Mat kinh hang hieu 3High tibial closing wedge osteotomy for medial compartment osteoarthrosis of knee.(Original Article)
. Tuli, Varun. Kapoor
Patients with osteoarthrosis of the knee predominantly as a result of medial compartment participation have been cured by high tibial valgus osteotomy by various techniques. These contain a closing wedge osteotomy, opening wedge osteotomy, dome osteotomy, hemicallotasis progressive corrective osteotomy and other alterations. [sup],,,,,,, The osteotomy has been adjusted exploiting staples, plates, extraneous fixators, Kirschner cables, plaster casts and combinations. [sup],,,, We report the end result of a easy strategy of high tibial osteotomy within the medial compartment of osteoarthrosis of the knee.
Materials and techniques
Seventy eight knees in 65 patients with medial compartment osteoarthrosis and moderate Genu varum amidst 1996 and 2004 were as part of the present report. Patients chosen were those taking walks independently or with one stick and who approved the operation of "mending their joint" fairly than "substituting their joint". The patients were clarified the restrictions of both the operations. Preoperative and postoperative pt exercises were revealed to the sufferer and the household. Non-walkers as a result of generalized arthropathies or as a result of medicinal comorbidities, flexion deformity of the knee of greater than 10[degrees] or range of flexibility less than 90[degrees], active rheumatoid arthritis or active infection, gross personality lateral compartment participation, more than 1 cm lateral subluxation of the tibia as regarded in standing anteroposterior X-rays of both knees were thought out unfit for high tibial osteotomy operation. But still, there were patients who were more effective for knee substitution surgical treatments but they coveted a corrected natural joint fairly than a synthetic prosthetic joint. High tibial osteotomy was done in such patients like an stretched out sign. In patients with bilateral personality malady the one that was more advanced medically and radiologically was operated first. Two patients underwent the osteotomy operation on both their knees in one sitting since they had favourable household help from home. Of the nineteen patients with bilateral personality malady 11 patients underwent high tibial osteotomy on their 2nd knee 1-3 years afterwards the initial operation.
Knee is retained flexed approximately at 90[degrees] across the operation. A lazy arched incision prolonging from lateral epicondyle of femur about the cranium of fibula and proceeding distally to lessen magnitude of tibial tuberosity was made. The higher thing in lateral surface of tibia was disclosed subperiosteally and bleeds were cauterized. The higher finale of fibula was disclosed by subperiosteal mirrored image of lateral collateral ligament, attachment of biceps femoris and origin of peronei as a steady flap (to be resutured to mushy tissues afterwards completion of operation). The superior tibio-fibular joint was liberated. The medial kinh can half of fibular cranium was excised obliquely, resecting from superolateral to inferomedial guidance. The indirect resection allows the remaining fibula to slip proximally whilst fixing the varus deformity. Quite typical peroneal neurological fabrications medial about the distal thing in the biceps femoris tendon from where it traverses distally to wind round the fibular throat. As a govern the peroneal neurological may just be palpated and doesn't crave exposure. Lateral surface of the tibia proximal about the tibial tubercle was disclosed superiosteally. The muscle in back of the higher thing in the tibia were heightened subperiosteally, kinh thoi trang the posterior mushy tissues were retracted posteriorly with the addition of narrow bone levers. Flexed position of the knee joint and the posteriorly placed bone levers defends the mushy tissues and popliteal vessels. A fifteen- to twenty long Kirschner cable was passed latero-medially in the course of the knee joint space to supply the positioning of the articular surface of proximal tibia. The osteotomy slashes were made with a minor osteotome. Proximal osteotomy is made within the anterior half of tibia,, posterior cortex at this grade ain't trim. , latero-medially in an indirect fashion to meet the proximal trim medially. The distal osteotomy slashes through lateral, anterior, posterior and medial tibial cortices and stays proximal about the attachment of ligamentum patellae. The proximal and distal slashes are connected by a vertical osteotomy trim made on the antero-lateral surface of tibia. Anterior wedge-shaped bone part is taken away, medial cortex-cuts are concluded with a minor osteotome. Osteotomy is finished by gentle valgus distress.
The stitches are taken away at three to One month afterwards the operation and a well-molded plaster cylinder cast is applied making certain 7[degrees] of valgus, 5[degrees] of extraneous rotation at the osteotomy site and 5[degrees] of knee flexion. The semirigid preoccupation offered by two K-wires allow little corrections to obtain the best coveted laboratory position of the limb whilst applying the plaster. Ambulation with toe-touch is comforted three to 4 hours afterwards the operation with a runner or two crutches. Full streaming on the operated limb is comforted 3-4 weeks afterwards the operation with a singular crutch within the contralateral hand. The plaster cast is frequently taken away three to 3 and a half months afterwards the operation, full weight-bearing with a singular crutch is comforted and range of flexibility active exercises are begun. K-wires are taken away 6-12 months afterwards the osteotomy.
