scholarly journals Effects of the amount of valgus correction for medial compartment knee osteoarthritis on clinical outcome, knee kinetics and muscle co-contraction after opening wedge high tibial osteotomy

2007 ◽  
Vol 25 (3) ◽  
pp. 311-318 ◽  
Author(s):  
Kristin Briem ◽  
Dan K. Ramsey ◽  
William Newcomb ◽  
Katherine S. Rudolph ◽  
Lynn Snyder-Mackler
Keyword(s):  
Clinical Outcome ◽  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Medial Compartment ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Knee Kinetics ◽  
Wedge High Tibial Osteotomy

scholarly journals EVALUATION OF OUTCOME OF MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMY FOR UNICOMPARTMENTAL KNEE OSTEOARTHRITIS

2020 ◽  
pp. 1-4
Author(s):  
R. N. Shewale ◽  
Ketan J. Khatri
Keyword(s):  
Knee Osteoarthritis ◽  
Functional Outcome ◽  
High Tibial Osteotomy ◽  
Medial Compartment ◽  
Functional Score ◽  
Tibial Osteotomy ◽  
Knee Score ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Background: Osteoarthritis is often found in weight-bearing joints, the knee being the most common site. Most patients of symptomatic osteoarthritis of knee are associated with varus malalignment that is causative or contributory to painful arthritis. Correcting the malalignment of the knee relieves symptoms by transferring the functional load to the unaffected compartment. The goal of the treatment is to relieve medial compartment knee pain and slow down the arthritic progression. We report the outcome of a simple technique of medial opening wedge high tibial osteotomy in treating the medial compartment osteoarthritis of the knee. Materials and method: A prospective interventional study was carried out over a period of 2 years from November 2017 to October 2019 in a sample size of randomly selected 41 patients having unilateral knee osteoarthritis. All patients after a proper preoperative assessment underwent high tibial osteotomy and the outcome was evaluated using knee society scoring system. Results: The age of the patients ranged from 40 – 65 years with a mean age of 51 years, 13 were males and 28 were females showing female predominance (68.2%). The mean knee score and the mean functional score of the patients before surgery were 60 and 61.95 respectively and post operatively at the end of 6 months the knee score and functional score was 77 and 80.53 respectively. By the end of 6 months out of 41 patients, 12 patients (29.2%) had excellent functional outcome, 18 patients (43.90%) had good functional outcome, 09 patients (21.95%) had fair functional outcome while only 02 patients (04.87%) had poor functional outcome. Conclusions: The present study shows that HTO is a good option in isolated medial compartment OA of knee. Significant increase in the knee score and functional score was found after high tibial osteotomy for the patients of osteoarthritis with varus deformity. Success of high tibial osteotomy relies on appropriate patient selection, proper osteotomy type and precise surgical technique.

The Minimal Clinically Important Difference (MCID) for the WOMAC and Factors Related to Achievement of the MCID After Medial Opening Wedge High Tibial Osteotomy for Knee Osteoarthritis

2021 ◽  
pp. 036354652110168
Author(s):  
Man Soo Kim ◽  
In Jun Koh ◽  
Keun Young Choi ◽  
Yong Gyu Sung ◽  
Dong Chul Park ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Minimal Clinically Important Difference ◽  
Multivariate Logistic Regression Analysis ◽  
Medial Compartment ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Clinically Important Difference ◽  
Pain Subscale ◽  
Wedge High Tibial Osteotomy

