Medial Unicompartmental Knee Arthroplasty After Failed Open-Wedge High Tibial Osteotomy

BackgroundControversy exists whether or not a previous high tibial osteotomy (HTO) influences the outcome and survival of a unicompartmental knee arthroplasty (UKA). The aim of this retrospective study was to evaluate clinical, radiological, and functional outcomes of UKA after failed open-wedge HTO compared with UKA with no previous HTO.MethodsBetween 2001 and 2017, 24 post-HTO UKAs (group A) with an average follow-up of 8.1 years (range: 5 to 13) were compared with a control group of 30 patients undergoing simple UKA (group B) with an average follow-up of 9.5 years (range: 2 to 16). All patients were evaluated preoperatively and postoperatively using Knee Society Score, University of California at Los Angeles Activity Score, Western Ontario and McMaster University Osteoarthritis Index, and through objective evaluation. Mechanical coronal alignment and Caton-Deschamps index were measured both preoperatively and postoperatively.ResultsIn both groups, Knee Society Score, University of California at Los Angeles Activity Score, and Western Ontario and McMaster University Osteoarthritis Index scores significantly improved at follow-up (P < .001). In addition, statistically significant greater improvements in clinical and functional scores were reported in group B compared with group A (P < .001). No statistically significant differences concerning postoperative mechanical axis were observed between groups (2.7° and 3.2°, respectively, P = .27) and with regard to Caton-Deschamps index (1.0° and 1.1°, respectively, P = .44).ConclusionThis study demonstrated improvements in clinical and functional outcomes compared with preoperatory status in both groups irrespective of a previous HTO. A prior HTO was a determinant for having reduced postoperative clinical and functional outcomes after UKA.     

Arthroscopic Direct Repair for a Complete Radial Tear of the Posterior Root of the Medial Meniscus

We report here on a new arthroscopic direct repair technique for a radial tear of the posterior root of the medial meniscus (PRMM) using a posterior trans-septal portal. Radial tears of the PRMM are commonly observed in the elderly population of Korea and Japan, and the life style of these people requires squatting and kneeling down in daily life. A radial tear of the PRMM results in the loss of hoop tension and this accelerates degenerative changes in the knee joint and causes early osteoarthritis. Several reports in the medical literature have focused on various repair techniques for these tears by using pull out sutures. These techniques result in nonanatomic fixation of the meniscus, which may lead to disturbed meniscal excursion and failure to restore hoop tension. Arthroscopic direct repair may contribute to restoring hoop tension and preventing accelerated degenerative changes in the knee joint of these patients.     

Simple Medial Meniscus Posterior Horn Root Repair Using an All-Inside Meniscal Repair Device Combined with High Tibial Osteotomy to Maintain Joint-Space Width in a Patient with a Repairable Tear

PurposeTo compare the radiological and clinical outcomes using simple medial meniscus posterior horn (MMPH) root repair using an all-inside meniscal repair device combined with high tibial osteotomy (HTO) and HTO alone.MethodsBetween November 2013 and December 2016, patients treated for MMPH root tear along with HTO were enrolled. Based on the tear gap, the participants were divided into repairable (< 2 mm) and unrepairable (> 2 mm) categories. The participants in each group were divided into those amenable to simple MMPH root repair using an all-inside meniscal repair device and those that required no procedure for meniscus. Radiological parameters including mechanical femorotibial alignment (MA), posterior tibial slope (PTS) and medial joint-space width (JSW) were evaluated preoperatively and postoperatively at 2 years. For clinical evaluation, the WOMAC score was determined at the 2-year visit postoperatively.ResultsA total of 81 knees including 48 repairable (group R) and 33 unrepairable (group I) knees were enrolled. A total of 43 knees underwent simple MMPH root repair using an all-inside meniscal repair device (subgroup r), whereas the other 38 knees did not (subgroup n). The MA, PTS, and their postoperative changes as well as the WOMAC scores showed no differences. However, the JSW in group Rr increased from 3.1 to 3.6 mm, but decreased from 3.7 to 3.4 in group Rn, which was a statistically significant difference.ConclusionSimple MMPH root repair using an all-inside meniscal repair device combined with HTO was more effective for the maintenance of JSW compared with HTO without a meniscal procedure in patients with repairable MMPH root tear and varus alignment. However, other options are needed for unrepairable MMPH root tear.     