Postoperative standing X-ray of both knees at 2 years indicated maintenance of the valgus from 5[degrees] to 10]. Nil elemental augment within the medial joint space height was witnessed. The radiological staging 2 years afterwards the operation continued to be un-damaged. Complications witnessed in 78 HTO good examples were foot drop in two women: one retrieved spontaneously in Half a year time, one didn't recuperate up to twelve months when tendon exchange for foot drop was functioned. Inspection of the average peroneal neurological at that period didn't reveal any crack within the continuity of the neurological. One male patient had overdue unification that healed by streaming in a knee brace by 5 months afterwards HTO. Shallow infection and cease working of the surgical pain happened in one woman with medicinal comorbidities. The infection healed by outfit and antibiotics.
Medial compartment osteoarthrosis of knee linked with genu varum deformity should be thought about a malalignment contributing to degenerative alters. It is certainly logical to adjust malalignment that would exchange the burden about the less influenced compartment of the knee to alleviate laboratory syndromes and optimistically reduce the speed the evolution of degeneration.[sup] , We do not a single thing expect reversal or halting of osteoarthritic alters within the operated knee joints as these are natural age-related alters. We but still didn't examine speeded up degenerated alter within the operated knee joints when compared about the alters within the contralateral unoperated knees all through a follow-up of two years.
Our learn can't make a announcement in regards to the positive point or another way of utilizing a closing wedge osteotomy when compared to an opening wedge osteotomy, but still, report about the literature favors a closing wedge osteotomy. [sup],,,,,,,,,,,, Closing wedge osteotomy as functioned by our maneuver is thru the cancellous bone that might mitigate occasions of overdue unification or nonunion. Closing wedge HTO is a wonderful surgical selection with a lengthy experience of accomplishment with very least occasions of nonunion. [sup],,,,,,,,, The osteotomy near to the joint row made certain more accurate correction of deformity.
Many laborers have used intricate implants to mend the osteotomy, a report about their results, but still, don't reflect any exclusive positive point within the laboratory outcome. Less expansive implants would seemingly bring about least interference for any upcoming substitution procedures.[sup] ,,,,,, We certainly have used a non-rigid preoccupation with two K-wires, but still posterior and lateral ledges of bone from inside the proximal part of tibia added some sense of balance at the site of osteotomy. We supplemented sense of balance for streaming utilizing a postoperative plaster cast. The initial alter of plaster (always done by the surgeon) afterwards sew eradication was done around 3 weeks afterwards the operation. The semirigid preoccupation allowed greater corrections of the position and immobilization within the best coveted position of seven] of valgus and 5[degrees] of extraneous rotation at the site of osteotomy and 5[degrees] of flexion at the knee joint.
The significance of ample correction and maintenance of valgus alignment has been accentuated by many laborers to accomplish optimal laboratory outcome.[sup] ,,, The follow-up of our patient 2-9 years afterwards osteotomy didn't show reversal to a varus deformity in any case.
Factors linked with less favourable results are fatness (more than 30% of the suitable weight) and harsh restriction of mobility before surgery.[sup]  High tibial osteotomy offers an replacement for unicompartmental substitution or over all knee arthroplasty in chosen patients. When correctly functioned, HTO shouldn't much compromise later arthroplasty if it turns into needful. The sufferer could accomplish appreciable pain relief unceasing for 10-15 years with quite typical proprioception and without any drastic limitation of preoperative performances. [sup],,,,,
mat kinh thoi trang References
1. Conventry MB. Osteotomy of mat kinh the higher ingredient of the tibia for degenerative arthritis of the knee: An initial report. J Bone Joint Surg Am 1965;47:984-90.
2. Conventry MB. Upper tibial osteotomy. Clin Orthop Relat Res 1984;182:46-52
. Conventry MB. Upper tibial osteotomy for osteo arthritis. J Bone Joint Surg Am 1985;67:1136-40.
4. Conventry MB, Hstrup DM, Wallrichs SL. Proximal tibial osteotomy: A decisive long-term learn of eighty-seven good examples. J Bone Joint Surg Am 1993;75:196-201.
5. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteo arthritis with varus deformity: A 10 to thirteen yr followup learn. J Bone Joint Surg Am 1987;69:332-54.
6. Magyar G, Ahl TL, Vibe P, Toksvig-Larsen S, Lindstrand A. Open-wedge way of osteo arthritis of the knee: A randomized learn of fifty operations. J Bone Joint Surg Br 1999;67:444-8.
7. Sundaram NA, Hallett JP, Sullivan MF. Dome osteotomy of the tibia for osteo arthritis of the knee. J Bone Joint Surg Br 1986;68:782-6.
