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Tassinari CJ, Higham R, Smith IL, Arnold S, Mujica-Mota R, Metcalfe A, Simpson H, Murray D, McGonagle DG, Sharma H, Hamilton TW, Ellard DR, Fernandez C, Reynolds C, Harwood P, Croft J, Stocken DD, Pandit H. Clinical and cost-effectiveness of Knee Arthroplasty versus Joint Distraction for Osteoarthritis (KARDS): protocol for a multicentre, phase III, randomised control trial. BMJ Open 2022; 12:e062721. [PMID: 35772819 PMCID: PMC9247693 DOI: 10.1136/bmjopen-2022-062721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Knee replacement (KR) is a clinically proven procedure typically offered to patients with severe knee osteoarthritis (OA) to relieve pain and improve quality of life. However, artificial joints fail over time, requiring revision associated with higher mortality and inferior outcomes. With more young people presenting with knee OA and increasing life expectancy, there is an unmet need to postpone time to first KR. Knee joint distraction (KJD), the practice of using external fixators to open up knee joint space, is proposed as potentially effective to preserve the joint following initial studies in the Netherlands, however, has not been researched within an NHS setting. The KARDS trial will investigate whether KJD is non-inferior to KR in terms of patient-reported postoperative pain 12 months post-surgery. METHODS AND ANALYSIS KARDS is a phase III, multicentre, pragmatic, open-label, individually randomised controlled non-inferiority trial comparing KJD with KR in patients with severe knee OA, employing a hybrid-expertise design, with internal pilot phase and process evaluation. 344 participants will be randomised (1:1) to KJD or KR. The primary outcome measure is the Knee Injury and Osteoarthritis Outcomes Score (KOOS) pain domain score at 12 months post-operation. Secondary outcome measures include patient-reported overall KOOS, Pain Visual Analogue Scale and Oxford Knee Scores, knee function assessments, joint space width, complications and further interventions over 24 months post-operation. Per patient cost difference between KR and KJD and cost per quality-adjusted life year (QALY) gained over 24 months will be estimated within trial, and incremental cost per QALY gained over 20 years by KJD relative to KR predicted using decision analytic modelling. ETHICS AND DISSEMINATION Ethics approval was obtained from the Research Ethics Committee (REC) and Health Research Authority (HRA). Trial results will be disseminated at clinical conferences, through relevant patient groups and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN14879004; recruitment opened April 2021.
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Affiliation(s)
- Cerys Joyce Tassinari
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK
| | - Ruchi Higham
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK
| | - Isabelle Louise Smith
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK
| | - Susanne Arnold
- Warwick Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
| | | | - Andrew Metcalfe
- Warwick Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hamish Simpson
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - David Murray
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Dennis G McGonagle
- Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Hemant Sharma
- Department of Orthopaedics, Hull and East Yorkshire Hospitals NHS Trust, Hull, Kingston upon Hull, UK
| | - Thomas William Hamilton
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, University of Warwick Warwick Medical School, Coventry, UK
| | - Catherine Fernandez
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK
| | - Catherine Reynolds
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK
| | - Paul Harwood
- University of Leeds, Leeds Institute of Medical Research, Leeds, West Yorkshire, UK
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK
| | - Deborah D Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials, University of Leeds, Leeds, UK
| | - Hemant Pandit
- Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Leeds, UK
- Chapel Allerton Hospital, Leeds, West Yorkshire, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Moghtadaei M, Yeganeh A, Boddouhi B, Alaee A, Farahini H, Otoukesh B. Effect of high tibial osteotomy on hip biomechanics in patients with genu varum: A prospective cohort study. Interv Med Appl Sci 2017; 9:94-99. [PMID: 28932503 PMCID: PMC5598133 DOI: 10.1556/1646.9.2017.2.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and aims The aim of this study is to evaluate the effect of proximal tibia osteotomy on hip biomechanics. Methods This cohort study was conducted on 50 knees of 37 patients divided into two groups of unilateral and bilateral surgeries during 2015–2016. Patients underwent medial open-wedge osteotomy of proximal tibia. Axial alignment of lower limb radiography was carried out for the patients before and after the osteotomy. Results Findings from unilateral and bilateral high tibial osteotomies demonstrated that the average of greater trochanter (GT) angle from femoral head center and also the average angle of knee varus were significantly decreased (P = 0.001). Although not statistically significant, the average angle of the mechanical axis of lower limb showed an increase in unilateral osteotomy (P = 0.889) and a decrease in bilateral osteotomy (P = 0.887). The average angle of pelvic obliquity after unilateral osteotomy increased significantly (P = 0.001) but showed no statistically significant difference in bilateral osteotomy (P = 0.631). Conclusion High tibial osteotomy significantly affects the GT and causes the downward replacement of GT and consequent shortening of the abductors moment arm, increased hip joint reaction force, and reduction of the shear force on the femoral neck.
