ObjectiveTo evaluate the effects of the improved precision alignment method of lower limbs mecha-nical alignment for osteoarthritis of the knee in open wedge high tibial osteotomy (OWHTO).MethodsA retrospective analysis was made on the clinical data of 62 patients (68 knees) with knee osteoarthritis in the medial compartment treated with OWHTO between January 2012 and December 2015 who accorded with the inclusion criteria. The traditional method for positioning lower limb mechanical force line was used in 29 cases (32 knees) (traditional group), and improved method for positioning lower limb mechanical force line in 33 cases (36 knees) (modified group). There was no significant difference in gender, age, side, course of disease, and osteoarthritis grading between two groups (P>0.05) with comparable. The operation time, intraoperative fluoroscopy times, and intraoperative blood loss were recorded in two groups; Before and after operation, the lower limb mechanical force line was observed on the X-ray films, which was expressed by hip-knee-ankle angle (HKA). The clinical efficacy was evaluated by the American Hospital for Special Surgery (HSS) score, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC).ResultsIncision hematoma occurred in 1 case of traditional group and was cured at 3 weeks after symptomatic treatment; and primary healing was obtained in the other patients, with no early complications. The operation time and intraoperative fluoroscopy times of the modified group were significantly lower than those of the traditional group (t=11.934, P=0.000; t=11.663, P=0.000), but there was no significant difference in blood loss between the two groups (t=0.209, P=0.835). The patients were followed up for 6 to 24 months (mean, 12.7 months) in the traditional group and for 3 to 22 months (mean, 13.2 months) in the modified group. The medial knee pain disappeared in all patients. At last follow-up, the HSS score and WOMAC score were significantly improved when compared with preoperative scores in two groups (P<0.05), but there was no significant difference between the two groups (P>0.05). Postoperative X-ray examination showed that the tibiofemoral angle was corrected in the two groups. The HKA angle at immediate after operation and last follow-up was significantly higher than angle at pre-operation in two groups (P<0.05), but there was no significant difference between at immediate after operation and at last follow-up (P>0.05).ConclusionCompared with the traditional method for positioning lower limb mechanical force line, the improved precision alignment method can reduce the times of intraoperative fluoroscopy and shorten the operation time, which reduces the radiation exposure of both doctors and patients.
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.
Objective To evaluate the effectiveness of open wedge high tibial osteotomy (OWHTO) in treatment of medial unicompartmental knee osteoarthritis (MUKOA). Methods A clinical data of 61 cases with MUKOA who were treated with OWHTO between January 2015 and January 2017 were retrospectively analyzed. There are 14 males and 47 females with an average age of 52.8 years (mean, 44-60 years). The body mass index ranged from 19.1 to 34.7 kg/m2 (mean, 25.3 kg/m2). Twenty-seven cases were left side and 34 cases were right side. The disease duration was 1-9 years (mean, 5.3 years). The MUKOA was rated as stage Ⅱ in 33 cases and stage Ⅲ in 28 cases. Preoperative Hospital for Special Surgery (HSS) score was 56.0±3.7. Walking visual analogue scale (VAS) score was 4.6±1.0. Results The operation time was 49-85 minutes (mean, 66.5 minutes). The length of incision was 10-13 cm (mean, 11.0 cm). The total overt blood loss was 80-210 mL (mean, 139.1 mL). The postoperative bed-rest time was 1-10 days (mean, 4.7 days). All patients were followed up 12-24 months (mean, 17.3 months). The bearing area of tibial platform at 3 months after operation was 60.3%-66.8%, with an average of 63.4%. At 3 and 6 months after operation, the HSS score was 79.1±4.2 and 85.3±3.1 respectively, and the VAS score was 1.7±0.7 and 0.6±0.5 respectively, all showing significant differences (P<0.05). Conclusion OWHTO is an ideal choice for treating MUKOA with less postoperative complications. The force line could be corrected by OWHTO. However, the preoperative preparations are very important, especially that the open angle should be measured accurately.
