Aims. To compare time dependent functional improvement for patients with medial, respectively lateral knee osteoarthritis (OA) after treatment with
Abstract. Introduction. Changes in posterior tibial slope (PTS) and patellar height (PH) following proximal tibial osteotomies have been a recent focus for knee surgeons. Increased PTS and decreased PH following medial
Aims. We aimed to investigate factors related to the technique of medial
opening wedge high tibial osteotomy which might predispose to the
development of a lateral hinge fracture. Patients and Methods. A total of 71 patients with 82 osteotomies were included in the
study. Their mean age was 62.9 years (37 to 80). The classification
of the type of osteotomy was based on whether it extended beyond
the fibular head. The level of the osteotomy was classified according
to the height of its endpoint. Results. At a mean follow-up of 20 months (6 to 52), a total of 15 lateral
hinge fractures (18.3%) were identified. A sufficient osteotomy,
in which both anterior and posterior tibial cortices were involved
with extension into the lateral aspect of the plateau in relation
to an anteroposterior line tangential to the medial edge of the
fibular head in the CT axial plane, was seen in 48 knees (71.6%)
in those without a lateral hinge fracture and in seven (46.7%) in
those with a lateral hinge fracture. An osteotomy which ended above
the level of the fibular head was seen in nine (13.4%) of the knees
without a lateral hinge fracture and seven (46.7%) of the those
with a lateral hinge fracture. There was a significant relationship
between the absence of a lateral hinge fracture and both a sufficient
osteotomy and one whose endpoint was at the level of the fibular
head (p = 0.0451 and p = 0.0214, respectively). Conclusion. A sufficient osteotomy involving both the anterior and posterior
cortices, whose endpoint is at the level of the fibular head, should
be performed when undertaking a medial
A prospective, randomised, controlled trial compared two different techniques of high tibial osteotomy with a lateral closing wedge or a medial
Improved surgical techniques and new fixation methods have revived interest in high tibial osteotomy surgery in recent years. Our aim was to review our first 59 cases. All patients underwent radiological and clinical review including pre and post operative scores. Mean age at surgery was 43 (22-59) and mean follow up is 22 months. The mean pre-operative limb alignment was 5.4° varus (range 1°-16°) with correction to 2° valgus (range -1° - 7°). HTO is known to increase tibial slope and in this series the change in tibial slope from -5.2° (95%CI: -6.36 to -4.07)) to -7.8° (-8.83 to –6.89) was statistically significant. p= 0.0014 (Mann Whitney). Patellar height is often reduced following
Aim. It has been suggested that the use of a pilot-hole may reduce the risk of fracture to the lateral cortex. Therefore the purpose of this study was to determine the effect of a pilot hole on the strains and occurrence of fractures at the lateral cortex during the opening of a high tibial osteotomy (HTO) and post-surgery loading. Materials and Methods. A total of 14 cadaveric tibias were randomized to either a pilot hole (n = 7) or a no-hole (n = 7) condition. Lateral cortex strains were measured while the osteotomy was opened 9 mm and secured in place with a locking plate. The tibias were then subjected to an initial 800 N load that increased by 200 N every 5000 cycles, until failure or a maximum load of 2500 N. Results. There was no significant difference in the strains on the lateral cortex during HTO opening between the pilot hole and no-hole conditions. Similarly, the lateral cortex and fixation plate strains were not significantly different during cyclic loading between the two conditions. Using a pilot hole did not significantly decrease the strains experienced at the lateral cortex, nor did it reduce the risk of fracture. Conclusions. The nonsignificant differences found here most likely occurred because the pilot hole merely translated the stress concentration laterally to a parallel point on the surface of the hole. Cite this article: K. Bujnowski, A. Getgood, K. Leitch, J. Farr, C. Dunning, T. A. Burkhart. A pilot hole does not reduce the strains or risk of fracture to the lateral cortex during and following a medial
