scholarly journals Knee Arthroplasty in Severe Varus Advanced Knee Osteoarthritis with Proximal Tibia Malunion: a case report

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0005
Author(s):  
Nyoman Aditya Sindunata ◽  
Prettysia Suvarly ◽  
Rio Aditya ◽  
John Butarbutar
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Proximal Tibia ◽  
Varus Deformity ◽  
Left Knee ◽  
Tibial Osteotomy ◽  
Posterior Stabilized ◽  
Stem Extension ◽  
Closed Wedge ◽  
And Function

Alignment is crucial for successful knee arthroplasty.1 Tibia malunion will make arthroplasty more challenging. In this case, we present advanced knee osteoarthritis with tibia vara due to malunion that needs corrective osteotomy during knee arthroplasty. Case Presentation: A 70 years old female presented to our office complaining pain in both knees markedly on the left, profoundly felt during walking. She has a history of being hit by motorcycle 15 months ago and left knee was more bent since then. Physical examination of the left knee showed severe varus, mild effusion, tenderness on medial tibial condyle, otherwise normal. Plain radiographs showed advanced bilateral knee osteoarthritis with left proximal tibia malunion. Patient underwent left knee arthroplasty with corrective tibia and fibula osteotomy. Solutions and Outcome: Patient underwent closed wedge tibial osteotomy together with fibula osteotomy followed by knee arthroplasty with posterior-stabilized implant and tibial stem extension in a single surgery. Tibial osteotomy was reinforced using plate and screws. Partial weight bearing was achieved in second postoperative day and discharged on the third day. Patient able to walk with painless left knee after 1 month. Discussion: Severe deformity that causes huge malalignment makes knee arthroplasty difficult. Some methods are available to correct malalignment.1 In this case, the surgeon chose to do closed wedge tibial osteotomy reinforced with plate and screws to correct the proximal tibia malunion. Arthroplasty was done using posterior-stabilized implant and tibial stem extension. Patient shows good result in alignment and function. Conclusion: Correcting the associated deformity is crucial in achieving good alignment in knee arthroplasty. Even in our case of severe genu varus due to proximal tibia malunion, correcting proximal tibia varus deformity prior to knee arthroplasty shows good alignment and function. References: Mullaji AB, Padmanabhan V, Jindal G. Total Knee Arthroplasty for Profound Varus Deformity. 2005;20(5):550–61.

scholarly journals The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity

2018 ◽  
Vol 53 (6) ◽  
pp. 754-760
Author(s):  
Leonardo Antunes Bellot de Souza ◽  
Vinícius Magno da Rocha ◽  
Max Rogerio Freitas Ramos
Keyword(s):  
Knee Osteoarthritis ◽  
Varus Deformity ◽  
Tibial Osteotomy

scholarly journals Effect of unicompartmental knee arthroplasty and high tibial osteotomy with tomofix internal fixation in the treatment of unicompartmental knee osteoarthritis

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0054
Author(s):  
Yingzhou Hou ◽  
Shaohua Wang ◽  
Aiguo Wang
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Internal Fixation ◽  
Range Of Motion ◽  
High Tibial Osteotomy ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Tibial Osteotomy ◽  
Unicompartmental Knee ◽  
Active Range Of Motion

