BACKGROUND High tibial osteotomy(HTO)is a well-established method for the treatment of medial compartment osteoarthritis of the knee with varus deformity.However,HTO alone cannot adequately repair the arthritic joint,...BACKGROUND High tibial osteotomy(HTO)is a well-established method for the treatment of medial compartment osteoarthritis of the knee with varus deformity.However,HTO alone cannot adequately repair the arthritic joint,necessitating cartilage regeneration therapy.Cartilage regeneration procedures with concomitant HTO are used to improve the clinical outcome in patients with varus deformity.AIM To evaluate cartilage regeneration after implantation of allogenic human umbilical cord blood-derived mesenchymal stem cells(hUCB-MSCs)with concomitant HTO.METHODS Data for patients who underwent implantation of hUCB-MSCs with concomitant HTO were evaluated.The patients included in this study were over 40 years old,had a varus deformity of more than 5°,and a full-thickness International Cartilage Repair Society(ICRS)grade IV articular cartilage lesion of more than 4 cm2 in the medial compartment of the knee.All patients underwent second-look arthroscopy during hardware removal.Cartilage regeneration was evaluated macroscopically using the ICRS grading system in second-look arthroscopy.We also assessed the effects of patient characteristics,such as trochlear lesions,age,and lesion size,using patient medical records.RESULTS A total of 125 patients were included in the study,with an average age of 58.3±6.8 years(range:43-74 years old);95(76%)were female and 30(24%)were male.The average hip-knee-ankle(HKA)angle for measuring varus deformity was 7.6°±2.4°(range:5.0-14.2°).In second-look arthroscopy,the status of medial femoral condyle(MFC)cartilage was as follows:73(58.4%)patients with ICRS grade I,37(29.6%)with ICRS grade II,and 15(12%)with ICRS grade III.No patients were staged with ICRS grade IV.Additionally,the scores[except International Knee Documentation Committee(IKDC)at 1 year]of the ICRS grade I group improved more significantly than those of the ICRS grade II and III groups.CONCLUSION Implantation of hUCB-MSCs with concomitant HTO is an effective treatment for patients with medial compartment osteoarthritis and varus deformity.Regeneration of cartilage improves the clinical outcomes for the patients.展开更多
BACKGROUND Most populations worldwide,who are used to squatting and sitting cross-legged for their activities of daily living,largely comprise the lower socioeconomic strata,thus making them candidates for exclusion f...BACKGROUND Most populations worldwide,who are used to squatting and sitting cross-legged for their activities of daily living,largely comprise the lower socioeconomic strata,thus making them candidates for exclusion for total knee arthroplasty.Proximal/high tibial osteotomy(HTO)is a preferred strategy for clinically symptomatic osteoarthritis(OA)with genu varum due to painful medial compartment OA which is not amenable to conservative measures.AIM To evaluate the outcomes of medial open-wedge HTO along with autologous bone grafting and buttress plate for the treatment of genu varum due to OA of the knee in a rural population of central India.METHODS A total of 65 knees in 56 patients with a mean age of 58.22±5.63 years with genu varum due to intractable painful knee OA were treated with medial open-wedge HTO along with autologous bone grafting and buttress plate osteosynthesis from June 2015 to May 2018.The mean preoperative radiological angle of genu varum was 13.4°.Clinical outcomes were assessed by the range of movement,knee scores,pain scores,and functional scores.Radiographic studies were performed preoperatively and at regular intervals during the follow-up period.RESULTS All patients reported pain relief immediately after the osteotomy and during the long-term analysis covering between one to three years.The genu varum angle was overcorrected to approximately four degrees in all patients.There was a loss of reduction by approximately three degrees in all patients at around six weeks postoperatively.Preoperative knee movements were restored in all patients.No major perioperative complications were noted during surgery and postoperative follow-up and the clinical scores were significantly improved during the final analysis which revealed good pain relief.CONCLUSION Medial open-wedge HTO is a reliable,safe,practical,physiological,and feasible treatment for populations who are used to increased activity in their occupation and lifestyle and is associated with excellent short-term and long-term results for OA in genu varum knees.展开更多