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Affiliation(s)
- Mehdi Moghtadaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Yeganeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Boddouhi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atefe Alaee
- Department of Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Farahini
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Otoukesh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Moghtadaei M, Yeganeh A, Boddouhi B, Alaee A, Farahini H, Otoukesh B. Effect of high tibial osteotomy on hip biomechanics in patients with genu varum: A prospective cohort study. Interv Med Appl Sci 2017. [DOI: 10.1556/1646.9.2017.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mehdi Moghtadaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Yeganeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Boddouhi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atefe Alaee
- Department of Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Farahini
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Otoukesh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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McClelland D, Barlow D, Moores TS, Wynn-Jones C, Griffiths D, Ogrodnik PJ, Thomas PBM. Medium- and long-term results of high tibial osteotomy using Garches external fixator and gait analysis for dynamic correction in varus osteoarthritis of the knee. Bone Joint J 2016; 98-B:601-7. [DOI: 10.1302/0301-620x.98b5.34875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 11/05/2022]
Abstract
In arthritis of the varus knee, a high tibial osteotomy (HTO) redistributes load from the diseased medial compartment to the unaffected lateral compartment. We report the outcome of 36 patients (33 men and three women) with 42 varus, arthritic knees who underwent HTO and dynamic correction using a Garches external fixator until they felt that normal alignment had been restored. The mean age of the patients was 54.11 years (34 to 68). Normal alignment was achieved at a mean 5.5 weeks (3 to 10) post-operatively. Radiographs, gait analysis and visual analogue scores for pain were measured pre- and post-operatively, at one year and at medium-term follow-up (mean six years; 2 to 10). Failure was defined as conversion to knee arthroplasty. Pre-operative gait analysis divided the 42 knees into two equal groups with high (17 patients) or low (19 patients) adductor moments. After correction, a statistically significant (p < 0.001, t-test,) change in adductor moment was achieved and maintained in both groups, with a rate of failure of three knees (7.1%), and 89% (95% confidence interval (CI) 84.9 to 94.7) survivorship at medium-term follow-up. At final follow-up, after a mean of 15.9 years (12 to 20), there was a survivorship of 59% (95% CI 59.6 to 68.9) irrespective of adductor moment group, with a mean time to conversion to knee arthroplasty of 9.5 years (3 to 18; 95% confidence interval ± 2.5). HTO remains a useful option in the medium-term for the treatment of medial compartment osteoarthritis of the knee but does not last in the long-term. Cite this article: Bone Joint J 2016;98-B:601–7.
