Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy.

نویسندگان

  • Robert F Laprade
  • Stanislav I Spiridonov
  • Lukas M Nystrom
  • Kyle S Jansson
چکیده

PURPOSE The purpose of this study was to conduct a prospective outcome analysis of proximal tibial opening wedge osteotomies performed in young and middle-aged patients (aged <55 years) for the treatment of symptomatic medial compartment osteoarthritis of the knee. METHODS A consecutive series of young and middle-aged adults who underwent proximal tibial opening wedge osteotomies for symptomatic medial compartment osteoarthritis and genu varus alignment were prospectively followed up. Patients were evaluated with preoperative and postoperative modified Cincinnati Knee Scores and International Knee Documentation Committee objective knee subscores for knee effusions and the single-leg hop. Calculations were made of the preoperative and postoperative long-leg radiographic mechanical weight-bearing axis, patellar height (Insall-Salvati index), and tibial slope. A separate cohort of asymptomatic patients was used to quantify tibial plateau anatomy to provide an objective description of the lower extremity mechanical axis. RESULTS There were 47 patients, with a mean age of 40.5 years, with a minimum of 2 years' follow-up, who formed this patient cohort. Modified Cincinnati Knee Scores improved significantly from 42.9 preoperatively to 65.1 at a mean of 3.6 years of follow-up. Radiographic analysis of a separate cohort showed the medial tibial eminence to be located at the 41% point along the tibial plateau from medial (0%) to lateral (100%). There was a significant improvement in malalignment: the mean mechanical axis passed through the tibial plateau at 23% of the distance along the proximal tibia preoperatively versus 54% postoperatively. The Insall-Salvati index decreased from 1.03 to 0.95 (P < .05), and posterior tibial slope increased from 9.4° to 11.7° (P < .05). Of the osteotomies, 3 (6%) were considered failures, defined by revision of the osteotomy or conversion to total knee arthroplasty. CONCLUSIONS Performing proximal tibial opening wedge osteotomies to treat symptomatic medial compartment osteoarthritis in carefully selected patients leads to a significant improvement in subjective and objective clinical outcome scores with correction of malalignment at a mean of 3.6 years postoperatively. LEVEL OF EVIDENCE Level IV, therapeutic case series.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Combination of bone marrow derived cells transplantation and high tibial osteotomy in early osteoarthritis of knee: A preliminary study

Purpose: high tibial osteotomy (HTO) is a recommended treatment for medial compartment knee osteoarthritis. Newer cartilage regenerative procedures may add benefits to the result of HTO. In this prospective study we investigate safety and also results of HTO associated with bone marrow derived cells (BMDC) transplantation in relatively young and middle aged active individuals with early osteoar...

متن کامل

Combination of High Tibial Osteotomy and Autologous Bone Marrow Derived Cell Implantation in Early Osteoarthritis of Knee: A Preliminary Study.

Background High tibial osteotomy (HTO) is a recommended treatment for medial compartment knee osteoarthritis. Newer cartilage regenerative procedures may add benefits to the results of HTO. In this prospective study we have investigated the safety and also results of HTO associated with autologous bone marrow derived cells (BMDC) implantation in relatively young and middle aged active individua...

متن کامل

Opening Wedge High Tibial Osteotomy, Microfracture, and Bone Marrow Aspirate Concentrate for Treatment of Varus Deformity and Osteoarthritis of the Knee

Osteoarthritis in the setting of varus deformity can be difficult to treat in young and middle aged patients. Treatment options typically include arthroplasty versus joint preservation techniques. In young and middle aged patients, unicompartmental or total knee arthroplasty is often considered a less desirable treatment option due to the increased likelihood of requiring revision arthroplasty ...

متن کامل

The Clinical Outcome of Simultaneous Lateral Closed- Wedge Distal Femoral Osteotomy and Anterior Cruciate Ligament Reconstruction in the ACL-deficient Knees with Symptomatic Femoral Varus Deformity

Background: Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effectivesurgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varusdeformity is sometimes the femoral bone. No studies have reported concomitant ACL reconstruction and distal femoralosteotomy in ACL-deficient knees wit...

متن کامل

High tibial osteotomy: closed wedge versus combined wedge osteotomy

BACKGROUND High tibial osteotomy is a common procedure to treat symptomatic osteoarthritis of the medial compartment of the knee with varus alignment. This is achieved by overcorrecting the varus alignment to 2-6° of valgus. Various high tibial osteotomy techniques are currently used to this end. Common procedures are medial opening wedge and lateral closing wedge tibial osteotomies. The latera...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

دوره 28 3  شماره 

صفحات  -

تاریخ انتشار 2012