Objective:To observe the clinical efficacy and advantages of 3D printed patient-specific instrumentation(PSI)assisted distal tibial tuberosity-high tibial osteotomy in the treatment of medial compartment knee osteoart...Objective:To observe the clinical efficacy and advantages of 3D printed patient-specific instrumentation(PSI)assisted distal tibial tuberosity-high tibial osteotomy in the treatment of medial compartment knee osteoarthritis.Methods:75 patients with medial compartment knee osteoarthritis were included in the study performed DTT-HTO in our hospital from August 2017 to August 2019.The patients were divided into the PSI group(n=39)and conventional group(n=36)According to whether PSI was used in surgery.The differences of lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time,weight bearing line(WBL),Posterior tibial slope(PTS)and Caton-Deschamps index(CDI)were compared between the two groups.Visual analogue scale(VAS)scores and Hospital for Special Surgery(HSS)scores were recorded to evaluate knee pain and function before surgery and after surgery at 3 months and 12 months.Results:All 75 patients were followed up for more than 12 months,the ranged from 12-26(18.74±6.21)months.Three lateral cortical fractures in the conventional group and no fracture in PSI group.The lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time in PSI group were lower than those in conventional group(p敿0.05).WBL in two groups were significantly improved after surgery(p敿0.05),and PTS,CDI were no statistically improved after surgery(p>0.05).While there was no statistically significant difference with WBL,PTS and CDI between two groups(p>0.05).At 1 months,3 months and 12 months after surgery;VAS and HSS scores in both groups were significantly improved compared with that before surgery(p0.05),and were no statistically significant difference between two groups.Conclusion:3D printed patient-specific instrumentation assisted DTT-HTO has significant clinical efficacy,and effectively standardized surgical procedures,meanwhile reduced the time of intraoperative X-ray exposure,intraoperative blood loss and risk of lateral cortical fracture.展开更多
Main intention of the research is to understand about significance of techniques associated with HTO. This research reviewed the techniques of high tibial osteotomy namely high tibial osteotomy, open wedge high tibial...Main intention of the research is to understand about significance of techniques associated with HTO. This research reviewed the techniques of high tibial osteotomy namely high tibial osteotomy, open wedge high tibial osteotomy, closedhigh tibial osteotomy. Patients who are suffering from knee arthritis, high tibial osteotomy assists to prevent or delay the requirement for total or partial replacement of knee to preserve damaged tissue of joint. High tibial osteotomy technique is mainly suitable for active and young patients with knee osteoarthritis. Age plays a main factor in success rate of high tibial osteotomy technique. It could be done in open wedge or closed wedge high tibial osteotomy. For some cases, surgery could be done in combined method (open wedge and closed wedge high tibial osteotomy). When compared with clinical outcomes of closed wedge high tibial osteotomy and open wedge high tibial osteotomy, open wedge high tibial osteotomy performs well in reducing the pain, duration of weight-bearing and return to normal life as soon as possible.展开更多
Introduction: Recently, new plates with locking screws have been developed and used for medial open-wedge high tibial osteotomy (HTO). The purpose of this study was to evaluate and compare biomechanical properties of ...Introduction: Recently, new plates with locking screws have been developed and used for medial open-wedge high tibial osteotomy (HTO). The purpose of this study was to evaluate and compare biomechanical properties of different internal fixations in open-wedge HTO using the two currently available locking plates. Methods: Eight paired fresh-frozen cadaveric lower extremities were vertically embedded in steel boxes. The axial compression load was applied to the legs using the mechanical testing machine. The axial compression load test from 0 N to 550 N and the failure test were performed before and after HTO. One side of the leg of a specimen was fixed with the Puddu locking plate and the other side was fixed with the TomoFix plate to compare the two plates using the same specimen. A mode of failure and vertical displacement of the medial and lateral parts of the tibia at the osteotomy gap was recorded using a video camera in the failure test. The load–displacement data were analyzed to calculate stiffness, failure load, and displacement at failure. Results: The mean failure load was 1471.4 N and 1692.3 N and total vertical displacement at failure was 3.1 mm and 2.9 mm with the Puddu and TomoFix plates, respectively. During axial compression loading, displacements mainly occurred at the lateral osteotomy gap, while the medial gap was well preserved. No significant differences were observed in the failure load, displacement, or mode of failure between the two plates. Conclusions: The Puddu and TomoFix plates had similar biomechanical properties in open-wedge HTO. The results indicated reliable stability after open-wedge HTO without fibular osteotomy.展开更多