8. Klinger HM, Lorenz F, Harer mat kinh thoi trang T. Open wedge tibial osteotomy by hemicallotasis for medial compartment osteo arthritis. Arch Orthop Shock to the system Surg 2001;121:245-7.
9. Koshino T, Morii T, Wada J, Saito H, Ozawa N, Noyori K. High tibial osteotomy with preoccupation by a sword platter for medial compartment osteo arthritis of the knee. Orthop Clin Northern Am 1989;20:227-47.
10. Geiger F, Schneider U, Lukoschek M, Ewerbeck V. Extraneous preoccupation in proximal tibial osteotomy: A comparability of 3 ways and means. Int Orthop 1999;23:160-3.
11. Billings A, Scott DF, Camargo MP, Hofmann AA. High tibial osteotomy with a calibrated osteotomy manual, solid internal and early mobility: Long-term followup. J Bone Joint Surg Am 2000;82:70-9.
A dozen. Weale AE, Shelter AS, Maceachern AG. High tibial osteotomy utilizing a vibrant axial extraneous fixator. Clin Orthop Relat Res 2001;382:154-67.
13. Amendola A, Panarella L. High tibial osteotomy for the cure of unicompartmental arthritis of the knee. Orthop Clin Northern Am 2005;36:497-504.
14. Yasuda K, Majima T, Suchida T, Kaneda K. A 10 to 15 yr followup observation of high tibial osteotomy in medial compartment osteo arthritis. Clin Orthop Relat Res 1992;282:186-95.
15. Goutallier D, Stephane Truck, Driessche SV, Manicom O, Ali ES, Bernageau J, et al. Influence of lower-limb torsion on long-term results of tibial valgus osteotomy for medial compartment knee osteo arthritis. J Bone Joint Surg Br 2006;88:2439-47.
16. Maquet Photo voltaic. Valgus osteotomy for osteo arthritis of the knee. Clin Orthop Relat Res 1976;120:143-8.
17. Aglietti P, Rinonapoli E, Stringa G, Tavinani A. Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop Relat Res 1983;176:239-51.
18. Stuart MJ, Elegance JN, Ilstrup DM, Kelly CM, Adams RA, Morrey BF. Late recurrence of varus deformity afterwards proximal tibial osteotomy. Clin Orthop Relat Res 1990;260:61-5.
19. Koshimo T, Tsuchiya K. The actual result of high tibial osteotomy on osteo arthritis of the knee. Int Orthop 1979;3:37-45.
20. Nguyen C, Rudan J, Simurda Mum, Cooke TD. High tibial osteotomy likened with high tibial and Maquet proceedings in medial and patellofemoral compartment osteo arthritis. Clin Orthop Relat Res 1989;245:179-87.
21. Aoki Y, Yasuda K, Mikami S, Ohmoto S, Majima T, Minami A. Reverse V-shaped high tibial osteotomy likened with closing-wedge high tibial osteotomy for osteo arthritis of knee. J Bone Joint Surg Br 2006;88:1336-40.
22. Catagni Mum, Guerreschi F, Ahmad TS, Cattaneo R. Cure of genu varum in medial compartment osteo arthritis of the knee trying the Ilizarov strategy. Orthop Clin Northern Am 1994;25:509-14.
23. Brouwer RW, Bierma- Zeinstra SM, Raaij TM, Ivan Verhaar JA. Osteotomy for medial compartment arthritis of the knee utilizing a closing wedge 07 or an opening wedge restrained by a Puddu platter. J Bone Joint Surg Br 2006;88:1454-9.
24. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install reward: survivorship of the high tibial valgus osteotomy: A ten to 22 years followup learn. Clin Orthop Relat Res 1999;367:18-27.
25. Levy M, Pauker M, Lotem M, Seelenfreund M, Fried mat kinh thoi trang A. High tibial osteotomy: A followup learn and dialog of a adapted technic. Clin Orthop Relat Res 1973;93:274-7.
26. Tjornstrand BA, Egund N, Hagstedt BV. High tibial osteotomy a seven years laboratory and radiographic followup. Clin Orthop Relat Res 1981;160:124-36.
27. Insall JN, Joseph DM, Miska C, High tibial osteotomy for varus gonarthrosis: a long followup learn. J Bone Joint Surg Am 1984;66:1040-8.
28. Ivarsson L, Myrnerts R, Gillquist J. High tibial osteotomy for medicinal osteo arthritis of the knee: A 5 to 7 and 11 yrs followup. J Bone Joint Surg Br 1990;72:238-44.
29. Rinonapoli E, Mancini GB, Corvaglia A, Musiello S. Tibial osteotomy for varus gonarthrosis: A ten to 21 years follouwp learn. Clin Orthop Relat Res 1998;353:185-93.