Abstract. Design. A pragmatic, multicentre, parallel-group, randomised controlled trial to determine whether the intervention is superior to comparator. Setting. 20 NHS Hospitals. Population. NHS patients <60 years with moderate-severe symptomatic knee OA localised to the medial compartment in whom surgical intervention is indicated. Intervention. Surgery with medial
Aims. The aim of this prospective randomised study was to compare the
time course of clinical improvement during the first two years following
a closing or
The role of high tibial osteotomy (HTO) is being questioned by
the use of unicompartmental knee arthroplasty (UKA) in the treatment
of medial compartment femorotibial osteoarthritis. Our aim was to
compare the outcomes of revision HTO or UKA to a total knee arthroplasty
(TKA) using computer-assisted surgery in matched groups of patients. We conducted a retrospective study to compare the clinical and
radiological outcome of patients who underwent revision of a HTO
to a TKA (group 1) with those who underwent revision of a medial
UKA to a TKA (group 2). All revision procedures were performed using
computer-assisted surgery. We extracted these groups of patients
from our database. They were matched by age, gender, body mass index,
follow-up and pre-operative functional score. The outcomes included
the Knee Society Scores (KSS), radiological outcomes and the rate
of further revision.Aims
Patients and Methods
Aims. The aim of this study was to evaluate whether achieving medial joint opening, as measured by the change in the joint line convergence angle (∆JLCA), is a better predictor of clinical outcomes after high tibial osteotomy (HTO) compared with the mechanical axis deviation, and to find individualized targets for the redistribution of load that reflect bony alignment, joint laxity, and surgical technique. Methods. This retrospective study analyzed 121 knees in 101 patients. Patient-reported outcome measures (PROMs) were collected preoperatively and one year postoperatively, and were analyzed according to the surgical technique (opening or closing wedge), postoperative mechanical axis deviation (deviations above and below 10% from the target), and achievement of medial joint opening (∆JLCA > 1°). Radiological parameters, including JLCA, mechanical axis deviation, and the difference in JLCA between preoperative standing and supine radiographs (JLCA. PD. ), an indicator of medial soft-tissue laxity, were measured. Cut-off points for parameters related to achieving medial joint opening were calculated from receiver operating characteristic (ROC) curves. Results. Patients in whom the medial joint opening was achieved had significantly better postoperative PROMs compared with those without medial opening (all p < 0.05). Patients who were outliers with deviation of > 10% from the target mechanical axis deviation had significantly similar PROMs compared with patients with an acceptable axis deviation (all p > 0.05). Medial joint opening was affected by postoperative mechanical axis deviation and JLCA. PD. The influence of JLCA. PD. on postoperative axis deviation was more pronounced in a closing wedge than in an
Abstract. Introduction. Osteotomy is recognised treatment for osteoarthritis of the knee. Evidence suggests favourable outcomes when compared to arthroplasty, for younger and more active individuals[1]. Double level osteotomy (DLO) is considered when a single level is insufficient to restore both joint line obliquity and adequate realignment[2]. This paper aims to establish the functional outcomes up to two years post operatively for patients undergoing DLO, using patient reported outcome measures (PROMs). Methodology. All patients who underwent a DLO at either Lister Hospital, Stevenage, or One Hatfield Hospital, Hertfordshire, between 1st January 2018 and 1st October 2020 were identified. DLO were performed by two specialist consultants, independently or in combination. PROMs including pain scores, health score, Oxford knee score (OKS) and knee injury and osteoarthritis outcome score (KOOS) were recorded pre-operatively and at six month, one and two year post operative intervals. Results. 24 patients underwent DLO; a medial
Abstract. Introduction. To investigate the impact medial
Introduction. The management of young patients with painful medial compartment osteoarthritis remains controversial.