Background: Biplanar medial opening wedge high tibial osteotomy (MOWHTO) is a treatment method that allows adequate correction of symptomatic varus knee deformity. However, MOWHTO tends to decrease patellar height and...Background: Biplanar medial opening wedge high tibial osteotomy (MOWHTO) is a treatment method that allows adequate correction of symptomatic varus knee deformity. However, MOWHTO tends to decrease patellar height and increase the posterior tibial slope, which can affect the knee joint stability. Objective: The aim of this study was to describe the technique of biplanar MOWHTO and fixation by TomoFix plate, as well as to evaluate the accuracy of the planned correction and the postoperative tibial slope. Patients and Methods: This prospective cohort study was conducted on patients who presented with varus knee deformity and underwent biplanar MOWHTO and fixation by TomoFix plate during the period from March 2016 to March 2017. Assessment of patients included pre- and postoperative Knee and function scores, mechanical femorotibial angle (mFTA), posterior tibial slope angle (pTSA), range of motion (ROM) and radiological evaluation of the healing of the osteotomy site. Results: The recruited patients were 13 (8 men and 5 women), with average age 31.7 years old. The knee and functional scores improved from the preoperative mean of 45 and 41 to the postoperative mean of 85 and 72 points, respectively. The average knee flexion was 115 degrees, which at the final follow-up remained unchanged except for one case. The mean preoperative mFTA was 13.5°varus and decreased post-operatively to a mean of 3°valgus. The average postoperative follow-up period was 12 months (10 - 18 M). Conclusion: The biplanar MOWHTO allows preservation of posterior tibial slope while correcting the varus knee adequately.展开更多
Patient-specific instrumentation(PSI)enables a more accurate alignment of the lower limbs in a high tibial osteotomy(HTO)than in traditional surgery;however,the current design of commercial PSIs is not perfect.Therefo...Patient-specific instrumentation(PSI)enables a more accurate alignment of the lower limbs in a high tibial osteotomy(HTO)than in traditional surgery;however,the current design of commercial PSIs is not perfect.Therefore,we designed a new patient-specific surgical guide to improve the accuracy of the osteotomy and verified its reliability through a clinical operation.Here,we describe a patient with isolated medial-compartment bilateral knee osteoarthritis,accompanied by a varus deformity of the proximal tibia.The patient was treated with HTO using a patient-specific 3D-printed surgical guide.We concluded that the patient-specific 3D-printed surgical guide improved the accuracy of the osteotomy and the alignment of the lower limb.展开更多
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 wit...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. Results: 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.展开更多
BACKGROUND High tibial osteotomy(HTO)is a well-known procedure for the correction of knee varus.The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using tw...BACKGROUND High tibial osteotomy(HTO)is a well-known procedure for the correction of knee varus.The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques:acute opening wedge correction using a plate and gradual correction with a monolateral external fixator.AIM To compare of the radiological results of two different techniques:acute opening wedge correction(a plate and screw)and gradual correction(external fixator).METHODS A total of 43 patients with plates and 36 patients with external fixators were included.All patients had moderate uniplanar varus deformities.We measured radiographic parameters,including the mechanical axis deviation(MAD),medial proximal tibial angle(MPTA),Caton-Deschamps Index(CDI),posterior proximal tibial angle,and joint line obliquity angle(JLOA).The accuracy of MAD correction was calculated based on a correction goal of neutral or overcorrection for medial compartment arthritis.RESULTS Demographics including age,body mass index,sex,and preoperative deformities were similar between the groups.The MAD significantly improved from 23.6 mm medial to the midline(SD=8.2 mm)to 6.9 mm lateral to the midline(SD=5.4 mm)(P<0.001).The accuracy of MAD correction did not differ between the groups and was 96.1%(SD=8.1%)in the plate group and 98.2%(SD=5.2%)in the external fixator group(P=0.18).The MPTA significantly improved from 83.9°(SD=2.9°)to 90.9°(SD=3.3°)(P<0.001),and the change was similar between the groups.Differences were noted in patella height,with a CDI change of-19.2%(SD=13.7%)and 3.1%(SD=8.0%)for the plate and external fixator groups,respectively(P<0.001).The change in JLOA was 1.6 degrees(SD=1.1 degrees)and 0.9 degrees(SD=0.9 degrees)for the plate and external fixator groups,respectively(P=0.04).CONCLUSION Reliable correction of moderate varus alignment was achieved with both the acute opening wedge technique with a plate and the gradual monolateral external fixator technique.The patellar height decreased with the open wedge plate technique.Joint line obliquity decreased to a greater degree with the open wedge plate technique,perhaps as a result of medial collateral ligament release.The appropriate technique should be selected based on surgeon and patient preferences;however,external fixation may be a better choice when the preservation of patellar height is deemed important.展开更多