Objective To investigate the effectiveness of double-plane high tibial osteotomy in treatment of medial compartment osteoarthritis. Methods The clinical data of 65 patients with medial compartment osteoarthritis who were treated with double-plane high tibial osteotomy between January 2014 and January 2017 was retrospectively analyzed. There were 28 males and 37 females. The age ranged from 46 to 75 years with an average of 53.2 years. There were 30 cases in the left knee and 35 cases in the right knee. The disease duration was 3-7 years (mean, 4.0 years). The patients had different degrees of pain in the knee joint and difficulty walking. The knee joint compression test was positive. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score and knee society score (KSS) clinical and functional scores. The visual analogue scale (VAS) score was adopted to pain measurement. The healing of osteotomy was observed by X-ray films during follow-up; the femur tibia angle (FTA), posterior tibial slope (PTS), medial proximal tibial angle (MPTA), and knee varus angle (KVA) were also calculated. Results All the incisions healed by first intention after operation. Only 1 case had numbness of the toe, and the symptoms disappeared after symptomatic treatment. All patients were followed up 13-18 months with an average of 15.4 months. X-ray examination showed that all patients had bone healing at 12 weeks after operation. There were significant differences in MPTA, FTA, PTS, and KVA between pre- and post-operation (P<0.05). There was no significant difference in above parameters among 1 week, 6 months, and 12 months after operation (P>0.05). There was no loosening and rupture of the fixator during the follow-up. The HSS score and KSS clinical and functional scores at 12 months after operation were significantly higher than those before operation (P<0.05). The VAS scores at 1 week, 6 months, and 12 months after operation were significantly lower than that before operation (P<0.05). Conclusion Double-plane high tibial osteotomy for medial compartment osteoarthritis can effectively relieve pain symptoms and improve joint function.
ObjectiveTo summarize the related research results of open wedge high tibial osteotomy (OWHTO) complicated with lateral hinge fracture. MethodsTo review the relevant literature of OWHTO at home and abroad in recent years and summarize and analyse the clinical experience. ResultsThe lateral hinge rupture may occur during the OWHTO, which may lead to the loss of correction angle after operation, delayed healing or non-union of osteotomy and so on. The lateral hinge plays an important role in the stability of the osteotomy. During the operation, the " safe zone” internal osteotomy can be used to protect the bone. Once the lateral hinge breaks, the TomoFix plate can be used to obtain the sufficient stability. For patients with lateral hinge rupture, functional exercise and full weight loading time should be guided by hinge breakage classification. ConclusionThe intact lateral hinge is beneficial to the healing and rehabilitation of OWHTO. The lateral hinge should be paid enough attention by clinicians.
ObjectiveTo summarize the management principle and clinical suggestions of the osteotomy gap of opening wedge high tibial osteotomy (OWHTO).MethodsThe related literature of the osteotomy gap of OWHTO in recent years was reviewed, summarized, and analyzed.ResultsDelayed union and non-union of the osteotomy gap are main complications of OWHTO. Tomofix plate, as locking steel plate, has the characteristics of angular stability and can better maintain the stability of the osteotomy gap, promote bone healing, and avoid loss of correction. There are some treatment options for the osteotomy gap site, such as, without bone, autologous bone graft, allogeneic bone graft, bone substitute materials graft, and augment factor graft to enhance bone healing. When the osteotomy gap is less than 10 mm, it achieves a good outcome without bone graft. For the obesity, lateral hinge fracture, large osteotomy gap, or correction angle more than 10°, the bone graft should be considered. In cases whose osteotomy gap is nonunion or delayed union, the autologous bone graft is still the gold standard. When the osteotomy gap repaired with the allogeneic bone graft, it is better to choose fragmented cancellous or wedge-shaped cancellous bone, combining with the locking plate technology, also can achieve better bone union. The bone substitute material of calcium-phosphorus is used in the osteotomy gap, which has the characteristics of excellent bone conduction, good biocompatibility, and resorption, combining with the locking plate technology, which can also achieve better bone union in the osteotomy gap. The augment factors enhance the bone healing of the osteotomy gap of OWHTO is still questionable. The bone union of the osteotomy gap is also related to the size of the osteotomy gap and whether the lateral hinge is broken or not.ConclusionNo matter what type of materials for the osteotomy gap, OWHTO can improve the function and relieve pain for knee osteoarthritis. More randomized controlled trials are needed to provide evidence for clinical decision to determine which treatment option is better for the osteotomy gap of OWHTO.
