Function after tibial osteotomy for medial gonarthrosis below aged 50 years

Twenty-seven patients (28 knees), with a median age of 42 (27-50) years treated with a high tibial osteotomy for early medial gonarthrosis (Ahlb?ck's Stage I) were examined after 11 (7-18) years. Twenty-four were men; 18 knees had had previous meniscus and ligament lesions. At follow-up, 22 knees were satisfactory and 9 patients managed high-activity sports or heavy work. In 25/28 knees, the arthrotic process had not progressed radiographically.     

Tibial osteotomy in medial gonarthrosis

Summary In a prospective series of 52 knees selected for high tibial osteotomy because of early medial arthrosis, special care was taken to obtain a final over-correction in valgus. The operative procedure and the pre- and post-operative radiographic examinations were standardized and the follow up was 1–3 years. 49 of the 52 knees had obtained a normal or over-corrected mechanical axis. 45 of these had improved painfree walking distance, and 31 were painfree. In 45 knees the arthrotic condition had not progressed, and in 5 of these there were signs of cartilage restitution.It is concluded that precise correction of medial gonarthrosis can be achieved, and this provides a rational basis for definitive treatment of early stages of this condition; for the majority an endoprothesis operation should not be needed in the future.Financial support has been obtained from Stiftelsen Konsul Thure Carlssons Minne, Stiftelsen för Bistånd åt Vanföra i Skåne, Alfred Österlunds Stiftelse, and Swedish Medical Research Council, project No. B81-17X-02031-15C.     

Revision after osteotomy for gonarthrosis. A 10-19-year follow-up of 314 cases

During a 10-year period, 314 tibial osteotomies were performed for medial gonarthrosis. At follow-up after 10-19 years, 62 knees had been revised by arthroplasty (52 cases) or reosteotomy (10 cases). The revision rate was 54/170 in undercorrected knees and 8/144 in knees with normalization or overcorrection of the hip-knee-ankle angle. Our results confirm that tibial osteotomy for gonarthrosis requires proper indications and precise surgery. Perhaps, given another 10 years, our osteotomies will have outlived contemporary arthroplasties.     

Ten-year results of tibial osteotomy for medial gonarthrosis

Summary The results in relation to the correction achieved 1 year after surgery of a series of tibial osteotomies in 50 patients (52 knees) are presented with a total observation time of 10 years. Mean age at the time of osteotomy was 56 years. Overcorrected knees had a significantly better result after 10 years. Progress of gonarthrosis occured in 6/34 overcorrected knees compared with 3/4 in the normo- and undercorrected group. One out of 34 overcorrected knees recurred in varus. Five knees were revised by knee arthroplasty or reosteotomy, one of which was overcorrected.     

Revision after osteotomy for gonarthrosis: A 10-19-year follow-up of 314 cases

During a 10-year period, 314 tibial osteotomies were performed for medial gonarthrosis. At follow-up after 10-19 years, 62 knees had been revised by arthroplasty (52 cases) or reosteotomy (10 cases). The revision rate was 54/170 in undercorrected knees and 8/144 in knees with normalization or overcorrection of the hip-knee-ankle angle. Our results confirm that tibial osteotomy for gonarthrosis requires proper indications and precise surgery. Perhaps, given another 10 years, our osteotomies will have outlived contemporary arthroplasties.     

Proteoglycan epitope in synovial fluid in gonarthrosis. 28 cases of tibial osteotomy studied prospectively for 2 years.

High tibial osteotomy was performed for medial gonarthrosis in 28 patients. Preoperatively, and at 3, 12, and 24 months after surgery, clinical and radiographic examinations were made, and joint-fluid samples were aspirated. Arthroscopy was performed preoperatively and at 24 months. Immunoassay of proteoglycan epitope in joint fluid showed an increase in concentration at all times as compared with a reference population with normal knee joints. An increase in both the concentration and the total amount of proteoglycan epitope in joint fluid was noted at 3 months postoperatively with a return to preoperative values at later times. Regrowth of fibrocartilage did not correlate with proteoglycan epitope data.     

Early knee mobilization after osteotomy for gonarthrosis

In a prospective study, 32 knees in 32 patients were randomized to either a cylinder plaster cast (17 knees) or hinged cast-brace (15 knees) after high tibial osteotomy for medial gonarthrosis. At 6 weeks, 3 months, and still 1 year after surgery, the range of motion was better in the cast-brace group. There was no difference in the other clinical results at 3 months and at 1 year after surgery, nor in changes of osseous correction or in the final knee alignment. All the patients in the cast-brace group were satisfied with early motion.     

