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Yuwen P, Sun W, Yang Y, Feng C, Wu D, Chen W, Zhang Y. Medium to long term of self-report outcomes of high tibial osteotomy in advanced age patients. INTERNATIONAL ORTHOPAEDICS 2024; 48:1743-1749. [PMID: 38286924 DOI: 10.1007/s00264-024-06091-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024]
Abstract
PURPOSE This study aimed to investigate the mid- to long-term benefits of high tibial osteotomy in advanced age patients. METHODS This retrospective study was conducted in our hospital from January 2017 to January 2021 with data prospectively collected, 47 patients with knee osteoarthritis who over 65 years old were included, and a 1:1 propensity score (PS) of patients < 65 years were matched according to gender, body mass index, and side. Patient demographics, intraooperative and postoperative variables, and patient self-reported outcomes were compared. A generalized linear model was used to screen possible risk factors. RESULTS A total of 94 consecutive patients were included; the average age of advanced age group was 69.47 + 4.26 years and 57.87 + 5.51 years in the younger group. There were no statistically difference in K-L grade, smoke, drink, comorbidity, ASA, blood loss, operative duration, length of stay, surgical site infection, hinge fracture, DVT, and preooperative and postoperative aFTA; significantly statistical difference of the eFI was found between two groups (P < 0.05). Two groups had comparable VAS and MOMAC scores at one year postoperatively (P > 0.05), while the younger group had lower VAS and WOMAC scores than the advanced age group at the end of follow-up (P < 0.05). Generalized linear model showed both age and eFI were associated with WOMAC scores; there was a statistically significant difference in the effect of eFI on WOMAC scores at different ages (P > 0.05). CONCLUSIONS Compared with younger patients, advanced age patients have similar short-term benefits, but less long-term benefits. We recommend that patients proposed for HTO be discriminated by eFI, and patients with higher scores should be cautiously selected.
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Affiliation(s)
- Peizhi Yuwen
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Weiyi Sun
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Yanjiang Yang
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Chen Feng
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Dongwei Wu
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China
| | - Wei Chen
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, the Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
- Hebei Orthopaedic Clinical Research Center, the Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, China.
- Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, the Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
- Hebei Orthopaedic Clinical Research Center, the Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
- Department of Orthopedic Joint, the Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
- Engineering Research Center of Orthaepedic, the Third Hospital of Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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Mallick MB, Baliga S, Tunglut P, Arya P. Combining proximal fibular osteotomy with high tibial osteotomy – Is it better than high tibial osteotomy alone? Comparative evaluation of early outcome. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2022. [DOI: 10.4103/jotr.jotr_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ashraf M, Purudappa PP, Sakthivelnathan V, Sambandam S, Mounsamy V. Proximal fibular osteotomy: Systematic review on its outcomes. World J Orthop 2020; 11:499-506. [PMID: 33269216 PMCID: PMC7672796 DOI: 10.5312/wjo.v11.i11.499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/25/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The morbidity and burden of knee osteoarthritis affecting millions of lives worldwide has created a constant pursuit in finding the ideal treatment for knee osteoarthritis. There has been a paradigm shift in the surgical treatment of osteoarthritis ever since the initial description of Volkmann’s tibial osteotomy. This review focuses on one such recent procedure, the proximal fibular osteotomy (PFO) for medial compartment knee osteoarthritis. This review encompasses the history, evidence, risk factors, outcomes and technical considerations of PFO.
AIM To understand the evidence and its techniques, and whether this could be an alternative solution to the problem of knee osteoarthritis in the developing world.
METHODS The phrases “proximal fibular osteotomy” and “knee osteoarthritis” were searched (date of search December 20, 2019) on PubMed to identify articles evaluating the biomechanical and clinical outcomes of PFO in patients with knee osteoarthritis. A total of 258 were retrieved. After reviewing the summary of the texts, 22 articles written in English were marked for abstract review. Articles that were case studies or cadaver experiments were excluded. The abstracts of the remaining articles were read, and only those that focused on the history, outcomes of case studies and technical considerations of PFO were included in the review. A total of 12 articles were included in this review.
RESULTS At least six studies reported improvement in the visual analogue scale(VAS) from the average preoperative VAS score [6.32, 95% confidence interval (CI) = (4.05, 8.59)] to average postoperative VAS score [1.23, 95%CI: (-1.20, 3.71)], which was statistically significant. Similarly, the American Knee Society Score (KSS) functional score improved from an average preoperative KSS functional score [43.11, 95%CI: (37.83, 48.38)] to postoperative KSS functional score [66.145, 95%CI: (61.94, 70.35)], which was statistically significant. The femorotibial angle improved by around 7º, and the hip knee ankle angle improved by around 6º.
CONCLUSION With the existing data, it seems that PFO is a viable option for treating medial joint osteoarthritis in selected patients. Long term outcome studies and progression of disease pathology are some of the important parameters that need to be addressed by use of multicenter randomized controlled trials.