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Affiliation(s)
- D. McClelland
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
| | - D. Barlow
- Wrexham Maelor Hospital, Croesnewydd
Road, Wrexham, LL13 7TD, UK
| | - T. S. Moores
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
| | - C. Wynn-Jones
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
| | - D. Griffiths
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
| | | | - P. B. M. Thomas
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
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Mucha A, Dordevic M, Hirschmann A, Rasch H, Amsler F, Arnold MP, Hirschmann MT. Effect of high tibial osteotomy on joint loading in symptomatic patients with varus aligned knees: a study using SPECT/CT. Knee Surg Sports Traumatol Arthrosc 2015; 23:2315-2323. [PMID: 24817166 DOI: 10.1007/s00167-014-3053-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 05/02/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose was to prospectively evaluate the outcome, in particular the SPECT/CT bone tracer uptake (BTU) after high tibial osteotomy (HTO) due to symptomatic varus malalignment. It was the hypothesis that the BTU after HTO decreases in the medial compartment, clinical outcome and the degree of correction correlates with BTU and asymptomatic patients after HTO reveals a significantly decreased BTU in the medial subchondral areas. METHODS Twenty-two consecutive patients with 23 knees undergoing medial opening-wedge HTO for medial compartment overloading were assessed pre- and postoperatively (12 and/or 24 months) using Tc-99m-HDP-SPECT/CT including our 4D-SPECT/CT protocol. BTU was quantified and localized to specific biomechanically relevant joint areas. Maximum absolute and relative values (mean ± standard deviation, median and range) for each area were recorded. Pre- and postoperative mechanical alignment was measured. At 24 months after HTO, the WOMAC score was used. RESULTS A significant decrease of BTU in the medial subchondral zones after HTO was found (preoperatively to 12 and 24 months postoperatively, p < 0.01). BTU normalized in all asymptomatic patients within 24 months. This decrease was partly seen in the lateral compartments, but significantly higher in the medial compartments (p < 0.0001). A significant increase of the BTU was noted in zones directly adjacent to the plate or within the osteotomy zone (p < 0.01). Decreased BTU was observed in osteotomy zones at 24 months postoperatively following higher uptake values at 12 months postoperatively. The average valgus correction of the tibiofemoral angle was 5.9° ± 2.8°. Less stiffness correlated significantly with a higher decrease in BTU (p < 0.05). Higher postoperative BTU significantly correlated with more pain (p < 0.05). No statistical significant associations between BTU and alignment correction were found. CONCLUSION In patients with medial compartment, overloading due to varus malalignment HTO led to a significant decrease in BTU in the medial joint compartments. SPECT/CT BTU patterns and intensity in these patients pre- to 12 and 24 months postoperatively were seen. These correlated significantly with pain and stiffness. Hence, SPECT/CT could be used for assessment of adequate correction and healing after HTO. SPECT/CT could be further used to identify the optimal individualized correction for each patient and clinical scenario. CLINICAL EVIDENCE Diagnostic prospective study, Level II.
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Affiliation(s)
- Armin Mucha
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - Milos Dordevic
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - Anna Hirschmann
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Helmut Rasch
- Institute for Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | | | - Markus P Arnold
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.
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Nakamura E, Okamoto N, Nishioka H, Irie H, Mizuta H. Development and validation of formulae to predict leg length following medial opening-wedge osteotomy of the proximal tibia with hemicallotasis. Knee 2014; 21:815-20. [PMID: 24800646 DOI: 10.1016/j.knee.2014.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND A medial open-wedge osteotomy of the proximal tibia with hemicallotasis (HCO) affects the relative coronal alignment of the femur and tibia with respect to the floor; this also potentially reflects a change in leg length. PURPOSE The aims of this study are to develop and verify formulae for predicting the postoperative whole leg length (WLL) in HCO. METHODS We analyzed a training set of 25 HCOs in 25 patients. Formulae for predicting the postoperative leg length were developed using various factors including the length and coronal alignment of the femur and tibia, the length of the proximal or distal fragment from the tibial osteotomy site, the femoro-tibial angle, and the correction angle. The formulae were then verified using the interclass correlation coefficient in an independent consecutive set of 25 HCOs. RESULTS Significant postoperative increases in tibial bone length and WLL were noted with no postoperative change in femoral bone length. Furthermore, the coronal alignments of femoral and tibial bone axes were significantly abducted. For the formulae for predicting postoperative WLL developed in the training set, the interclass correlation coefficients between the predicted values and the real radiographic measurements in the validation set were more than 0.90, showing great consistency. CONCLUSION The mathematical models established in this study seemed to predict almost completely the change in leg length after HCO. Our results suggest that these formulae may offer accurate, extremely useful information about the postoperative possibility of leg lengthening for patients planning an HCO. LEVEL OF EVIDENCE Therapeutic case series; level 4.
