scholarly journals STUDY TO EVALUATE THE ROLE OF HIGH TIBIAL OSTEOTOMY (HTO) FIXED WITH ANGLE STABLE PLATE IN TREATMENT OF OSTEOARTHRITIS OF KNEE AT NMCH, ROHTAS, BIHAR

2021 ◽  
pp. 1-4
Author(s):  
Sandeep Kumar ◽  
Kumari Rashmi ◽  
Kumar Anshuman ◽  
Debarshi Jana
Keyword(s):  
High Tibial Osteotomy ◽  
Wedge Osteotomy ◽  
P Value ◽  
Tibial Osteotomy ◽  
Open Wedge Osteotomy ◽  
Definite Improvement ◽  
Angle Stable ◽  
And Function ◽  
Angle Stable Plate

Background: Osteoarthritis is more common in females. It is because osteoarthritis in post-menopausal women is associated with higher body weight, higher subcutaneous fat, calcium deficiency and weaker muscles linked to hormonal changes. The purpose of this study was to evaluate the role of high tibial osteotomy fixed with angle stable plate in treatment of osteoarthritis of knee. Material and Methods: In our study 10 cases were operated by modified coventry technique, 10 cases were operated by open wedge osteotomy with non locking plates and bone graft and 104 cases were operated by medial open wedge osteotomy and iliac graft secured by locking plate. In these cases full weight bearing was allowed at 8 week, 6 week and 3rd post operative day respectively. Radiographical analysis include post operatively change in tibio-femoral angle. Mean follow up of these cases was 2 year. Results: In our study thee knee pain and function score were significantly improved (p value <0.001). The average pain score preoperatively was 1 8± 7(the maximum pain score for pain is 50) and post-operatively was 44±5. According to the grading used for functional assessment in knee scores there was definite improvement in the function of cases 122 (98.38%) at 2 yrs. The preoperatively mean functional knee score in of 110 cases (88.7%) cases was 28.86 (the maximum functional knee score is 100) and postoperatively was 70.45. There is correction in tibiofemoral angle (mean preoperative and postoperative tibiofemoral angle was 5.2±1.5 degrees varus and 5.8±1.3 degrees valgus respectively). Conclusion: There was definite improvement in the pain and function of the knee after the correction of the deformity (P value <0.001). The results of high tibial osteotomy in 88.23 percentage knees were rated as excellent. 104 out of these 124 cases were fix by locking plates. 2 cases had poor results due to excessive over correction and associated comorbidities. There is a definite correlation between the postoperative valgus obtained and relief in the pain.

scholarly journals UNICOMPARTMENTAL OSTEOARTHRITIS OF KNEE

2018 ◽  
Vol 25 (11) ◽  
Author(s):  
Assad Mehmood ◽  
Mohammad Ishaq ◽  
Muhammad ShafiquE
Keyword(s):  
High Tibial Osteotomy ◽  
Subcutaneous Fat ◽  
Deformity Correction ◽  
Wedge Osteotomy ◽  
P Value ◽  
Tibial Osteotomy ◽  
Knee Score ◽  
Unicompartmental Osteoarthritis ◽  
Osteoarthritis Of Knee ◽  
Poor Outcomes