ObjectiveTo compare the clinical and radiologic effectiveness in patients with versus without lateral hinge fracture during medial opening-wedge high tibial osteotomy (MOWHTO) to evaluate the effect of lateral hinge fracture on short-term effectiveness.MethodsThe clinical data of 84 patients (97 knees) with medial compartment osteoarthritis who treated with MOWHTO between September 2015 and July 2018 was retrospectively analyzed. There were 10 males (10 knees) and 74 females (87 knees). The age ranged from 45 to 65 years with an average of 57.7 years. Lateral hinge fracture was recognized by the intraoperative fluoroscopy or immediate postoperative X-ray film. Fractures were classified into types Ⅰ, Ⅱ, and Ⅲ according to the Takeuchi classification. The healing of osteotomy was observed by radiographs during follow-up; the femur tibia angle (FTA), medialproximal tibial angle (MPTA), and hip-knee-ankle angle (HKA) were also calculated. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score and knee society score (KSS).ResultsThe incision healed by first intention. All patients were followed up 15-48 months with an average of 24.8 months. No hinge fracture occurred in 78 knees (80.41%, group A), and lateral hinge fractures were observed in 19 knees (19.59%, group B) and were divided into the type Ⅰ (13 knees, 13.40%) and type Ⅲ (6 knees, 6.19%) groups. Type Ⅰ fractures were not additionally treated, type Ⅲ fractures were anatomic reduced fixed with additional lag screws. X-ray film and CT examination showed that all patients had bone healing at 3 months after operation without delayed healing or nonunion. During follow-up, there was no loosening or fracture of internal fixation plates and screws. HKA, FTA, and MPTA of patients in group A and group B (type Ⅰ and Ⅲ) were significantly improved at each time point after operation compared with preoperative values (P<0.05); there was no significant difference between groups at each time point before and after operation (P>0.05). After operation, the pain of knee joint was alleviated and the function of joint was improved. At last follow-up, KSS score and HSS score of groups A and B were significantly improved compared with those before operation (P<0.05), but there was no significant difference between the two groups (P>0.05).ConclusionThe lateral hinge fracture may occur during MOWHTO. As long as the treatment and rehabilitation were guided according to the fracture classification of the hinge, the effectiveness can be similar to those without the hinge fracture.
ObjectiveTo investigate the effectiveness of arthroscopy combined with high tibial osteotomy (HTO) in the treatment of knee medial compartment osteoarthritis and its influence on cartilage injury.MethodsThe clinical data of 57 patients with knee medial compartment osteoarthritis treated with arthroscopy combined with HTO between March 2017 and March 2019 were retrospectively analyzed. There were 27 males and 30 females with an average age of 52.4 years (range, 44-57 years). The disease duration ranged from 3 to 6 years, with an average of 3.6 years. Twenty-one cases were grade Ⅰ and 36 cases were grade Ⅱ according to Kellgren-Lawrence classification. Flexion contracture of knee joint ranged from 0° to 8° with an average of 1.36° and varus deformity ranged from 5° to 10° with an average of 7.60°. Preoperative arthroscopic evaluation showed that there were 11 cases with grade Ⅰ, 42 cases with gradeⅡ, and 4 cases with grade Ⅲ according to the international cartilage repair classification system (ICRS). Lysholm score, American Hospital for Special Surgery (HSS) score, and International Knee Documentation Committee (IKDC) score were used to evaluate knee function before operation, at 3 months, at 1 year after operation, and at last follow-up. Visual analogue scale (VAS) score was used to evaluate pain. The mechanical medial proximal tibial angle (mMPTA) and femoral tibial angle (FTA) were measured before operation and at last follow-up. When the internal fixator was removed, the knee arthroscopy was performed again to explore the cartilage repair condition, and the regeneration level and maturity level were selected for cartilage grading evaluation.ResultsAll patients’ incisions healed by first intention after operation, and no incision infection or skin necrosis occurred. After operation, the knee