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Affiliation(s)
- Eiichi Nakamura
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Japan.
| | - Nobukazu Okamoto
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Japan
| | - Hiroaki Nishioka
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Japan
| | - Hiroki Irie
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Japan
| | - Hiroshi Mizuta
- Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Japan
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Nakamura E, Okamoto N, Nishioka H, Karasugi T, Hirose J, Mizuta H. The long-term outcome of open-wedge osteotomy of the proximal tibia with hemicallotasis. Bone Joint J 2014; 96-B:467-72. [PMID: 24692612 DOI: 10.1302/0301-620x.96b4.31345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the long-term outcome of 33 patients (37 knees) who underwent proximal tibial open-wedge osteotomy with hemicallotasis (HCO) for medial osteoarthritis of the knee between 1995 and 2000. Among these, 29 patients with unilateral HCO were enrolled and 19 were available for review at a mean of 14.2 years (10 to 15.7) post-operatively. For these 19 patients, the mean Hospital for Special Surgery knee score was 60 (57 to 62) pre-operatively and 85 (82 to 87) at final follow-up (p < 0.001; paired t-test). The femorotibial angle and tibial inclination angle (IA) were measured at short-term follow-up, one to four years post-operatively, and showed no significant subsequent changes. The clinical scores and radiological measurements showed little change over time. One patient required conversion to total knee replacement during this time. These results suggest that the coronal angle achieved at operation is maintained at long-term follow up after HCO without alteration of the IA, providing a good long-term clinical outcome. Cite this article: Bone Joint J 2014;96-B:467–72.
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Affiliation(s)
- E. Nakamura
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - N. Okamoto
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - H. Nishioka
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - T. Karasugi
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - J. Hirose
- Kumamoto University, Department
of Medical Information Science and Administration Planning, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
| | - H. Mizuta
- Kumamoto University, Department
of Orthopaedic Surgery, Faculty of Life Sciences, 1-1-1
Honjo, Chuo-ku, Kumamoto-City, Kumamoto, 860-8556, Japan
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Hirschmann MT, Schön S, Afifi FK, Amsler F, Rasch H, Friederich NF, Arnold MP. Assessment of loading history of compartments in the knee using bone SPECT/CT: a study combining alignment and 99mTc-HDP tracer uptake/distribution patterns. J Orthop Res 2013; 31:268-74. [PMID: 22886713 DOI: 10.1002/jor.22206] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/10/2012] [Indexed: 02/04/2023]
Abstract
This study investigates if the mechanical/anatomical alignment influences the intensity values as well as the distribution pattern of SPECT/CT tracer uptake. Eighty-five knees (mean age 48 ± 16) undergoing 99mTc-HDP-SPECT/CT due to pain were prospectively included. SPECT/CTs were analyzed using a previously validated localization method. The maximum intensities in each femoral, tibial, and patellar joint compartment (medial, lateral, central, superior, and inferior) were noted using a color-coded grading scale (0-10). The Kellgren-Lawrence osteoarthritis score (KL) was assessed on standardized radiographs. Long leg radiographs were used to assess the mechanical/anatomical leg alignment, which was classified as varus, valgus, or neutral. The alignment and KL was correlated with the intensity of tracer uptake in each area of interest (p < 0.05). The intensity of SPECT/CT tracer uptake in the medial and lateral knee compartment significantly correlated with varus or valgus alignment of the knee. A higher degree of osteoarthritis was significantly related to higher tracer uptake in the corresponding joint compartments. SPECT/CT reflects the specific loading pattern of the knee with regard to its alignment. It is also related to the degree of osteoarthritis. Hence, SPECT/CT should be considered for follow-up of patients after realignment treatments, osteotomies, deloader devices, or insoles.
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Affiliation(s)
- Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, CH-4101 Bruderholz, Switzerland.