Background: Osteoarthritis is more common in females because inpostmenopausal state, it is linked with high body weight, higher subcutaneous fat, deficiencyof calcium and weakness of muscles associated with changes in harmones. Objectives: Toassess the outcome of high tibial osteotomy in unicompartmental osteoarthritis of knee in termsof pain and improvement in function. Study Design: Prospective study. Setting: King AbdullahTeaching Hospital, Mansehra. Period: 1st January 2016 to 31st December 2017. Materialsand Methods: Two hundred and forty eight cases were included in which twenty cases wereoperated by the use of modified coventry technique, twenty cases were operated by openwedge osteotomy with non locking plates as well as bone graft and remaining 208 cases wereoperated by medial open wedge osteotomy and iliac graft secured by locking plate. In all casesat eight weeks, six weeks and third post operative day respectively allowed full weight bearing.Post-operative changes in tibio femoral angle included in radiographical analysis. 2 years meanfollow-up of all these cases. Results: Function score and pain of knee improved considerably asthe p value <0.001 in our study. Maximum pain score is 50, pre-operatively average pain scorewas 18±7 and 44±5 was postoperatively. There was a significant improvement at two years inthe function of cases 244 (98.38%) according to grading used for judgment of function in kneescore. Pre-operatively mean functional knee score in 110 cases (88.70%) cases were 28.86,(100 is the maximum functional knee score) and 70.45 was post-operatively. In tibiofemoralangle there was a correction of 5.2±1.5 degree varus preoperatively and postoperatively aswell as valgus 5.8±1.3 degree respectively. Conclusion: In function and pain of the knee,there was significant improvement after the deformity correction (p value <0.001). In 88.23%outcomes of high tibial osteotomy in knees rated as excellent. Due to associated comorbidityand excessive over correction, there were poor outcomes in two cases. There is significantassociation between the obtained postoperative valgus and relief in pain.

scholarly journals Prognostic Factors Influencing Outcomes of High Tibial Osteotomy in The Varus Knee: The Role of The Deformity

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
Carola Pilone ◽  
Federico Verdone ◽  
Roberto Rossi ◽  
Davide Bonasia ◽  
Federica Rosso
Keyword(s):  
Prognostic Factors ◽  
Regression Model ◽  
High Tibial Osteotomy ◽  
Womac Score ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Inclusion Criteria ◽  
Opening Wedge

Objectives: High Tibial Osteotomy (HTO) is widely performed to treat early arthiritis in the varus knee. The aim of this prospective study is to evaluate different prognostic factors affecting the outcomes of HTO and, with special attention to the role of the site of deformity. Methods: 231 Opening Wedge HTO (OWHTO) were performed in 202 patients and included in the study. Inclusion criteria were: 1) age > 18 years, 2) no major associated procedures (i.e. ACL reconstruction, major cartilage procedure, 3) only OWHTO, 4) pre-operative complete clinical and radiological evaluation available. Patients were evaluated with (1) the Knee Society score (KSS), (2) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, (3) another self-evaluation scale, (4) long-leg radiographs, and (5) plain radiographs. On the x-ray different angles were evaluated, including Join Line Congruence Angle. Furthermore, the location of deformity was established. Three main outcomes were identified: Indication to Total Knee Arthroplasty (TKA), KSS poor or fair and WOMAC < 76 points), and different prognostic factors were identified (Fig. 1). All the variables were firstly tested in a single regression model to evaluate the association with each outcome. All the variables with p<0.1 were re-tested in a multiple regression model. Results: 32 patients were lost to follow-up and 31 patients did not meet the inclusion criteria, leaving 139 patients (156 OWHTOs) for the study. The average age was 52.9 ± 9.6 years, and the average follow-up was 97.7 ± 42.8 months. Post-operatively there was a significant improvement in both the KSS and WOMAC score compared to the pre-operative period (p<0.0001). The only variable related to TKA indication was a pre-operative JLCA ≥5° (OR=24.3, p=0.0483). Conversely, different variables were related to a worse KSS, including pre-operative BMI >30 Kg/m2 (OR=78.9, p=0.0028), pre-operative ROM <120° of flexion (OR=40.8, p=0.0421), pre-operative mLDFA ≥91° (OR=36,6,p=0.0401) and femoral pre-operative CORA ≥3° of varus (OR=39,9 p=0.0269). Furthermore, a pre-operative BMI >30 Kg/m2 (OR=29,5, p=0.0314) was associated to a worse WOMAC score. Conversely, patients with a pre-operative mMPTA ≤84° had lower risk to obtain a worse KSS oe WOMAC score (respectively OR= 0,2 p=0.0364 and OR=0,3 p=0.0071). The cumulative survivorship was calculated with the Kaplan-Meier method, and it resulted equal to 98.6% at 5 years and decreased to 85.5% at 10 years. Conclusion: OWHTO is a good treatment for early arthritis in the varus knee if the correct indications are applied. The outcomes can be considered good, with 85% of 10-year survivorship. It is mandatory to correctly address the location of the deformity, because the presence of a femoral varus deformity is related to worse outcomes. Similarly, presence of a pre-operative JLCA ≥5° is the only factor associated to TKA indication. [Table: see text]