BACKGROUND Tibial tubercle osteotomy(TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty(RTKA). However, several reports have described potential osteotomy-relat...BACKGROUND Tibial tubercle osteotomy(TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty(RTKA). However, several reports have described potential osteotomy-related complications such as nonunion, tibial tubercle migration and fragmentation, and metalware related pain.AIM To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and complications.METHODS MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication rate.RESULTS Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases,respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were reported.CONCLUSION The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.展开更多
BACKGROUND Femoral and tibial stress injuries are commonly found in long distance running athletes.Stress fractures have rarely been reported in athletes performing high intensity interval training(HIIT)exercise.The o...BACKGROUND Femoral and tibial stress injuries are commonly found in long distance running athletes.Stress fractures have rarely been reported in athletes performing high intensity interval training(HIIT)exercise.The objective of this study was to report a case of a patient who presented with medial tibial stress syndrome and femoral neck stress fracture after performing HIIT exercises.CASE SUMMARY A 26 year old female presented with bilateral medial tibial pain.She had been performing HIIT exercise for 45 min,five times weekly,for a seven month period.Her tibial pain was gradual in onset,and was now severe and worse on exercise,despite six weeks of rest.Magnetic resonance imaging(MRI)revealed bilateral medial tibial stress syndrome.As she was taking norethisterone for birth control,a dual energy X-ray absorbitometry scan was performed which demonstrated normal bone mineral density of her lumbar spine and femoral neck.She was managed conservatively with analgesia and physiotherapy,but continued to exercise against medical advice.She presented again six months later with severe right hip pain.MRI of her right hip demonstrated an incomplete stress fracture of her subtrochanteric region.Her symptoms resolved with strict rest and physiotherapy.CONCLUSION HIIT may cause stress injury of the tibia and femur in young individuals.展开更多
Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resecti...Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone(genu varum) will result in persistence of the internal tibial torsion(the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blount's disease. Both coronal and axial deformities were corrected in this patient. We propose this combination(rather than the lateral growth modulation alone) as the method of treatment for early stages of Blount's disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy.展开更多
From March 1988 to March 1992, a total of 40 high tibial osteotomies(HTO) were performed according to Koshino technique in 35 patients, suffering fromosteoarthritis of knee joints. There were 9 male and 26 female pati...From March 1988 to March 1992, a total of 40 high tibial osteotomies(HTO) were performed according to Koshino technique in 35 patients, suffering fromosteoarthritis of knee joints. There were 9 male and 26 female patients. The right kneeand left knee were involved in 15 cases each and both knees involved in 5 cases. The ageof the patients ranged from 33 to 75 years with an average of 58. 6 years. Allosteoarthritis of knee joint were primary except 4 patients with secondary disease due toupper tibiai fracture in the past. According to the classification of knee osteoarthritis ofthe Yokohama City University in Japan, all our patients suffered from medialpatellofemoral type of knee osteoarthritis. On the basis of the pre-operative evaluation ofknee function with the Yokohama City University criteria, the patients had from 40 pointsto 65 points with an average of 53 points. The femoro-tibial angles (FTA) before opera-tion wcre from 178°to 192°with an average of 185.1°±4.7°. The size of bone wedgeto be removed was accurately calculated so as to produce a femoro-tibial angle of 170°after operation, giving 10°of valgus. In severe cases the exposed bone and cartilage ero-sion were found during the operation. In knees with deformity adequately corrected,marked relief of pain was obtained and walking resumed by 4-6 months after operation.The post-operative follow-up ranged from 6 months to 2 years and 3 months with an av-erage of 14.2 months. Out of the 40 patients 17 had their implant removed over a year.Early complications, such as wound infection, hematoma, joint adhesion, deep-veinthrombosis or non-union of bone, did not occur. The post-operative FTA ranged from166°to 177°with an average of 170.3°±3.7°. Post-operative evaluating showed kneefunction from 75 points to 95 points with an average of 88 points, implying good func-tional results. We consider that the Koshino technique of high tibial osteotomy has manyadvantages. It is suited to medial and medial patello-femoral osteoarthritis of the kneejoint.展开更多
