A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis

Objective : To observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees. Methods: A retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996. Resnits: One hundred and sixty-one knees (144 patients) were followed up for 1.5-12 years with an average of 7.5 years and their data were reviewed. The proportion of excellent outcome were 97.3 %, 93.6 % and 78.2 % two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was 11.8% (19 knees retreated with TKA for HTO failure ). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of 98.7%, 95.0% and 84.1% 2, 5 and 10 years after HTO, respectively. There were 5.6% complications ( 12 /161 ), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees ) missed follow-up, among them 10 patients (11 knees) died. Conclusions: HTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.     

Undiagnosed Hoffa fracture of medial femoral condyle presenting as chronic pain in a post-polio limb

Isolated coronal fracture of medial femoral condyle with intact lateral femoral condyle is extremely rare. A high index of suspicion is necessary for early diagnosis especially in cases of undisplaced fractures. Here we report a case of medial Hoffa fracture in a post-polio limb presenting as chronic pain. Management of such fractures in limbs affected by late sequelae of poliomyelitis is particularly problematic in view of osteoporosis and osseous hypoplasia. The fracture was approached through medial parapatellar arthrotomy and fixation was done with cannulated cancellous screws in anteroposterior direction. Union was achieved at 16 weeks.     

全膝关节置换治疗僵硬膝关节的早期疗效分析

Objective To evaluate the outcome of primary total knee arthroplasty (TKA) in treatment of stiff knee, and discuss the key points of operative technique and rehabilitation. Methods From February 2005 to April 2009, 23 patients with 34 stiff knees were treated with primary TKA. The study included 3 males (4 knees) and 20 females (30 knees), with the mean age of 56.9 years. Primary disease of the patients included rheumatoid arthritis (26 knees in 15 cases) and osteoarthritis (8 knees in 8 cases). Varus deformity was found in 10 knees (5°-15°), and valgus was found in 5 knees (5°-10°). Evaluations included preoperative and postoperative range of motion (ROM) measurement, hospital for special surgery knee score (HSS), blood loss, operative time and assessment of postoperative complications. Results All patients were followed up. The mean follow-up time was 32.2 (range, 24 to 40) months. At the final follow-up visit, the HSS score increased from 42.9±5.2 preoperatively to 85.7±4.3, the range of motion increased from 42.6°±5.7° preoperatively to 89.2°±10.5°. Sixteen knees in 12 cases underwent manipulation at 3 to 8 weeks postoperatively for unsatisfied ROM, but ROM was still less than 90° in 8 knees at the last follow-up. The average blood loss were (632.4±180.2) ml in first 24 hours (450-850 ml) and the operative time were (98.1±18.6) min (80-150 min). Deep venous thrombosis was found in 3 patients. All the symptoms relieved after anticoagulant therapy. Postoperative varus deformity was seen in one patient, but the function of knee was good. No revision was needed. Conclusion Primary total knee arthroplasty is reliable method in treatment of stiff knees. Sufficient soft tissue release during the operation, postoperative muscle strength exercise and essential manipulation are key points for satisfactory outcomes.     

Akagi胫骨前后轴在全膝关节置换术中的定位作用

Objective To investigate the relationship between tibial anteroposterior axis and other anatomic landmarks in determining the rotation of tibial prosthesis in total knee arthroplasty using computed tomography. Methods Transverse CT scans of 40 volunteers' right knee in full extension were made. The anteroposterior axis of the tibia was defined as a line which was perpendicular to the transepicondylar axis and passing through the middle point of the posterior crnciate ligament. At the tibial plateau and optimum re-section level, the mean medial percentage width of intersection point of the patellar tendon anti the antero-posterior axis was measured. The mean angle between the anteroposterior axis and a line connecting the middle of the posterior cruciate ligament and the medial of the patellar tendon and the medial 1/3 of the patellar tendon were measured. Results At the tibial plateau level, the mean medial percentage width of intersection point of the patellar tendon was 10.1%±8.3%. At the optimum resection level, the mean medial percentage width of intersection point of the patellar tendon was 0.2%±10.0%. At the optimum resection lev-el, the mean angle between the anteroposterior axis and a line connecting the middle of the posterior cruciate ligament and the medial of the patellar tendon was 0.1°±2.7°. The mean angle between the anteroposterior axis and a line connecting the middle of the posterior cruciate ligament anti the medial 1/3 of the patellar tendon was 10.3°±3.6°. Conclusion There was a tendency to align the tibial component in external rotation relative to the femoral component when the medial 1/3 of the patellar tendon was used. The line connecting the middle of the posterior cruciate ligament and the medial of the patellar tendon can be used as a reliable axis for correct rotational orientation of the tibial component.     

