Changes in the total knee joint moment in patients with medial compartment knee osteoarthritis over 5 years

Background: Osteoarthritis involves degeneration of articular cartilage seen with increasing age. The knee joint, the most common joint that falls prey to attacks of osteoarthritis, has 30% incidence in population above 60 years. Total knee arthroplasty (TKA) is the main surgical option for orthopaedics. Though it corrects the deformity and relieves pain, yet it is not the treatment of choice in younger population. This study aimed to validate the effects of proximal fibular osteotomy (PFO) as a newer technique in managing medial compartment knee osteoarthritis. Methods: The diagnosed patients for medial compartment knee joint osteoarthritis were selected for study from Dr. Ziauddin University hospital of Karachi. Excluded were aged less than 40 years, or with BMI more than 30, and patients with tri-compartmental arthritis. Medial and lateral joint spaces along with Oxford knee score were measured and recorded pre- and post-operatively. Patients underwent PFO after giving written and informed consent. Results: Total number of patients selected was 30 for this study; 21 (70%) females, and 9 (30%) males (mean age 58.8 years). Mean pre-operative measured medial joint space on standard antero-posterior (AP) radiograph was 0.442± 0.04 cm. Mean recorded pre-operative Oxford knee score was 23.87±3.74 mm. Improvement was observed in mean postoperative medial joint space to 0.572± 0 .066 cm and mean post-operative Oxford knee score to 40.2±5.8mm. Conclusion: This study concludes that PFO significantly improves joint function in patients with medial compartment osteoarthritis knee and may delay the need for total knee arthroplasty, if carried out at an appropriate stage. Keywords: Osteotomy; Osteoarthritis; Total Knee Arthroplasty.

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Radiographic vs. MRI vs. arthroscopic assessment and grading of knee osteoarthritis - are we using appropriate imaging?

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00442-y ◽

2022 ◽

Vol 9 (1) ◽

Author(s):

Samuel Newman ◽

Huzefah Ahmed ◽

Nader Rehmatullah

Keyword(s):

Knee Joint ◽

Knee Osteoarthritis ◽

Imaging Techniques ◽

Lateral Compartment ◽

Medial Compartment ◽

Actual Condition ◽

Tertiary Centre ◽

Arthroscopic Findings ◽

Mri Scans ◽

Outerbridge Grade

Abstract Purpose Radiographs and MRI scans are commonly used imaging techniques in the assessment of knee osteoarthritis. However, it currently remains uncertain how good a representation of the actual condition of the knee joint these investigations provide. By comparing them against arthroscopic findings the aim of our study was to conclude how accurate these imaging techniques are at grading knee osteoarthritis. Methods This was a retrospective study looking at knee arthroscopies performed at a tertiary centre over a 5 year period. The Outerbridge grade given at arthroscopy was correlated with pre-operative radiograph and MRI scores, so as to assess the reliability of these imaging techniques at predicting the actual severity of knee osteoarthritis seen. Results Kellgren-Lawrence (KL) grading of radiographs was moderately correlated with Outerbridge grades from arthroscopy for the medial compartment of the knee (Spearman’s rho (SR) 0.483, p < 0.001), with a milder correlation in the lateral compartment (SR 0.218, p = 0.003). MRI reporting of knee osteoarthritis was moderately correlated with Outerbridge grades in the medial compartment (SR 0.451, p < 0.001), mildly correlated for both the lateral (SR 0.299, p < 0.001) and patellofemoral joint compartments (SR 0.142, p = 0.054). KL and MRI grading was moderately correlated for the medial compartment (SR 0.475, p < 0.001) and mildly correlated for the lateral compartment (SR 0.277, p < 0.001). Conclusion The ability of radiographs to represent the actual condition of knee osteoarthritis is underestimated. KL grading especially best represents the disease seen in the medial compartment of the knee joint, with a moderate correlation to Outerbridge scores given on arthroscopic assessment. We suggest that whilst MRI is a useful tool in the investigation of knee symptoms, it is often unnecessarily used in patients with OA, when in fact, radiographs alone would be sufficient. Evidence level III

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