joint function of the patients was significantly improved, the pain symptoms were relieved, and the force line measurement reached the target set before operation. The VAS score, Lysholm score, HSS score, and IKDC score were significantly improved at 3 months, 1 year after operation, and at last follow-up when compared with those before operation. They were gradually improved with the time and there were significant differences between time points (P<0.05). mMPTA and FTA were significantly improved at last follow-up when compared with those before operation (P<0.05). When the internal fixator was removed, the arthroscopic re-assessment found that the cartilage regeneration was classified into 10 cases of grade Ⅰ and 47 cases of grade Ⅱ; 18 cases of immature cartilage regeneration and 29 cases of mature cartilage regeneration were found in the knee joints of grade Ⅱ cartilage regeneration. There was no significant difference in the cartilage regeneration grade between different ICRS gradings (H=0.176, P=0.916), and the difference in maturity grading was significant (H=10.500, P=0.005).ConclusionArthroscopy combined with HTO for the treatment of knee medial compartment osteoarthritis can effectively improve the symptoms and function of the knee joint, and can promote the regeneration of articular cartilage.
Objective To compare the effectiveness of modified distal tibial tubercle-high tibial osteotomy (DTT-HTO) and open-wedge HTO (OWHTO) in the treatment of medial compartment osteoarthritis. Methods A clinical data of 80 patients with medial compartment osteoarthritis treated with HTO between January 2016 and January 2019 was retrospectively analyzed, including 40 patients treated with DTT-HTO (DTT-HTO group) and 40 patients treated with OWHTO (OWHTO group). There was no significant difference in gender, age, body mass index, affected side, disease duration, Kellgren-Lawrence grading of osteoarthritis, and preoperative knee society score (KSS), Hospital for Special Surgery (HSS) score, knee joint visual analogue scale (VAS) score, hip-knee-ankle angle (HKA), posterior tibial slope (PTS), weight-bearing line ratio (WBL), Blackburne-Peel index (BPI), Caton-Deschamps index (CDI), and Insall-Salvati index (ISI) between the two groups (P>0.05). The operation time, incision length, bleeding volume, hospital stay, and complications in both groups were recorded. The KSS, HSS, and VAS scores were used to evaluated the effectiveness. A self-made questionnaire was used to evaluate the recovery of low-impact sports ability of the knee. X-ray films were used to observe the osteotomy healing and measure the HKA, PTS, WBL, and the patellar height indexes (BPI, CDI, ISI). Results All operations successfully completed in both groups. The OWHTO group operated longer than the DTT-HTO group (P<0.05). There was no significant difference in the incision length, bleeding volume, and hospital stay between the two groups (P>0.05). All incisions healed by first intention in both groups. There were 2 cases of lateral hinge fractures in the OWHTO group, and 1 case of lateral hinge fracture and 2 cases of tibial plateau fractures in the DTT-HTO group. No other complications occurred. The patients in both groups were followed up 2-4 years with an average of 2.8 years. The HSS, KSS, and VAS scores in both groups significantly improved after operation when compared with preoperative scores (P<0.05). All scores gradually improved with the time and there were significant differences between different time points (P<0.05). The HSS, KSS, and VAS scores were significantly better in the DTT-HTO group than in the OWHTO group at 3 months after operation (P<0.05). There was no significant difference between the two groups at 6 months, 1 year, and 2 years (P>0.05). At 1 year, the low-impact sports ability of the OWHTO group was rated as excellent in 8 cases, general in 25 cases, and poor in 7 cases, and as excellent in 7 cases, general in 26 cases, and poor in 7 cases of the DTT-HTO group. There was no significant difference between the two groups (Z=−0.715, P=0.475). X-ray film reexamination showed that the osteotomies healed in both groups. The healing time was (4.52±1.23) months in the OWHTO group, and (4.23±1.56) months in the DTT-HTO group, showing no significant difference (t=0.923, P=0.359). At immediate after operation, the HKA and WBL