中老年膝内侧半月板后角放射裂的临床研究

目的讨论膝内侧半月板后角放射状撕裂的临床特点和关节镜下半月板部分切除术后的随访结果。方法自2000年6月至2006年6月对386例（418膝）关节镜下治疗的膝内侧半月板撕裂患者进行回顾性研究,其中后角放射状撕裂93膝（22．2％）,全部行半月板部分切除术。在详细的手术记录和关节镜图像资料基础上,分析患者术前体征、MRI结果、术中所见和术后Lysholm膝关节评分。结果中老年患者中膝内侧半月板后角放射状撕裂有较高的发生率,大多数患者表现出机械卡压或撞击症状,MRI很难发现这种撕裂,有特点的疼痛症状和物理检查有助于诊断。虽然大多数患者年龄较大,关节软骨已发生退变,但关节镜下半月板部分切除术后,症状会明显改善。结论膝内侧半月板放射状撕裂比较常见,但因为多数患者同时伴有骨关节炎症状,且MRI上假阴性率较高,诊断比较困难。在严格掌握手术指征下,关节镜下半月板部分切除术有助于改善症状。     

Prior High Tibial Osteotomy Does Not Affect the Survival of Total Knee Arthroplasties: Results From the Danish Knee Arthroplasty Registry

Background

High tibial osteotomy (HTO) is a joint preserving treatment of unicompartmental osteoarthritis in the knee. In cases with insufficient or deteriorating clinical results patients may undergo a total knee arthroplasty (TKA). The influence of prior HTO on TKA survival is debated.

Comparison of Long-Term Survival Analysis Between Open-Wedge High Tibial Osteotomy and Unicompartmental Knee Arthroplasty

BackgroundTo compare unicompartmental knee arthroplasty (UKA) and open-wedge high tibial osteotomy (OWHTO) in a long-term follow-up propensity score matching analysis.MethodsPatients who underwent UKA or OWHTO for unilateral medial unicompartmental osteoarthritis (OA) between 2004 and 2010 were included. The ROM, HSS score, KS score, WOMAC score, forgotten joint score, OA progression in patellofemoral and lateral compartments, and survivorship were compared within ten years of follow-up between 67 UKA and 67 OWHTO patients after propensity score matching for age, gender, body mass index, range of motion, and osteoarthritis (OA) grade.ResultsAt the last follow-up, there were no significant differences between the two groups in clinical outcomes, but the WOMAC score showed better results after UKA (13.1 in UKA vs 18.9 in OWHTO, P = .011). The OA progression also showed no significant difference between the two groups. After a 10-year follow-up, the survival rate was higher in UKA patients (96.2%) than in OWHTO patients (87.7%), with no statistical difference (P = .06).ConclusionUKA showed better clinical outcomes and OA progressions than OWHTO. The survival rate presented a superiority of 8.5% for the UKA group in the 10-year follow-up, without significant difference.     

Increased Posterior Tibial Slope After Medial Open-Wedge High Tibial Osteotomy May Result in Degenerative Changes in Anterior Cruciate Ligament

BackgroundThis study aimed at evaluating changes in posterior tibial slope angle (PTSA) and the anterior cruciate ligament (ACL) before and after medial open-wedge high tibial osteotomy (MOWHTO) through 2-staged arthroscopic findings and verified whether the ACLs would be affected by the changed PTSA. We also evaluated which predisposing factors could influence ACL changes after MOWHTO.MethodsFrom July 2010 to March 2016, 164 knees that could follow the second-look arthroscopy at the time of plate removal were enrolled. Radiologically, preoperative and postoperative hip-knee-ankle angle, femorotibial angle, medial proximal tibial angle, and PTSA were evaluated. Based on our previous study, we assessed the ACL using the macroscopic grading system (normal, abnormal degenerative, and partially ruptured ACL) by first- and second-look arthroscopy and compared it before and after HTO. The correlation between changes in PTSA (△PTSA) and ACL was evaluated. We also assessed predisposing factors that might affect ACL changes.ResultsMean age at the time of osteotomy was 57.2 ± 5.1 years and time interval between the 2-stage arthroscopies was 26.3 ± 4.0 months. PTSA significantly increased after MOWHTO (P < .001). ACL stage at second-look arthroscopy was significantly progressed compared to first-look findings (P < .001). △PTSA was larger in the progressed group (2.1°; P < .001). Multivariate logistic regression indicated that greater body mass index (odds ratio, 1.2; P = .029) and larger △PTSA (odds ratio, 1.3; P = .008) were predisposing factors.ConclusionIncreased posterior tibial slope following MOWHTO may result in degenerative ACL changes. Greater body mass index and larger △PTSA were predisposing factors for ACL degeneration after MOWHTO.     

Complications Associated With Medial Opening-Wedge High Tibial Osteotomy Using a Locking Plate: A Multicenter Study

Background

The aim of this study is to investigate complications following medial opening-wedge high tibial osteotomy using a locking plate. In addition, we aimed to compare postoperative outcomes between the complicated and the uncomplicated group.