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Jensen LK, Rytter S, Bonde JP. Symptomatic knee disorders in floor layers and graphic designers. A cross-sectional study. BMC Musculoskelet Disord 2012; 13:188. [PMID: 23009280 PMCID: PMC3517438 DOI: 10.1186/1471-2474-13-188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 09/17/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Previous studies have described an increased risk of developing tibio-femoral osteoarthritis (TF OA), meniscal tears and bursitis among those with a trade as floor layers. The purpose of this study was to analyse symptomatic knee disorders among floor layers that were highly exposed to kneeling work tasks compared to graphic designers without knee-demanding work tasks. METHODS Data on the Knee injury and Osteoarthritis Outcome Score (KOOS) were collected by questionnaires. In total 134 floor layers and 120 graphic designers had a bilateral radiographic knee examination to detect TF OA and patella-femoral (PF) OA. A random sample of 92 floor layers and 49 graphic designers had Magnetic Resonance Imaging (MRI) of both knees to examine meniscal tears. Means of the subscales of KOOS were compared by analysis of variance. The risk ratio of symptomatic knee disorders defined as a combination of radiological detected knee OA or MRI-detected meniscal tears combined with a low KOOS score was estimated by logistic regression in floor layers with 95% confidence interval (CI) and adjusted for age, body mass index, traumas, and knee-straining sports activities. Symptomatic knee OA or meniscal tears were defined as a combination of low KOOS-scores and radiographic or MRI pathology. RESULTS Symptomatic TF and medial meniscal tears were found in floor layers compared to graphic designers with odds ratios 2.6 (95%CI 0.99-6.9) and 2.04 (95% CI 0.77-5.5), respectively. There were no differences in PF OA. Floor layers scored significantly lower on all KOOS subscales compared to graphic designers. Significantly lower scores on the KOOS subscales were also found for radiographic TF and PF OA regardless of trade but not for meniscal tears. CONCLUSIONS The study showed an overall increased risk of developing symptomatic TF OA in a group of floor layers with a substantial amount of kneeling work positions. Prevention would be appropriate to reduce the proportion of kneeling postures e.g. by working with tools used from a standing working position.
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Affiliation(s)
- Lilli Kirkeskov Jensen
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, DK 2400, NV, Denmark.
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Henriksen M, Aaboe J, Bliddal H. The relationship between pain and dynamic knee joint loading in knee osteoarthritis varies with radiographic disease severity. A cross sectional study. Knee 2012; 19:392-8. [PMID: 21839636 DOI: 10.1016/j.knee.2011.07.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 07/05/2011] [Accepted: 07/11/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In a cross sectional study, we investigated the relationships between knee pain and mechanical loading across the knee, as indicated by the external knee adduction moment (KAM) during walking in patients with symptomatic knee OA who were distinguished by different radiographic disease severities. METHODS Data from 137 symptomatic medial knee OA patients were used. Based on Kellgren/Lawrence (K/L) grading, the patients were divided into radiographically less severe (K/L ≤ 2, n=68) or severe (K/L>2, n=69) medial knee OA. Overall knee pain was rated on a 10 cm visual analog scale, and peak KAM and KAM impulses were obtained from gait analyses. Mixed linear regression analyses were performed with KAM variables as the outcome, and pain and disease severity as independent variables, adjusting for age, gender, and walking speed. RESULTS In adjusted analyses, less severe patients demonstrated negative relationships between pain intensities and dynamic loading. The severe patient group showed no relationship between pain intensity and peak KAM, and a positive relationship between pain intensity and KAM impulse. CONCLUSION In radiographically less severe knee OA, the negative relationships between pain intensity and dynamic knee joint loading indicate a natural reaction to pain, which will limit the stress on the joint. In contrast, either absent or positive relationships between pain and dynamic loading in severe OA may lead to overuse and accelerated disease progression. These findings may have a large potential interest for strategies of treatment in knee OA.
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Affiliation(s)
- Marius Henriksen
- Clinical Motor Function Laboratory, The Parker Institute, Frederiksberg Hospital, Ndr. Fasanvej 57, DK-2000 Frederiksberg C, Denmark.
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