【Abstract】 Objective To make the young patients with osteoarthritis and genu varum of knee delay total knee arthroplasty,to observe the cl inical effect of mosaicplasty of femoral medial condyle, patellar-plasty and high tibial osteotomy inthe treatment of osteoarthritis of knee with varum. Methods From June 2004 to February 2006, 8 patients with osteoarthritisof knee with varum(10 knees) were treated with combined operation such as mosaicplasty of femoral medial condyle, patellarplastyand high tibial osteotomy. There were 2 males with 3 knees, and 6 females with 7 knees,with an average age of 50 years(42-56 years). The left knees and right knees were involved in 3 cases respectively and bilateral knees in 2 cases. All patients hadknee ache after walk or long-time standing. The X-ray showed hyperosteogeny at peri-patella and circum ferential femur-tibialjoint，especially in the medial. The gap between patella and femur narrowed or disappeared，especially in the medial femurtibialjoint. The femoral tibial angel (FTA) was 185-200°(mean 190°). The HSS score of knee was 55-75(mean 60). The history ofknee ache was 1-12 years(mean 5 years). Results All patients were followed up for 7-24 months (mean 15 months). All theincisions healed by first intention, no early compl ication occurred. The cl inical bone heal ing time was 8-11 weeks(mean 9 weeks).Rectification of FTA was 15-30°(mean 20°). Normal weight-loading al ignment was recovered. The valgus angle of knee was 10°.The range of motion of knee was 100-120° after operation, increasing by 5-20° (mean 10°) when compared with preoperation.The X-ray of postoperation showed that genu varum was corrected obviously and that no displacement, loosening and breakageoccurred. The mean score of HSS was 80 (75-88), increasing by 20 when compared with preoperation. Conclusion Mosaicplastyof femoral medial condyle can make articular cartilage repair in certain degrees, patellar-plasty can rel ieve ache of fore region of knee effectively, and high tibial osteotomy can recover normal weight-loading al ignment. The curative effect is good withthe combined methods.
Objective To analyze formation of the varus angle of the knee dueto osteoarthritis and to explore techniques of the soft tissue balance in the total knee arthroplasty(TKA). Methods One hundred patients with145 varus knees (18 males, 25 varus knees; 82 females, 120 varus knees) underwent TKA from January 1999 to December 2003. Their ages averaged 62.4 years (range, 45.80 years), and their HSS（hospital of special surgery）scores were 38.0±3.2 points. Before operation，all the patients were measured in the alignment of the lower extremity, accurate bonecutting was performed, and their static alignment was achieved. Then, the soft tissue release was made. The release performance consisted of 3 steps: release before the bone-cutting, release during the bone-cutting, and release after the bonecutting. Release of themedial ligament and capsule, elimination of the osteophytes, and release of thelateral patellar retinaculum were more important. Results The varus angles in these patients were 9.2±3.1° before operation. Among them,the varus angles caused by the soft tissue imbalance accounted for 53.2%，and caused by the bone structure accounted for 46.8%； and the latter caused by thetibia varus, 22.8%, and by the tibia plateau destruction, 24.0%. There was nosignificant difference between the varus angles caused by the soft tissue imbalance and the varus angles caused by the bone structure deformity (P＞0.05). According to the postoperative imaging studies, the correction degree for the varus angles by the bone-cutting was 4.3°, which represented 27.9% of the total corrected angles, and the correction degree for the varus angles corrected by the soft tissue balance was 10.7°, which represented 72.1% of the total corrected angles. The HSS scores were 87.0±4.5 points after operation, and the difference between preoperation and postoperation was significant. Conclusion The varus knee due to osteoarthritis results from the varus angle in the bone structure and the angles caused by the imbalance of the collateral ligaments and the soft tissues around the knee. The latter causative factor is more important in the formation of the varus knee and should only be corrected through the soft tissue release. The more important part to be released isthe attachments of the medial ligament and the posterior capsule. The release performance should be followed by the principles, i.e., step by step, tests at all the time, and avoidance of the excessive release.
Objective To assess the efficacy of medial wedged proximal tibial osteotomy for treating knee osteoarthritis with varus deformity. Methods From July 1996 to September 1999, 19 patients with knee osteoarthritis accompanied by varus deformity were treated by medial wedged proximal tibial osteotomy combined with internal fixation. Full-length anteriorposterior radiographs were taken preoperatively, 8 weeks and 2 years postoperatively. The parameters including the femorotibial angle, the tibial angle, the femoral angle, the femoral condyletibial plateau angle, and the medial joint space, were measured from these radiographs. The function of knee was evaluated according to the 100point rating scale standard of knee.Results Themean postoperative score had been significantly improved from 48.6±16.6 pointsto 81.7±14.8 points after 2 years of operation. The medial joint spacehad been increased from 2.2±1.6mm to 4.9±1.5 mm and the femoral condyle-tibial anglehad been decreased from 7.4°±3.1° to 1.7°± 3.1°. There were complications in 3 cases: 2 casesof superficial wound infections and 1 case of intraarticular fracture. There were no delayed union and recurrence of varus deformity. Conclusion Medial wedged proximal tibial osteotomy combined with internal fixation provides an efficacious approach to treat knee osteoarthritis with varus deformity.
The osteoarthritis of knee is a common disorder but no always to be treated satisfactorily. Between 1988 and 1992, the method, a high tibial osteotomy to correct the genu varum combined with autogenous periosteal or perichondrial graft to deal with the chondromalacia patella was used. Thirty-two patients (51 knees) were treated by this method and the patients were followed up for an average of 5.1 years. The excellent and good results were obtained in 90.2%. This method was obviously better than any other simple high tibial osteotomy. Therefore, this method was considered to be effective for treatment of osteoarthritis of knee with varum deformity and chondromalcia patella.