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Affiliation(s)
- Munis Ashraf
- Department of Orthopedic Surgery, Yenepoya Medical College Hospital, Mangalore 575108, India
| | | | | | | | - Varatharaj Mounsamy
- Department of Orthopedic Surgery, Dallas VA Medical center, Dallas, TX 75216, United States
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Sun M, He R, Guo L, Chen G, Duan X, Zhang Y, Yang L. [Clinical application and research status of open wedge high tibial osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:640-643. [PMID: 31090361 PMCID: PMC8337196 DOI: 10.7507/1002-1892.201901014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/06/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the clinical application and research status of open wedge high tibial osteotomy (OWHTO). METHODS Relevant literature at home and abroad was reviewed, and the clinical application, effectiveness and complications, technical comparison, and surgical skills of OWHTO were summarized and analyzed. RESULTS OWHTO is an effective treatment for mild to moderate medial compartment osteoarthritis due to knee varus. This method can delay the injury process of medial compartment of the knee, delay the time of total knee arthroplasty, and even avoid joint replacement surgery by adjusting the axial alignment of the lower extremity to the non-pathological lateral compartment through osteotomy and orthopedic. OWHTO has the advantages of small incision, dynamic adjustment of the axial alignment of the lower extremity, accurate correction of malformation, and rapid postoperative recovery. CONCLUSION With the development of surgical instruments and techniques, OWHTO once again enter the sight of orthopedic surgeons. This technique can solve the pain symptoms of arthritis, correct the tibial varus deformity and reconstruct the axial alignment of the lower extremity, and satisfactory clinical results has been obtained.
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Affiliation(s)
- Maolin Sun
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Rui He
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Lin Guo
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Guangxing Chen
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Xiaojun Duan
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Ying Zhang
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, P.R.China
| | - Liu Yang
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038,
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Dabis J, Templeton-Ward O, Lacey AE, Narayan B, Trompeter A. The history, evolution and basic science of osteotomy techniques. Strategies Trauma Limb Reconstr 2017; 12:169-180. [PMID: 28986774 PMCID: PMC5653603 DOI: 10.1007/s11751-017-0296-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/19/2017] [Indexed: 02/07/2023] Open
Abstract
Osteotomy techniques date back to Hippocrates circa 415 BC (Jones Hippocrates collected works I, Harvard University Press, Cambridge, 2006; Brorson in Clin Orthop Relat Res 467(7):1907-1914, 2009). There is debate about the best way to divide the bone surgically and which technique yields the best bone regenerate in lengthening; ensuring predictable new bone formation and healing of the osteotomy are the primary goals. We review the history and techniques of the osteotomy and consider the evidence for optimum bone formation. Methods discussed include variants of the 'drill and osteotome' technique, use of the Gigli saw and use of a power saw. Differences in bone formation through the different techniques are covered.
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Affiliation(s)
- John Dabis
- St. Georges University Hospital, Blackshaw Road, Tooting, London, SW17 0QT UK
| | | | - Alice E. Lacey
- Health Education England (NW), 3 Piccadilly, Manchester, M1 3BN UK
| | - Badri Narayan
- Royal Liverpool and Broadgreen University Hospital, Broadgreen Hospital, Liverpool, L13 4LB UK
| | - Alex Trompeter
- St. Georges University Hospital, Blackshaw Road, Tooting, London, SW17 0QT UK
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Smith WB, Steinberg J, Scholtes S, Mcnamara IR. Medial compartment knee osteoarthritis: age-stratified cost-effectiveness of total knee arthroplasty, unicompartmental knee arthroplasty, and high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2017; 25:924-933. [PMID: 26520646 DOI: 10.1007/s00167-015-3821-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 09/25/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare the age-based cost-effectiveness of total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and high tibial osteotomy (HTO) for the treatment of medial compartment knee osteoarthritis (MCOA). METHODS A Markov model was used to simulate theoretical cohorts of patients 40, 50, 60, and 70 years of age undergoing primary TKA, UKA, or HTO. Costs and outcomes associated with initial and subsequent interventions were estimated by following these virtual cohorts over a 10-year period. Revision and mortality rates, costs, and functional outcome data were estimated from a systematic review of the literature. Probabilistic analysis was conducted to accommodate these parameters' inherent uncertainty, and both discrete and probabilistic sensitivity analyses were utilized to assess the robustness of the model's outputs to changes in key variables. RESULTS HTO was most likely to be cost-effective in cohorts under 60, and UKA most likely in those 60 and over. Probabilistic results did not indicate one intervention to be significantly more cost-effective than another. The model was exquisitely sensitive to changes in utility (functional outcome), somewhat sensitive to changes in cost, and least sensitive to changes in 10-year revision risk. CONCLUSIONS HTO may be the most cost-effective option when treating MCOA in younger patients, while UKA may be preferred in older patients. Functional utility is the primary driver of the cost-effectiveness of these interventions. For the clinician, this study supports HTO as a competitive treatment option in young patient populations. It also validates each one of the three interventions considered as potentially optimal, depending heavily on patient preferences and functional utility derived over time.
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Affiliation(s)
| | | | | | - Iain R Mcnamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, University of East Anglia, Colney Lane, Norwich, NR4 2UY, UK.