scholarly journals High tibial osteotomy: closed wedge versus combined wedge osteotomy

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Maarten R Huizinga ◽  
Reinoud W Brouwer ◽  
Tom M van Raaij
Keyword(s):  
High Tibial Osteotomy ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Closed Wedge

Primary stability of different plate positions and the role of bone substitute in open wedge high tibial osteotomy

The Knee ◽  
2017 ◽  
Vol 24 (6) ◽  
pp. 1299-1306 ◽  
Author(s):  
Ryohei Takeuchi ◽  
Jung Woon-Hwa ◽  
Hiroyuki Ishikawa ◽  
Yuichiro Yamaguchi ◽  
Katsunari Osawa ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Bone Substitute ◽  
Primary Stability ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

scholarly journals Double-Level Osteotomy in Severe Varus Malalignment to Optimize Knee Joint Restoration

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110466
Author(s):  
Jörg Harrer ◽  
Max Schenke ◽  
Christoph Lutter ◽  
Jörg Dickschas ◽  
Matthias Feucht ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Varus Deformity ◽  
Joint Line ◽  
Full Weight Bearing ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Partial Weight Bearing ◽  
Angle Stable ◽  
Angle Stable Plate ◽  
Partial Weight

Background: Lower extremity alignment-correcting procedures for unicompartmental osteoarthritis are experiencing a rapid rise. Medial open-wedge high tibial osteotomy (MOW-HTO) thereby represents the most common technique among osteotomies but is limited in cases of severe malalignment. Some cases make a double-level osteotomy necessary. Indications: If planning of malalignment correction using a MOW-HTO results in a mechanical medial proximal tibial angle (mMPTA) of more than 93° (causing an oblique joint line), double-level osteotomy is indicated to avoid nonphysiological knee kinematics. Technique Description: After clinical examination and detailed analysis of malalignment (full-weight-bearing long-leg radiograph: hip-knee-angle [HKA], mMPTA, mechanical lateral distal femoral angle [mLDFA], joint line convergence angle [JLCA]), as well as individualized planning of the correction, the surgical procedure starts with an arthroscopy to evaluate the cartilage conditions and eventually treat intraarticular pathologies. Then, the femoral supracondylar correction is performed (closed wedge, biplanar osteotomy [ to increase bony healing]) according to the presurgical planning by resecting the osteotomy wedge with the measured length. K-wires are placed to check the correction. An angle-stable plate is used for osteosynthesis. The wedge taken out will be used as bone stock for the MOW-HTO afterward. The biplanar open-wedge tibial osteotomy is then performed subsequently using a medial tibial approach and an angle-stable plate. Opening of the osteotomy is then performed and double checked with intraoperative fluoroscopy using an alignment rod. Postoperative partial weight bearing for 6 weeks is recommended. Results: In recent literature, only few publications report on results of double-level osteotomies. Babis et al reports that it is a valuable procedure for patients with large varus deformity. Nakayama et al noted a significant improvement in patient-registered clinical outcomes in early postoperative evaluation of 20 patients. Schröter et al reports on 37 knees and findings include good clinical results, despite progressive osteoarthritis. Discussion/Conclusion: In cases of severe malalignment, adequate axis correction may require a double-level osteotomy. Exact preoperative planning is essential. Results reported in recent publications are promising. By splitting 1 large correction into 2 smaller ones, complications like hinge fracture and delayed bone healing are lowered.

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