Early knee mobilization after osteotomy for gonarthrosis

In a prospective study, 32 knees in 32 patients were randomized to either a cylinder plaster cast (17 knees) or hinged cast-brace (15 knees) after high tibial osteotomy for medial gonarthrosis. At 6 weeks, 3 months, and still 1 year after surgery, the range of motion was better in the cast-brace group. There was no difference in the other clinical results at 3 months and at 1 year after surgery, nor in changes of osseous correction or in the final knee alignment. All the patients in the cast-brace group were satisfied with early motion.     

Prediction of long-term outcome of tibial osteotomy in medial gonarthrosis

To predict the long-term outcome after tibial osteotomy for medial gonarthrosis, multivariate statistical techniques were used and prognostic equations were defined. A comparison between different evaluation systems was also performed. Clinical and radiographic data from 81 patients followed up for more than 7 years were used. Twenty-eight preoperative variables were analysed in relation to the outcome at 7 years with the multivariate procedures discriminant analysis and cluster analysis. Among the variables, knee flexion and walking capacity were found to be the most dominant factors. Excluding the undercorrected osteotomies, preoperative walking capacity was now the dominating variable for prediction. Seven years postoperatively only small differences were found between the evaluation criteria of pain relief, London Hospital score, and HSS score. The discriminant functions for the highest ranked evaluation criteria are given in the text, as are dendrograms showing the patterns of interdependence between the evaluation criteria. Thus it was possible to transform clinical entities into factors suitable for determination and calculation of postoperative evaluation. The most commonly used evaluation systems had very similar discriminant functions showing good agreement.     

Prediction of long-term outcome of tibial osteotomy in medial gonarthrosis

Summary To predict the long-term outcome after tibial osteotomy for medial gonarthrosis, multivariate statistical techniques were used and prognostic equations were defined. A comparison between different evaluation systems was also performed. Clinical and radiographic data from 81 patients followed up for more than 7 years were used. Twenty-eight preoperative variables were analysed in relation to the outcome at 7 years with the multivariate procedures discriminant analysis and cluster analysis. Among the variables, knee flexion and walking capacity were found to be the most dominant factors. Excluding the undercorrected osteotomies, preoperative walking capacity was now the dominating variable for prediction. Seven years postoperatively only small differences were found between the evaluation criteria of pain relief, London Hospital score, and HSS score. The discriminant functions for the highest ranked evaluation criteria are given in the text, as are dendrograms showing the patterns of interdependence between the evaluation criteria. Thus it was possible to transform clinical entities into factors suitable for determination and calculation of postoperative evaluation. The most commonly used evaluation systems had very similar discriminant functions showing good agreement.

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Zusammenfassung Für die Vorhersage des Langzeitergebnisses einer proximalen Tibiaosteotomie bei medialer Gonarthrose wurden multivariante statistische Techniken benutzt and prognostische Zusammenhänge definiert. Außerdem wurde ein Vergleich zwischen verschiedenen Beurteilungssystemen vorgenommen. Klinische and röntgenologische Daten von 81 Patienten, die über mehr als 7 Jahre verfolgt wurden, sind dieser Untersuchung zugrunde gelegt wurden. 28 präoperative Variable wurden im Vergleich mit dem Ergebnis nach 7 Jahren mit der Diskriminanzanalyse untersucht. Unter den verschiede nen Variablen waren die Kniebeugung and die Gehstrecke die am meisten dominierenden Faktoren. Unter Ausschluß der unterkorrigierten Osteotomien war die präoperative Gehstrecke die wichtigste Variable für eine Vorhersage. 7 Jahre postoperativ wurden nur geringe Unterschiede gefunden zwischen den Beurteilungskriterien Schmerzlinderung, London Hospital Skala and HSS-Bewertungsskala. Die Diskriminanzfunktion fur die am höchsten bewerteten Beurteilungskriterien sind im Text erläutert, ebenso die Dendogramme, die das Muster der Wechselbeziehungen zwischen den Beurteilungskriterien zeigen. Dementsprechend war es möglich, klinische Begriffe in kalkulierbare Faktoren für die postoperative Beurteilung zu üiberführen.

     

Cartilage regeneration after proximal tibial osteotomy for medial gonarthrosis. An arthroscopic, roentgenographic, and histologic study.