Background: Many approaches have been used to determine the minimal clinically important difference (MCID) in patients undergoing total knee arthroplasty, but the MCID for outcome measures after medial opening wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis (OA) has not been reported. Purpose: To define the MCID for the Western Ontario and McMaster Universities Arthritis Index (WOMAC) after MOWHTO and to identify risk factors for not achieving the MCID. Study Design: Case-control study; Level of evidence, 3. Methods: Among patients with medial compartment knee OA who underwent MOWHTO, 174 patients who were followed for 2 years were included in the study. The MCID and substantial clinical benefit (SCB) for the WOMAC were determined using the anchor-based method with a 15-item questionnaire. Preoperative OA severity was measured by the Kellgren-Lawrence (K-L) grading system, and the acceptable range of the postoperative weightbearing line ratio was 50% to 70%. Patients were divided into 2 groups based on whether the MCID and SCB were achieved, and then factors related to failure to achieve the MCID and SCB were analyzed using multivariate logistic regression analysis. Results: The MCID for the WOMAC was 4.2 points for the pain subscale, 1.9 points for the stiffness subscale, 10.1 points for the function subscale, and 16.1 points for the total. Additionally, the SCB for the WOMAC was 6.4 for pain, 2.6 for stiffness, 16.4 for function, and 25.3 for the total. Overall, 116 (66.7%), 99 (56.9%), 127 (73.0%), and 128 (73.6%) patients achieved the MCID for the WOMAC pain, stiffness, function, and total, respectively, after MOWHTO. The odds of not achieving the MCID for the WOMAC total were 1.09 times greater (95% CI, 1.05-1.13; P < .001) in patients with a low preoperative WOMAC total score (cutoff values: 10.5 for pain, 3.5 for stiffness, 34.5 for function, and 51.0 for the total), 11.77 times greater (95% CI, 3.68-37.70; P < .001) in patients with K-L grade 4 OA compared with K-L grades 2 or 3 OA, and 8.39 times greater (95% CI, 2.98-23.63; P < .001) in patients with undercorrection or overcorrection. A low preoperative WOMAC score, K-L grade 4 OA, and undercorrection or overcorrection were also associated with not achieving the SCB for the WOMAC total (all P < .05). Conclusion: Patients treated with a MOWHTO require a 16.1-point improvement in the WOMAC total score to achieve a MCID from the procedure. Low preoperative WOMAC scores, severe OA, and undercorrection or overcorrection were related to failure to achieve the MCID.

Medial Opening Wedge High Tibial Osteotomy for Medial Compartment Overload/Arthritis in the Varus Knee

2014 ◽  
Vol 42 (3) ◽  
pp. 690-698 ◽  
Author(s):  
Davide Edoardo Bonasia ◽  
Federico Dettoni ◽  
Gabriele Sito ◽  
Davide Blonna ◽  
Antongiulio Marmotti ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Medial Compartment ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

scholarly journals Medial Opening Wedge High Tibial Osteotomy in Knee Osteoarthritis—A Biomechanical Approach

2020 ◽  
Vol 10 (24) ◽  
pp. 8972
Author(s):  
Nicolae Florin Cofaru ◽  
Mihai Dan Roman ◽  
Ileana Ioana Cofaru ◽  
Valentin Stefan Oleksik ◽  
Sorin Radu Fleaca
Keyword(s):  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
Medical Procedure ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Initiation Point ◽  
Wedge High Tibial Osteotomy ◽  
Osteotomy Plane ◽  
Optimal Values ◽  
Force Displacement

This paper provides an analysis from a biomechanical perspective of the medial opening wedge high tibial osteotomy surgery, a medical procedure commonly used in treating knee osteoarthritis. The aim of this research is to improve the analysed surgical strategy by establishing optimal values for several very important parameters for the geometric planning of this type of surgical intervention. The research methods used are numerical and experimental. We used finite element, a numerical method used to study the intraoperative behavior of the CORA area for different positions of the initiation point of the cut of the osteotomy plane and for different correction angles. We also used an experimental method in order to determine the maximum force which causes the occurrence of cracks or microcracks in the CORA area. This helped us to determine the stresses, the maximum forces, and the force-displacement variations in the hinge area, elements that allowed us to identify the optimal geometric parameters for planning the surgery.

scholarly journals Progression of pelvic retroversion is a critical factor for clinical outcome after Opening-wedge high tibial osteotomy among elderly patients

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Shuhei Otsuki ◽  
Hitoshi Wakama ◽  
Kuniaki Ikeda ◽  
Nobuhiro Okuno ◽  
Yoshinori Okamoto ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Clinical Outcome ◽  
High Tibial Osteotomy ◽  
Knee Extension ◽  
Lysholm Score ◽  
Compensatory Mechanism ◽  
Tibial Osteotomy ◽  
Critical Factors ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