Aims. In patients undergoing medial
Between 2003 and 2007, 99 knees in 77 patients
underwent
The use of high tibial osteotomy (HTO) to delay total knee arthroplasty (TKA) in young patients with osteoarthritis (OA) and constitutional deformity remains debated. The aim of this study was to compare the long-term outcomes of TKA after HTO compared to TKA without HTO, using the time from the index OA surgery as reference (HTO for the study group, TKA for the control group). This was a case-control study of consecutive patients receiving a posterior-stabilized TKA for OA between 1996 and 2010 with previous HTO. A total of 73 TKAs after HTO with minimum ten years’ follow-up were included. Cases were matched with a TKA without previous HTO for age at the time of the HTO. All revisions were recorded. Kaplan-Meier survivorship analysis was performed using revision of metal component as the endpoint. The Knee Society Score, range of motion, and patient satisfaction were assessed.Aims
Methods
Meniscal allograft transplantation (MAT) for patients with symptomatic meniscal loss has demonstrated good clinical results and survivorship. Factors that affect both functional outcome and survivorship have been reported in the literature. These are typically single-centre case series with relatively small numbers and conflicting results. Our aim was to describe an international, two-centre case series, and identify factors that affect both functional outcome and survival. We report factors that affect outcome on 526 patients undergoing MAT across two sites (one in the UK and one in Italy). Outcomes of interest were the Knee injury and Osteoarthritis Outcome Score four (KOOS4) at two years and failure rates. We performed multiple regression analysis to examine for factors affecting KOOS, and Cox proportional hazards models for survivorship.Aims
Methods
The aim of this study was to report the outcome of femoral condylar fresh osteochondral allografts (FOCA) with concomitant realignment osteotomy with a focus on graft survivorship, complications, reoperation, and function. We identified 60 patients (16 women, 44 men) who underwent unipolar femoral condylar FOCA with concomitant realignment between 1972 and 2012. The mean age of the patients was 28.9 years (10 to 62) and the mean follow-up was 11.4 years (2 to 35). Failure was defined as conversion to total knee arthroplasty, revision allograft, or graft removal. Clinical outcome was evaluated using the modified Hospital for Special Surgery (mHSS) score.Aims
Patients and Methods
The objective of this study was to validate the
efficacy of Takeuchi classification for lateral hinge fractures
(LHFs) in open wedge high tibial osteotomy (OWHTO). In all 74 osteoarthritic
knees (58 females, 16 males; mean age 62.9 years, standard deviation
7.5, 42 to 77) were treated with OWHTO using a TomoFix plate. The
knees were divided into non-fracture (59 knees) and LHF (15 knees)
groups, and the LHF group was further divided into Takeuchi types
I, II, and III (seven, two, and six knees, respectively). The outcomes
were assessed pre-operatively and one year after OWHTO. Pre-operative
characteristics (age, gender and body mass index) showed no significant
difference between the two groups. The mean Japanese Orthopaedic
Association score was significantly improved one year after operation
regardless of the presence or absence of LHF (p = 0.0015, p <
0.001, respectively). However, six of seven type I cases had no
LHF-related complications; both type II cases had delayed union;
and of six type III cases, two had delayed union with correction
loss and one had overcorrection. These results suggest that Takeuchi
type II and III LHFs are structurally unstable compared with type
I. Cite this article:
Little is known about the relative outcomes of revision of unicompartmental
knee arthroplasty (UKA) and high tibial osteotomy (HTO) to total
knee arthroplasty (TKA). The aim of this study is to compare the
outcomes of revision surgery for the two procedures in terms of
complications, re-revision and patient-reported outcome measures (PROMs)
at a minimum of two years follow-up. This study was a retrospective review of data from an institutional
arthroplasty registry for cases performed between 2001 and 2014.
A total of 292 patients were identified, of which 217 had a revision
of HTO to TKA, and 75 had revision of UKA to TKA. While mean follow-up
was longer for the HTO group compared with the UKA group, patient
demographics (age, body mass index and Charlson co-morbidity index)
and PROMs (Short Form-36, Oxford Knee Score, Knee Society Score,
both objective and functional) were similar in the two groups prior
to revision surgery. Outcomes included the rate of complications
and
re-operation, PROMS and patient-reported satisfaction at six months
and two years post-operatively. We also compared the duration of
surgery and the need for revision implants in the two groups. Aims
Patients and Methods