High tibial osteotomy for medial gonarthrosis was performed in 28 patients (28 knees). At the time of surgery, arthroscopy was also performed and a cartilage-bone biopsy was obtained. Postoperatively, 15 patients were randomized to a cylinder plaster cast, whereas 13 patients had a hinged cast brace for early knee mobilization. At follow-up examination, two years after surgery, 16 patients accepted an arthroscopic examination with a cartilage-bone biopsy. In overcorrected knees, cartilage regeneration was found in eight of 14 patients on the medial tibial condyle and in nine of 14 on the medial femoral condyle. The main repair feature was proliferation of fibrocartilage, which covered bone and areas of fibrillated cartilage and filled vertical clefts in hyaline cartilage. The hyaline cartilage showed an increased cellularity with numerous nests of proliferating chondrocytes. No correlation was found between clinical outcome and the degree of cartilage regeneration as observed by arthroscopy, biopsy, or roentgenography. Knees with a brace postoperatively had better knee flexion two years after surgery. No difference in cartilage regeneration was recorded between knees with a plaster cast or a cast brace postoperatively.     

Different patterns of cartilage wear in medial and lateral gonarthrosis

We studied the morphologic changes of cartilage wear on the resected parts of the joint in 42 knees operated on with a total knee prosthesis. The medial and lateral compartments were divided into 6 equal regions on both the tibial and femoral sides. The amount of cartilage/bone destruction was classified into 4 grades in each region. In medial and lateral arthrosis, maximal wear was found in the middle of the joint, but it was more marked in the lateral group. In the medial group, wear was greater in the anterior regions. In the lateral group, we found more wear in the posterior regions. We ascribed these findings to different anterior/posterior translations of the medial and lateral condyles during flexion/extension of the knee joint.     

A histological study of articular cartilage after rotational acetabular osteotomy for hip dysplasia

Acetabular dysplasia was produced in 24 immature white rabbits. A rotational acetabular osteotomy was then carried out and radiological and histological studies of the articular cartilage were made.In the hips which did not undergo osteotomy, radiographs at 26 weeks showed that residual subluxation remained and arthritic changes such as narrowing of the joint space or dislocation were still seen. However, in the operated group there was a remarkable increase in cover, but arthritic changes were not observed. After 24 weeks, the Mankin grading score in the operated group was significantly lower than that in the non-operated group. The latter hips showed an irregular surface of the cartilage, exfoliation and proliferation of synovial tissue. In those undergoing osteotomy, primary cloning of chondrocytes or hypercellularity was seen and at 24 weeks after operation and metaplasia of the cartilage in the fibrous tissue was observed in the boundary between the medial area of the acetabulum and the acetabular fossa.     

High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study

This retrospective study reviewed the long-term experience with high tibial osteotomy and determined which factors influence the results. Between 1980 and 1989, 120 closing wedge high tibial osteotomies for varus gonarthrosis were performed in 102 patients. Twenty-nine knees were excluded because the patients died (17 knees), were bedridden (7 knees), or lost to follow-up (5 knees). Thirty of the remaining 91 knees had a conversion to total knee replacement (TKR) after 11 years on average, leaving 61 knees with a high tibial osteotomy available for clinical and radiographic evaluation at an average follow-up of 15 years (range: 10-21 years). Of the 91 knees, excellent/good results were found in 49% and fair/poor in 51%. Anatomical femorotibial angle in the 61 knees at follow-up averaged 4.7 degrees +/- 5 degrees of valgus (range: 3 degrees varus to 23 degrees valgus). Alignment obtained at consolidation changed with varus recurrence at follow-up in 14% of 61 knees and did not correlate with the clinical results. Twelve (19%) knees showed a patella baja (Caton ratio <0.6) at follow-up, which correlated with patients immobilized postoperatively by a cylinder cast (P=.04). A valgus alignment at consolidation between 8 degrees and 15 degrees, good muscle strength, and male gender correlated with better results (P<.05). Survivorship analysis, considering an unsatisfactory result or revision to TKR as the endpoint, was 96% at 5 years, 88% at 7 years, 78% at 10 years, and 57% at 15 years. High tibial osteotomy provides symptomatic relief for approximately 10 years, but is unlikely to provide permanent relief.     

Roentgen stereophotogrammetry in high tibial osteotomy for gonarthrosis

Summary In three cases operated with high tibial osteotomy for medial gonarthrosis the exact method of roentgen stereophotogrammetry with tantalum balls as bone markers (Selvik 1974) was used to study angular and translational movements in three dimensions at the operation and during the healing period. Tibial osteotomy caused angular and translational movements even in planes where correction was not intended, and the stereo technique revealed that stability was not present when knee mobilisation started. Correlation between the stereo values and conventional radiographic measurements were best in the frontal plane (root mean square value of discrepancies 1.3°). Roentgen stereophotogrammetry gives superior information compared with the conventional radiographic technique, but it is concluded that the latter has sufficient accuracy for the clinical assessment of corrections in the frontal plane.