.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.jpg)
Outcome of High Tibial Osteotomy in Patients with Osteoarthritis Knee
Keywords:
Osteoarthritis Knee, High Tibial Osteotomy, Functional OutcomeAbstract
Objective: To determine the radiological, functional and anatomical outcome in patients with osteoarthritic knee undergoing high tibial osteotomy.
Methods: This descriptive study was conducted in the Orthopedic Departments of District Head Quarter Hospital Faisalabad affiliated with Punjab Medical University Faisalabad from Jan 2016 to March 2018.A total of 40 patients of both genders, between 40-65 years of age having advanced degenerative disease of knee limited to medial compartment of joint. Medial open wedge osteotomy was done and outcome was evaluated after 5 years of surgery in terms of radiological knee mechanics, functional outcome scores and arthroscopic evidence of cartilage regeneration in the medial compartment. A signed written consent was taken from every patient.
Results: There was a female predominance(1:4 male female ratio) .The mean age of the patients was 53.2±6.9 years. The values of the radiographic parameters signi?cantly changed from pre-operative condition after high tibial osteotomy; MTFA (-8.1±1.2o vs. 2.5±1.2o; p-value<0.0001), TPI (5.3±1.1o vs. 3.4±1.1o; p-value<0.0001), G-KJLO (0.3±0.1o vs. 4.6±1.5o; p-value<0.0001) and G-AJLO (8.3±3.2o vs. 2.3±1.7o; p-value<0.0001). There was significant improvement in patient’s functional status; KOOS-ADL score (45.5±7.8 vs. 73.7±8.6; p-value<0.0001), IKDC score (42.4±6.9 vs. 68.5±12.7; p-value<0.0001), IKS score (149.4±11.9 vs. 179.4±10.2; p-value<0.0001), KSS (54.2±5.6 vs. 69.7±12.7; p-value<0.0001) and HSS (50.8±3.3 vs. 64.8±10.7; p-value<0.0001). 42.5% patients showed excellent regeneration of femoral and 30.0% patients showed excellent regeneration of tibial cartilage in the medial compartment.
Conclusion: By significantly alternating the knee biomechanics, high tibial osteotomy was found to unload the medial compartment leading to regeneration of the articular cartilage and dramatic improvement in the symptoms and quality of life of these patients. It is therefore recommended in the management of patients with arthritic changes limited to medial compartment only
References
2. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage 2013;21(9):1145-53. doi: 10.1016/j.joca.2013.03.018.
3. Chen D, Shen J, Zhao W, Wang T, Han L, Hamilton JL, et al. Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone Res 2017;5:16044. doi: 10.1038/boneres.2016.44.
4. Man GS, Mologhianu G. Osteoarthritis pathogenesis - a complex process that involves the entire joint. J Med Life 2014;7(1):37-41.
5. Hermann W, Lambova S, Muller-Ladner U. Current treatment options for osteoarthritis. Curr Rheumatol Rev 2018;14(2):108-16. doi: 10.2174/1573397113666170829155149.
6. Zhang W, Ouyang H, Dass CR, Xu J. Current research on pharmacologic and regenerative therapies for osteoarthritis. Bone Res 2016;4:15040. doi:10.1038/boneres.2015.40.
7. Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee osteoarthritis: a primer. Perm J 2017;21:16-183. doi: 10.7812/TPP/16-183.
8. Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High tibial osteotomy: a systematic review and current concept. Arch Bone Jt Surg 2016;4(3):204-12.
9. Kyung HS. High tibial osteotomy for medial knee osteoarthritis. Knee Surg Relat Res 2016;28(4):253-4. doi: 10.5792/ksrr.16.253.
10. Amoako AO, Pujalte GG. Osteoarthritis in young, active, and athletic individuals. Clin Med Insights Arthritis Musculoskelet Disord 2014;7:27-32. doi: 10.4137/CMAMD.S14386.
11. Brosset T, Pasquier G, Migaud H, Gougeon F. Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res 2011;97(7):705-11. doi: 10.1016/j.otsr.2011.06.011.
12. Bonasia DE, Governale G, Spolaore S, Rossi R, Amendola A. High tibial osteotomy. Curr Rev Musculoskelet Med 2014;7(4):292-301. doi: 10.1007/s12178-014-9234-y.
13. Pipino G, Indelli PF, Tigani D, Maffei G, Vaccarisi D. Opening-wedge high tibial osteotomy: a seven - to twelve-year study. Joints 2016;4(1):6-11. doi:10.11138/jts/2016.4.1.006.
14. Giuseffi SA, Replogle WH, Shelton WR. Opening-wedge high tibial osteotomy: review of 100 consecutive cases. Arthroscopy 2015;31(11):2128-37. doi: 10.1016/j.arthro.2015.04.097.
15. Lee KM, Chang CB, Park MS, Kang SB, Kim TK, Chung CY. Changes of knee joint and ankle joint orientations after high tibial osteotomy. Osteoarthritis Cartilage 2015;23(2):232-8. doi: 10.1016/j.joca.2014.11.001.
16. Schuster P, Geßlein M, Schlumberger M, Mayer P, Mayr R, Oremek D, et al. Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 2018;46(6):1362-70. doi: 10.1177/0363546518758016.
17. Polat G, Balc? H?, Çakmak MF, Demirel M, ?en C, A??k M. Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis. J Orthop Surg Res 2017;12(1):44. doi: 10.1186/s13018-017-0547-6.
18. Roos EM, W-Dahl A, Toksvig-Larsen S, Lohmander LS. High tibial osteotomy and total knee replacement for knee OA - similar outcomes from the patient’s perspective. Orthop Res Soc 2017;2017:2463.