ObjectiveTo evaluate the effectiveness of reduction osteotomy for correction of varus knee during total knee arthroplasty. MethodsA retrospective analysis was made on the clinical data of 16 patients (24 knees) who received reduction osteotomy for correcting varus knee during total knee arthroplasty between May 2010 and July 2012. There were 2 males (3 knees) and 14 females (21 knees), with an average age of 67 years (range, 57-79 years). The disease duration ranged from 3 to 15 years (mean, 9.1 years). The Knee Society Score (KSS) was 38.71±10.04 for clinical score and 50.31±14.31 for functional score. The range of motion (ROM) of the knee was (91.88±13.01)°. The tibiofemoral angle was (9.04±4.53)° of varus deformity. Reduction osteotomy was applied to correct varus knee. ResultsThe operation time was 85-245 minutes (mean, 165.5 minutes); the obvious blood loss was 10-800 mL (mean, 183.1 mL); the hospitalization time was 8-22 days (mean, 13.6 days). All incisions healed by first intention. No neurovascular injury or patellar fracture occurred. The follow-up duration ranged from 37 to 62 months (mean, 48 months). The tibiofemoral angle was corrected to (3.92±1.89)° of valgus at 48 hours after operation. The lower limb alignment recovered to normal. The X-ray films showed no evidence of obvious radiolucent line, osteolysis, or prosthesis subsidence. The results of KSS were significantly improved to 84.21±6.49 for clinical score and 85.31±6.95 for functional score (t=20.665, P=0.000; t=9.585, P=0.000); and ROM of the knee was significantly increased to (105.83±11.29)° (t=8.333, P=0.000) at last follow-up. ConclusionThe effectiveness of reduction osteotomy for varus knee deformity during total knee arthroplasty is satisfactory. Proper alignment, ROM, and function of knee can be achieved.
ObjectiveTo evaluate the effectiveness of high tibial osteotomy (HTO) assisted by three-dimensional (3-D) printing technology for correction of varus knee with osteoarthritis. MethodBetween January 2014 and June 2015, 16 patients (20 knees) with varus knee and osteoarthritis underwent HTO assisted by 3-D printing technology; a locking compression plate was used for internal fixation after HTO. There were 6 males and 10 females, aged 30-60 years (mean, 45.5 years). The disease duration was 1-10 years (mean, 6.2 years). The unilateral knee was involved in 12 cases and bilateral knees in 4 cases. According to Koshino's staging system, 3 knees were classified as stage I, 7 knees as stage Ⅱ, 8 knees as stage Ⅲ, and 2 knees as stage IV. Preoperative Hospital for Special Surgery (HSS) knee score was 63.8±2.2; the femorotibial angle was (184.8±2.9) °; and Insall-Salvati index was 1.03±0.13. ResultsAll the wounds healed primarily, and no complication of infection, osteofacial compartment syndrom, or deep vein thrombosis was observed. All patients were followed up 6-18 months (mean, 12.6 months). Personal paralysis was observed in 1 case (1 knee), and was cured after expectant treatment. Bone union time was 2.7-3.4 months (mean, 2.9 months). At 6 months after operation, the femorotibial angle was (173.8±2.0) °, showing significant difference when compared with preoperative one (t=11.70, P=0.00) ; Insall-Salvati index was 1.04±0.12, showing no significant difference when compared with preoperative one (t=-0.20, P=0.85) ; and HSS knee score was significantly increased to 88.9±3.1 (t=-25.44, P=0.00) . At last follow-up, the results were excellent in 13 knees, good in 6 knees, fair in 1 knee, and the excellent and good rate was 95%. Conclusions3-D printing cutting block can greatly improve the accuracy of HTO, avoid repeated X-ray and multiple osteotomy, shorten the operation time, and ensure better effectiveness for correction of varus knee with osteoarthritis.
ObjectiveTo explore the short-term effectiveness of medial open wedge high tibial osteotomy (OWHTO) combined with posterior slope angle of tibial plateau correction to treat the osteoarthritis of limited flexion knee with varus deformity.MethodsThe data of 18 cases (18 knee) with osteoarthritis of limited flexion knee with varus deformity between January 2014 and July 2016 were analyzed retrospectively. There were 6 males and 12 females with an average age of 54.9 years (range, 48-64 years). There were 8 cases of left knee and 10 cases of right knee. The varus of knee ranged from 7.45 to 15.52° (mean, 10.63°). According to Kellgren-Lawrence grading standard, there were 4 cases of grade Ⅱ and 14 of grade Ⅲ. OWHTO was used to adjust the varus deformity, and the posterior slope angle of tibial plateau was adjusted to solve the limited flexion.ResultsThe thickness of osteotomy was 10-19 mm (mean, 14.91 mm). The operation time was 1.2-2.0 hours (mean, 1.4 hours). All incisions healed by first intension. All patients were followed up 1.0-2.5 years, with an average of 1.5 years. At last follow-up, the range of knee flexion and Lysholm score, Hospital for Special Surgery (HSS) score, and International Knee Documentation Committee (IKDC) score were significantly higher than preoperative ones, showing significant differences (P<0.05). X-ray films showed that the osteotomy healed at 3- 7 months (mean, 3.6 months) after operation. At last follow-up, the limb alignment by the relative position of tibial plateau and the posterior slope angle of tibial plateau were significantly improved, showing significant differences when compared with preoperative ones (P<0.05).ConclusionThe OWHTO combined with posterior slope angle of tibial plateau correction can significantly improve the range of flexion and functional score in short-term.