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Osteotomy around the knee: evolution, principles and results. Knee Surg Sports Traumatol Arthrosc 2013; 21:3-22. [PMID: 23052110 DOI: 10.1007/s00167-012-2206-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/03/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE This article summarises the history and evolution of osteotomy around the knee, examining the changes in principles, operative technique and results over three distinct periods: Historical (pre 1940), Modern Early Years (1940-2000) and Modern Later Years (2000-Present). We aim to place the technique in historical context and to demonstrate its evolution into a validated procedure with beneficial outcomes whose use can be justified for specific indications. MATERIALS AND METHODS A thorough literature review was performed to identify the important steps in the development of osteotomy around the knee. RESULTS The indications and surgical technique for knee osteotomy have never been standardised, and historically, the results were unpredictable and at times poor. These factors, combined with the success of knee arthroplasty from the 1980s onward, led to knee osteotomy being regarded as an irrelevant surgical option by many surgeons. Despite its fluctuating reputation, this article demonstrates the reasons for the enduring practice of osteotomy, not least because achieving the appropriate alignment is now recognised as the foundation step when planning any surgical intervention. CONCLUSIONS With appropriate patient selection, accurate pre-operative planning, modern surgical fixation techniques and rapid rehabilitation, osteotomy around the knee is now an effective biological treatment for degenerative disease, deformity, knee instability and also as an adjunct to other complex joint surface and meniscal cartilage surgery. LEVEL OF EVIDENCE V.
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Fujikawa K, Seedhom BB, Wright V. Biomechanics of the patello-femoral joint. Part II: A study of the effect of simulated femoro-tibial varus deformity on the congruity of the patello-femoral compartment and movement of the patella. ENGINEERING IN MEDICINE 1983; 12:13-21. [PMID: 6682056 DOI: 10.1243/emed_jour_1983_012_005_02] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This paper investigates the effect of different degrees of varus deformity on the pattern of contact, congruence of the patello-femoral joint, and movement of the patella. Varus deformity of 5, 10, and 15 degrees was imposed on the same cadaveric knee specimen used in the study reported in Part I (Fujikawa, Seedhom, Wright, 1983). This was done by high tibial osteotomy and the introduction of a wooden wedge of the appropriate thickness to effect the deformity. It was found that the contact gradually shifted to the medial side of the knee, and the congruence of the patello-femoral compartment was gradually destroyed as the degree of varus deformity increased to 15 degrees, although the effect of 5 degrees of varus deformity was minimal.Clinically, contact is shifted to the lateral side of the knee with varus deformity, but this is invariably associated with lateral tibial rotation. This rotation explains the difference between the results of the varus deformity imposed on cadaveric knees and those observed clinically. It is proposed that an adverse change in the congruence of the knee will occur after a sudden correction by high tibial osteotomy, just as that occurring in the normal cadaveric knee after imposing a sudden varus deformity, and therefore it may be useful to consider performing the correction at an early stage of the deformity.The effect of the varus deformity on the movement of the patella is also described.
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Arnoldi CC, Reimann I. The pathomechanism of human coxarthrosis. ACTA ORTHOPAEDICA SCANDINAVICA. SUPPLEMENTUM 1979; 181:1-47. [PMID: 294122 DOI: 10.3109/ort.1979.50.suppl-181.01] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Iveson JM, Longton EB, Wright V. Comparative study of tibial (single) and tibiofemoral (double) osteotomy for osteoarthrosis and rheumatoid arthritis. Ann Rheum Dis 1977; 36:319-26. [PMID: 901030 PMCID: PMC1006692 DOI: 10.1136/ard.36.4.319] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Osteotomies on 101 knees in 79 patients were assessed either prospectively or retrospectively. High tibial osteotomy was performed in 54 knees (27 with rheumatoid arthritis (RA) and 27 with osteoarthrosis (OA)) and double (tibiofemoral) osteotomy in 47 knees (25 RA and 22 OA), and were assessed prospectively in 46 and retrospectively in 55. Using a subjective assessment, 65% showed some improvement--70% of the single and 60% of the double osteotomies. Of the four groups (OA single or double, RA single or double), OA knees having a single osteotomy improved most frequently (74%), and OA knees having a double osteotomy least frequently (50%). Significant improvements in pain score and angular deformity were recorded. The mean range of movement of the operated knee was significantly reduced, and was particularly evident in those knees having a double osteotomy. We conclude that double osteotomies tend to have a higher incidence of complications, including impaired movement, and are not more efficient in relieving pain than single osteotomies in either OA or RA.
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Editorial: Osteotomy for arthritis of the knee. BRITISH MEDICAL JOURNAL 1975; 1:2. [PMID: 1120219 PMCID: PMC1671911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ahlberg A, Scham S, Unander-Scharin L. Osteotomy in degenerative and rheumatoid arthritis of the knee joint. ACTA ORTHOPAEDICA SCANDINAVICA 1968; 39:379-88. [PMID: 5730315 DOI: 10.3109/17453676808989473] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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