Biomechanical study on the suture strength of ligament in cruciate ligament reconstruction

Objective: To test the suture strength on the tendon or ligament end and evaluate the stitch in the reconstruction of cruciate ligament and its clinical application. Methods: Twenty-four specimens of patellar tendon with free ends were divided into 3 groups: Group I (3 Krackow stitches ), Group H ( 2 Krackow stitches ) and Group HI (2 Krackow stitches with the first stitch passing through the tendon tissue as a modified Krackow stitch).These 3 groups were further divided into 6 subgroups according to different suture materials, No 1 Ethilon or stainless steel wire (φ = 0.4 mm ). Tensile test was undertaken to f‘md out the least stitches with efficient suture pattern. Results: Two Krackow locking stitches had stronger strength than 0.4 mm-diameter stainless steel wire. The fixation strength of 2 stitches with No 1 Ethilon was more than 80 N, superior to the failure strength of the material itself. The same strength was maintained if the first stitch was across the tendon tissue transversely. There was no statistically significant difference in the suture strength between 2 and 3 Krackow locking stitches. Conclusions: The suture strength is greater than the failure strength of the suture material. Less suture exposure can be achieved when the first stitch is across the tendon tissue while maintaining a comparable strength to other sutures. To attain higher suture strength, stronger materials or multiple strands rather than more stitches are preferred. Therefore, a rapid early rehabilitation of range of motion (ROM) is possible and reliable in practice.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.     

膝关节单室置换的近期疗效

Objective To explore the indication and observe short-term clinical outcome of the medial Oxford Ⅲ mobile bearing unicompartmental knee replacement (UKR) through a minimal invasive approach for the patients with osteoarthritis of the knee. Methods A retrospective study of the clinical outcomes from May 2006 to May 2008 was done on 30 knees in 21 patients after receiving the UKR with the mobile bearing Oxford Ⅲ prosthesis. There were 9 males (12 knees), 12 females (18 knees), with the mean age of (61.4±7.3) years (ranged 46-76 years). All patients were evaluated pre and postoperatively using X-ray image, the Knee Society Score (KSS) and the WOMAC osteoarthritis index and examined the ROM and the varus deformity of the knee with osteoarthritis. Results The average follow-up time was 17 months. The mean operation time was (83.0±12.9) min and the mean hospital stay was (9.3±2.0) days. No complications of infection, thrombosis, mobile beating dislocation were found. The loss of flexion of the operated knee was not significant. The average femorotibial angle decreased from 182.0°±4.3° preoperatively to 177.0°±3.5° postoperatively in the anterioposterior view of X-ray. The KSS clinical score and function score were improved from average 44.0±3.7 and 54.0±5.1 to 93.0±3.2 and 92.0±2.4 respectively. The WOMAC Score was average 48.0±4.2 preoperatively, 14.0±2.5 at the last evaluation. Statistically significant differences were found pre and postoperatively from the aforementioned evaluation criterions. Conclusion The short-term clinical outcomes of medial Oxford Ⅲ mobile bearing UKR through a minimally invasive approach are ideal, and it is a good therapy choice for the patients with medial osteoarthritis of the knee. But it is also important to choose the suitable patients with indications.