Abstract Purpose To evaluate the clinical outcome after opening-wedge high tibial osteotomy (OWHTO) and to determine the critical factors for a poor clinical outcome after OWHTO in patients aged over 65 years. Methods Our retrospective analysis was based on the data from 233 patients who underwent OWHTO for medial compartment knee OA at our institution between January 2013 and December 2018, and 88 patients (36 men and 52 women) over 65 years of age were included in this study. Radiographic parameters of weight-bearing line ratio (WBLR) and pelvic inclination (PI); the knee function, range of motion (ROM) and extension; and clinical outcome with Lysholm score were obtained preoperatively and postoperatively at the final follow-up visit. To evaluate the critical factors for the clinical outcome, univariate regression analysis was used to identify the relationship between postoperative and improved Lysholm score and pre-and post-operative essential factors. To reveal the factor having a greater impact on the clinical outcome, a p < 0.05 in univariate factors was entered into a multivariate regression analysis. Results The preoperative WBLR was significantly changed, and Lysholm score improved from 59.5 to 81.5 (p < 0.0001), whereas the PI, knee extension and ROM were not changed after OWHTO. Regarding the essential factors affecting clinical outcome after OWHTO, age and delta PI were negative, whereas preoperative WBLR, postoperative ROM, especially extension, had a positive effect (p < 0.05). Furthermore, only delta PI had affected the improvement of clinical outcome with OWHTO (p < 0.01), and postoperative knee extension was negatively correlated with the progression of pelvic retroversion (p < 0.01). Conclusion Age at surgery and progression of pelvic retroversion were the critical factors for poor postoperative clinical outcomes after OWHTO. Care should be taken for the progression of pelvic retroversion after OWHTO because it deteriorates the clinical outcome by inducing the knee flexion contracture as the compensatory mechanism for the balance of sagittal alignment.

scholarly journals Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome

2021 ◽  
Author(s):  
B. L. Schelker ◽  
C. S. Moret ◽  
O. Dogan ◽  
F. Amsler ◽  
H. Rasch ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
High Tibial Osteotomy ◽  
Womac Score ◽  
Tracer Uptake ◽  
Tibial Osteotomy ◽  
Level Of Evidence ◽  
Opening Wedge ◽  
Alignment Correction ◽  
Wedge High Tibial Osteotomy ◽  
Bone Tracer Uptake

Abstract Purpose The purpose of this study was to investigate whether specific bone tracer uptake (BTU) patterns on preoperative SPECT/CT could predict which patients with varus alignment and medial overload would particularly benefit from medial opening-wedge high tibial osteotomy (MOWHTO). It was the hypothesis that an increased preoperative BTU relative to the reference BTU of the femur on SPECT/CT in the lateral and patellar compartments of the knee are predictive factors for inferior clinical outcome and that the clinical outcome correlates with the extent of alignment correction. Methods Twenty-three knees from 22 patients who underwent MOWHTO for medial compartment overload were investigated preoperatively using Tc-99m-SPECT/CT. BTU was quantified and localised to specific joint areas according to a previously validated scheme. Pre- and postoperative mechanical alignment was measured. Clinical outcome was assessed at a median of 24 months (range 11–30) after MOWHTO by collecting the WOMAC score. Results Significant correlations between BTU in the patellar area and the total WOMAC score and its subcategories pain and stiffness were found. Thus, BTU in the 1sPat area (superior lateral patellar compartment) correlated with total WOMAC (rho = 0.43, p = 0.04), pain subcategory (rho = 0.43, p = 0.04), and stiffness subcategory (rho = 0.59, p = 0.003). No significant correlations were found between alignment correction, age, gender and WOMAC. Conclusion This study highlights the role of preoperative SPECT in modern knee surgery to obtain information about the loading pattern on different compartments of the knee. Despite the limited number of participants, the present study shows that a preoperative SPECT/CT scan can help the treating surgeons to identify patients who may be at risk of inferior clinical outcome if an MOWHTO is considered, as an elevated BTU in the patellar region on preoperative SPECT/CT appears to be a potential risk factor for postoperative pain and stiffness. Level of evidence Level III.

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