKA.
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Affiliation(s)
- Andrea Parente
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | - Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy
| | - Marco Bargagliotti
- IRCCS Istituto Ortopedico Galeazzi, Joint Replacement Department, Milan, Italy
| | - Matteo Marullo
- IRCCS Istituto Ortopedico Galeazzi, Joint Replacement Department, Milan, Italy
| | - Sergio Romagnoli
- IRCCS Istituto Ortopedico Galeazzi, Joint Replacement Department, Milan, Italy
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10
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The outcomes of quadriceps tendon autograft for anterior cruciate ligament reconstruction in adolescent athletes: a retrospective case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:739-744. [PMID: 34110467 DOI: 10.1007/s00590-021-03032-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple graft options exist for anterior cruciate ligament (ACL) reconstruction in an adolescent athlete. Patellar tendon harvest can lead to anterior knee pain, while hamstring tendon harvest can affect knee flexion strength and alter mechanics. Allograft is less desirable in pediatric patients due to the higher failure rate and slight risk of disease transmission. Quadriceps tendon autograft has rarely been reported for adolescent ACL reconstruction in the USA, but is an excellent option due to its large size, low donor site morbidity, and versatility. The purpose of this study is to report the outcomes of adolescents who have undergone ACL reconstruction using quadriceps tendon autograft. METHODS Twenty-two ACL reconstructions using the quadriceps autograft were performed on 21 pediatric patients by the senior author between 2010 and 2017. The patient's demographics, injury characteristics, imaging, physical examination findings, operative findings, outcomes and sports were recorded. RESULTS The average age at the time of surgery was 15 years. Two patients had open physes; the remainder had closing physes. 64% of patients had additional meniscal tears and 76% had bony contusions. The average duration of follow-up was 2.8 years (range 2-5 years). At final follow-up, there were no angular deformities or leg length discrepancies. The average quadriceps atrophy of the operative leg was 4 mm. The average Lysholm score was 98. 86% of patients returned to sports. No patients had re-rupture of their operative ACL. No incidences of infections, numbness, or anterior knee pain were reported. Two patients had a second arthroscopy for re-injury, revealing new meniscal tears but intact ACL grafts. CONCLUSIONS Use of quadriceps tendon autograft for ACL reconstruction in adolescent patients allows reliable return to sport with minimal complications. LEVEL OF EVIDENCE Level IV, retrospective case series.
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11
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Imhoff FB, Fucentese SF, Harrer J, Tischer T. [The influence of axial deformities and their correction on the development and progression of osteoarthritis]. DER ORTHOPADE 2021; 50:378-386. [PMID: 33844033 PMCID: PMC8081714 DOI: 10.1007/s00132-021-04103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 12/02/2022]
Abstract
Die Beachtung der Beinachse und die Möglichkeiten zur deren Korrektur stellen beim jungen Patienten mit Arthrose ein Grundpfeiler der Therapie dar. Die Kombination einer Gelenksverletzung und einer Achsdeviation führt unweigerlich, je nach Ausmaß und Komorbiditäten, schon nach wenigen Jahren zur fortschreitenden Gonarthrose. Neben der genauen Deformitätenanalyse zur Osteotomieplanung, gilt es, Normbereiche der entsprechenden Winkel zu kennen und eine Zielgröße zur Achskorrektur festzulegen. Aus dem Repertoire der verschiedenen kniegelenksnahen Osteotomien sind dann die Nebeneffekte in Bezug auf patellofemorales Maltracking, ligamentäres Balancing und die Beinlänge abzuschätzen. Gerade im Hinblick auf mögliche (und wahrscheinliche) Folgeoperationen beim jungen Patienten müssen neue knöcherne Deformitäten oder ligamentäre Insuffizienzen, welche potenziell bei Überkorrektur entstehen, unbedingt vermieden werden.
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Affiliation(s)
- Florian B Imhoff
- Orthopädie, Universitätsklinik Balgrist, Forchstrasse 340, 8008, Zürich, Schweiz.
| | - Sandro F Fucentese
- Orthopädie, Universitätsklinik Balgrist, Forchstrasse 340, 8008, Zürich, Schweiz
| | - Jörg Harrer
- Abteilung für Orthopädie und Unfallchirurgie, Helmut-G.-Walther-Klinikum, Lichtenfels, Deutschland
| | - Thomas Tischer
- Sektion Sportorthopädie, Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland
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12
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Drenck TC, Preiss A, Domnick C, Herbort M, Frings J, Akoto R, Krause M, Frosch KH. The Popliteus Bypass provides superior biomechanical properties compared to the Larson technique in the reconstruction of combined posterolateral corner and posterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2021; 29:732-741. [PMID: 32372281 DOI: 10.1007/s00167-020-05987-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/07/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to compare the biomechanical properties of the popliteus bypass against the Larson technique for the reconstruction of a combined posterolateral corner and posterior cruciate ligament injury. METHODS In 18 human cadaver knees, the kinematics for 134 N posterior loads, 10 Nm varus loads, and 5 Nm external rotational loads in 0°, 20°, 30°, 60,° and 90° of knee flexion were measured using a robotic and optical tracking system. The (1) posterior cruciate ligament, (2) meniscofibular/-tibial fibers, (3) popliteofibular ligament (PFL), (4) popliteotibial fascicle, (5) popliteus tendon, and (6) lateral collateral ligament were cut, and the measurements were repeated. The knees underwent posterior cruciate ligament reconstruction, and were randomized into two groups. Group PB (Popliteus Bypass; n = 9) underwent a lateral collateral ligament and popliteus bypass reconstruction and was compared to Group FS (Fibular Sling; n = 9) which underwent the Larson technique. RESULTS Varus angulation, posterior translation, and external rotation increased after dissection (p < 0.01). The varus angulation was effectively reduced in both groups and did not significantly differ from the intact knee. No significant differences were found between the groups. Posterior translation was reduced by both techniques (p < 0.01), but none of the groups had restored stability to the intact state (p < 0.02), with the exception of group PB at 0°. No significant differences were found between the two groups. The two techniques revealed major differences in their abilities to reduce external rotational instability. Group PB had less external rotational instability compared to Group FS (p < 0.03). Only Group PB had restored rotational instability compared to the state of the intact knee (p < 0.04) at all degrees of flexion. CONCLUSION The popliteus bypass for posterolateral reconstruction has superior biomechanical properties related to external rotational stability compared to the Larson technique. Therefore, the popliteus bypass may have a positive influence on the clinical outcome. This needs to be proven through clinical trials.
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Affiliation(s)
- Tobias C Drenck
- Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Achim Preiss
- Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Christoph Domnick
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Muenster, Germany
| | - Jannik Frings
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ralph Akoto
- Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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