Introduction: Knee osteoarthritis is a common degenerative disease in the elderly clinically. Cartilage damage, osteophyte formation, joint space narrowing and bone exposure are the main pathological changes, mainly manifested as joint cartilage degeneration [1]. Since the knee joint load of normal people is mainly conducted through the medial side of the knee joint, it is easy to cause degeneration of the medial compartment and then narrow the joint space, which leads to the medial deviation of the lower limb line and the varus deformity of the knee joint. For patients aged 55-65 years with unilateral ventricular osteoarthritis of the knee, the current surgical methods are mostly high tibial osteotomy (HTO) or unicomartmental knee arthroplasty (UKA)[2,3]. HTO always thought to improve lower limb power line to correct deformities, effectively relieve pain and improve function, is an effective method for treatment of osteoarthritis knee inside, high cut bone is typically used in younger patients and patients from physical activity, can effectively reduce the load and delay of knee joint cartilage lesion replacement time, while UKA is more suitable for old age is not active, activity, and patients needs more intense in terms of pain relief. Hypotheses: To investigate the clinical effect of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with tomofix internal fixation in the treatment of unicompartmental knee osteoarthritis. Methods: 60 patients with unicompartmental knee osteoarthritis and varus deformity of the knee joint were randomly divided into two groups: the UKA group (30 cases) and the HTO group (30 cases). The average follow-up time was 6 months, Scores preoperative and postoperative knee joint function, postoperative complications and postoperative pain satisfaction were compared. Results: The scores of HSS, VAS, femorotibial angle(FTA) and active range of motion(ROM) were 82.6 ± 12.9, 1.9 ± 0.8,173.2 ± 1.4,135.2 ± 1.6 in the group of unicompartmental knee arthroplasty (UKA);The scores of HSS, VAS(Visual Analogue Score), femorotibial angle(FTA) and active range of motion(ROM) after tomofix internal fixation used in the group of high tibial osteotomy (HTO)were 81.9 ± 14.3, 1.8 ± 0.9, 174.5 ± 1.8 and 121.1 ± 2.7 . There was no significant difference between the UKA group and HTO group in the scores of HSS, VAS and femorotibial angle(FTA) (P > 0.05). The active range of motion(ROM) of the HTO group was better than that of UKA group (P < 0.05). Conclusion: Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) with tomofix internal fixation can improve the knee joint function and symptoms in the treatment of medial compartment osteoarthritis, but the active range of motion(ROM) in HTO group is better than UKA group.

Cruciate retaining versus posterior stabilized total knee arthroplasty after previous high tibial osteotomy

2014 ◽  
Vol 23 (12) ◽  
pp. 3607-3613 ◽  
Author(s):  
Jerry Yongqiang Chen ◽  
Ngai Nung Lo ◽  
Hwei Chi Chong ◽  
Hee Nee Pang ◽  
Darren Keng Jin Tay ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
High Tibial Osteotomy ◽  
Knee Arthroplasty ◽  
Tibial Osteotomy ◽  
Posterior Stabilized ◽  
Cruciate Retaining ◽  
Total Knee

scholarly journals A comparison of clinical outcomes and cartilage repair between opening wedge and closed wedge high tibial osteotomy procedures in patients with medial osteoarthritis of the knee

2020 ◽  
Author(s):  
Tomotaka Akamatsu ◽  
Ken Kumagai ◽  
Shunsuke Yamada ◽  
Shuntaro Nejima ◽  
Masaichi Sotozawa ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Tibial Osteotomy ◽  
Cartilaginous Tissue ◽  
Opening Wedge ◽  
Correction Angle ◽  
Closed Wedge ◽  
Wedge High Tibial Osteotomy ◽  
And Function ◽  
And Cartilage

Abstract Background: The aim of the present study was to assess differences in clinical outcomes and postoperative cartilage repair between opening wedge high tibial osteotomy (OWHTO) and closed wedge HTO (CWHTO) for medial osteoarthritis (OA) of the knee.Methods: A total of 90 knees of 76 patients who underwent HTO were investigated. OWHTO was performed in 45 knees of 40 patients with a correction angle of 15° or less, and CWHTO was performed in 45 knees of 36 patients with a correction angle of greater than 15°. Initial arthroscopy was performed at the time of HTO, and a second-look arthroscopy was performed at the time of plate removal. Cartilage repair was classified into the following stages: Stage 1 (no reparative change); Stage 2 (partial coverage with white cartilaginous tissue); and Stage 3 (full coverage with white cartilaginous tissue). Clinical outcomes were assessed using Knee Society scores, and radiographic assessment was carried out by measuring the femorotibial angle (FTA).Results: Regarding preoperative OA grade, varus alignment, and function score, CWHTO patients showed more advanced OA status than OWHTO patients. Knee scores and function scores were significantly improved after surgery with both HTO procedures (P<0.05), with no significant difference between the two procedures. Cartilage repair of stage 2 or 3 was found in more than 80% of the subjects in the medial femoral condyle and more than 60% in the medial tibial condyle. However, there were no significant differences between the two HTO procedures. There was no relationship between clinical outcomes and postoperative cartilage status in both HTO procedures. Multivariate logistic regression analysis showed that preoperative International Cartilage Repair Society (ICRS) grade was the only factor affecting cartilage repair.Conclusions: CWHTO improved clinical outcomes and cartilage status as much as OWHTO. Although the effects of cartilage repair on clinical outcomes are unknown, HTO is an effective treatment option even for severe medial OA of the knee.

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