Patient Expectations and Satisfaction After Medial Opening Wedge High Tibial Osteotomy

BackgroundThe objective of this study is to assess preoperative patient expectations of medial opening wedge high tibial osteotomy (MOWHTO) and related postoperative fulfillment, to increase understanding of associated factors of postoperative satisfaction.MethodsOne hundred fifteen patients who underwent MOWHTO were enrolled. Patients’ expectations were measured using the Hospital for Special Surgery-Knee Replacement Expectations Survey. Fulfillment of expectations and satisfaction was evaluated using the Hospital for Special Surgery Knee Replacement Fulfillment of Expectations Survey and a 5-point Likert scale at 2 years, postoperatively. The discrepancies between preoperative expectation and postoperative fulfillment score were also assessed. Preoperative and postoperative patient-reported outcomes were evaluated using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Univariate and multivariate analyses were performed to model predictions for satisfaction.ResultsThe most expected items were “pain relief,” “walking ability,” and “perform daily activities.” The top 3 items with the biggest discrepancies between expectation and fulfillment scores were “kneeling,” “squatting,” and “pain relief.” Ninety patients (78.3%) were satisfied and 25 (21.7%) were dissatisfied at 2 years postoperative. Multivariate logistic regressions showed that patient expectations did not affect satisfaction. Small discrepancies between expectation and fulfillment scores (odds ratio [OR] 105.304, 95% confidence interval 20.974-528.714, P < .001), high postoperative fulfillment scores (OR 1.198, 95% CI 1.110-1.293, P < .001), and low postoperative Western Ontario and McMaster Universities Arthritis Index total scores (OR 0.932, 95% CI 0.894-0.971, P < .001) were significantly associated with patient satisfaction.ConclusionThe small discrepancy between preoperative expectations and postoperative fulfillment of expectations was a major contributor to patients’ satisfaction following MOWHTO.     

改良内侧开放式胫骨高位截骨术治疗膝内侧间室骨性关节炎

目的探索新型改良内侧开放式胫骨高位截骨术(High tibial osteotomy,HTO)治疗膝内侧间室骨性关节炎的有效性和安全性。方法选择2017年7月到2018年7月在我院接受改良内侧开放式HTO的60位膝内侧间室骨性关节炎患者作为研究对象。记录每位患者的手术时间、出血量及手术并发症,并分别于术前和术后3、6个月对患者进行疼痛视觉评分(VAS)和美国膝关节协会评分(KSS评分);比较患者手术前后的胫股角、平台后倾角的影像学治疗。结果术后3、6个月的VAS评分和KSS评分均优于术前(P<0.001),且术后随着时间推移评分存在逐渐好转趋势。患者术后胫股角较术前胫股角减小(P<0.005),术后胫骨后倾角与术前无明显差异(P>0.05)。结论改良内侧开放式HTO治疗膝内侧间室骨性关节炎可显著缓解疼痛症状,重建膝关节功能。     

Knee Instability Before and After High Tibial Osteotomy

Knee joints were examined by three-point measurement (Edholm et al. 1976, 1977). the instability in arthrotic joints did not differ significantly from that in normal knees, but the varus/valgus deviation as measured by the three-point technique differed significantly from that in normal knees. After high tibial osteotomy for varus malalignment the instability increased significantly. An increase of more than 2° was associated with significantly poorer subjective results of operation. the findings indicate that shortening of the lateral stabilizing structures of the knee joint should be carried out in connection with high tibial osteotomy for varus malalignment. No upper limit of preoperative instability consistent with a good result of operation was established.     

High Tibial Osteotomy with Overcorrection of Varus Malalignment in Medial Gonarthrosis

Seventy-eight knee joints with varus malalignment were examined pre-operatively using three-point measurement. Operation was performed with or without 5° overcorrection of the varus deformity using random selection. the overcorrection group showed significantly better results than the normal-correction group.     

Clinical Results with the Saab Jig in High Tibial Osteotomy for Medial Gonarthrosis

In 56 patients with medial gonarthrosis high tibial osteotomy was performed using the SAAB jig, and another 43 patients with the same condition were operated on without this aid. Significantly greater precision was achieved in the removal of a wedge of the intended size with the aid of the SAAB jig. There was also significantly less increase in anterior inclination of the articular surface of the tibia on lateral X-rays when the SAAB jig was used. Operation using the device is not technically difficult, but is more time-consuming. the SAAB jig is a useful tool for achieving the predetermined correction in high tibial osteotomy.     

Intraoperative Fluoroscopic Assessment of Limb Alignment is a Reliable Predictor for Postoperative Limb Alignment in Biplanar Medial Opening-Wedge High Tibial Osteotomy

Background

The purpose of this study was to assess the reliability of pre-, intra operative, and postoperative limb alignment measurements and investigate the correlation between the measurements in biplanar medial opening-wedge high tibial osteotomy.