of the two groups significantly improved when compared with the preoperative values (P<0.05). However, the pre- and post-operational difference was not significant between the two groups (P>0.05). The PTS of the OWHTO group was significantly higher than preoperative value (P<0.05), while the PTS of the DTT-HTO group was lower than preoperative value (P>0.05). The pre- and post-operational difference between the two groups was significant (P<0.05). BPI and CDI in the OWHTO group were significantly lower than preoperative values (P<0.05), but there was no significant difference in ISI when compared with preoperative value (P>0.05). There was no significant difference in the BPI, CDI, and ISI of the DTT-HTO group between pre- and post-operation (P>0.05). The pre- and post-operational differences of BPI and CDI between the two groups were significant (P<0.05), and there was no significant difference in the pre- and post-operational difference of ISI (P>0.05). ConclusionThe two osteotomies in the treatment of medial compartment osteoarthritis can significantly change the varus deformity and achieve satisfactory effectiveness. The early functional recovery of DTT-HTO is faster, which can avoid the increased PTS and patellar baja of traditional OWHTO. However, neither of the two surgical procedures can restore the patient’s ideal low-impact sports ability of the knee.
Objective To investigate the feasibility and effectiveness of high tibial osteotomy (HTO) in treatment of chronic multi-ligament knee injury (MLKI) associated with lower extremity malalignment. Methods A clinical data of 14 patients (14 knees) of chronic MLKI associated with lower extremity malalignment, who were treated with HTO between January 2016 and September 2020, was retrospectively analyzed. There were 10 males and 4 females, with an average age of 30.5 years (range, 22-48 years). The causes of injury included traffic accident in 8 cases, bruising by a heavy object in 3 cases, falling from height in 2 cases, and twisting in 1 case. According to Schenck classification of knee dislocation (KD), there were 4 cases of KD-Ⅰ [2 cases of anterior cruciate ligament (ACL) and posterolateral complex (PLC) injuries and 2 cases of posterior cruciate ligament (PCL) and PLC injuries], 7 cases of KD-Ⅲ (all of ACL, PCL, and PLC injuries), and 3 cases of KD-Ⅳ. The preoperative hip-knee-ankle angle (HKA) was (167.1±4.7)°, and the posterior tibial slope angle (PTSA) was (16.3±2.7)°. The knee joint was severely unstable and the patients could not stand and walk normally. Among them, 5 cases of medial compartment cartilage were severely worn out (3 cases of Kellgren-Lawrence grading Ⅱ, 2 cases of grading Ⅲ) causing pain. After admission, 2 cases of KD-Ⅰ underwent HTO and ligament reconstruction in the first stage, 1 case of KD-Ⅲ and 1 case of KD-Ⅳ underwent HTO in the first stage and ligament reconstruction in the second stage; the remaining 10 patients only underwent HTO. Results All patients were followed up 12-50 months, with an average of 30 months. The incisions healed by first intention after operation, and no complications such as infection and deep vein thrombosis of the lower extremities occurred. At 12 months after operation, knee range of extension was –5°-0° (mean, –1.2°) and range of flexion was 110°-140° (mean, 125.5°). The Lachman test was negative in 11 cases and positive in 3 cases. The posterior drawer test was negative in 9 cases and positive in 5 cases. The 0/30° varus stress test was negative in 10 cases and positive in 4 cases. The 0/30° valgus stress test was negative in 13 cases and positive in 1 case. The visual analogue scale (VAS) score was significantly lower than that before operation (P<0.05), and the International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score were all significantly higher than those before operation (P<0.05). The X-ray film reexamination at 12 months after operation showed that the HKA was (178.2±3.8)° and the PTSA was (8.6±2.4)°, which were significantly different from those before operation (P<0.05). All osteotomies achieved bone union, and the healing time was 3-11 months, with an average of 6.8 months. Conclusion For chronic MLKI associated with lower extremity malalignment, HTO can restore normal lower extremity alignment and improve knee joint function, which is a feasible salvage operation.