We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-Mc...We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-McKeever type II injury of the tibial eminence. This is a reliable method in the correction of genu recurvatum. By using tricortical autogenous iliac crest graft, the osteotomy may be made very stable intra-operatively circumventing the need for fixation.展开更多
文摘BACKGROUND High tibial osteotomy(HTO)is a well-established method for the treatment of medial compartment osteoarthritis of the knee with varus deformity.However,HTO alone cannot adequately repair the arthritic joint,necessitating cartilage regeneration therapy.Cartilage regeneration procedures with concomitant HTO are used to improve the clinical outcome in patients with varus deformity.AIM To evaluate cartilage regeneration after implantation of allogenic human umbilical cord blood-derived mesenchymal stem cells(hUCB-MSCs)with concomitant HTO.METHODS Data for patients who underwent implantation of hUCB-MSCs with concomitant HTO were evaluated.The patients included in this study were over 40 years old,had a varus deformity of more than 5°,and a full-thickness International Cartilage Repair Society(ICRS)grade IV articular cartilage lesion of more than 4 cm2 in the medial compartment of the knee.All patients underwent second-look arthroscopy during hardware removal.Cartilage regeneration was evaluated macroscopically using the ICRS grading system in second-look arthroscopy.We also assessed the effects of patient characteristics,such as trochlear lesions,age,and lesion size,using patient medical records.RESULTS A total of 125 patients were included in the study,with an average age of 58.3±6.8 years(range:43-74 years old);95(76%)were female and 30(24%)were male.The average hip-knee-ankle(HKA)angle for measuring varus deformity was 7.6°±2.4°(range:5.0-14.2°).In second-look arthroscopy,the status of medial femoral condyle(MFC)cartilage was as follows:73(58.4%)patients with ICRS grade I,37(29.6%)with ICRS grade II,and 15(12%)with ICRS grade III.No patients were staged with ICRS grade IV.Additionally,the scores[except International Knee Documentation Committee(IKDC)at 1 year]of the ICRS grade I group improved more significantly than those of the ICRS grade II and III groups.CONCLUSION Implantation of hUCB-MSCs with concomitant HTO is an effective treatment for patients with medial compartment osteoarthritis and varus deformity.Regeneration of cartilage improves the clinical outcomes for the patients.
文摘BACKGROUND Most populations worldwide,who are used to squatting and sitting cross-legged for their activities of daily living,largely comprise the lower socioeconomic strata,thus making them candidates for exclusion for total knee arthroplasty.Proximal/high tibial osteotomy(HTO)is a preferred strategy for clinically symptomatic osteoarthritis(OA)with genu varum due to painful medial compartment OA which is not amenable to conservative measures.AIM To evaluate the outcomes of medial open-wedge HTO along with autologous bone grafting and buttress plate for the treatment of genu varum due to OA of the knee in a rural population of central India.METHODS A total of 65 knees in 56 patients with a mean age of 58.22±5.63 years with genu varum due to intractable painful knee OA were treated with medial open-wedge HTO along with autologous bone grafting and buttress plate osteosynthesis from June 2015 to May 2018.The mean preoperative radiological angle of genu varum was 13.4°.Clinical outcomes were assessed by the range of movement,knee scores,pain scores,and functional scores.Radiographic studies were performed preoperatively and at regular intervals during the follow-up period.RESULTS All patients reported pain relief immediately after the osteotomy and during the long-term analysis covering between one to three years.The genu varum angle was overcorrected to approximately four degrees in all patients.There was a loss of reduction by approximately three degrees in all patients at around six weeks postoperatively.Preoperative knee movements were restored in all patients.No major perioperative complications were noted during surgery and postoperative follow-up and the clinical scores were significantly improved during the final analysis which revealed good pain relief.CONCLUSION Medial open-wedge HTO is a reliable,safe,practical,physiological,and feasible treatment for populations who are used to increased activity in their occupation and lifestyle and is associated with excellent short-term and long-term results for OA in genu varum knees.
基金Young Teacher Project of Basic Scientific Research in Beijing University of Chinese Medicine(No.2019-JYB-JS-178)。
文摘Objective:To observe the clinical efficacy and advantages of 3D printed patient-specific instrumentation(PSI)assisted distal tibial tuberosity-high tibial osteotomy in the treatment of medial compartment knee osteoarthritis.Methods:75 patients with medial compartment knee osteoarthritis were included in the study performed DTT-HTO in our hospital from August 2017 to August 2019.The patients were divided into the PSI group(n=39)and conventional group(n=36)According to whether PSI was used in surgery.The differences of lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time,weight bearing line(WBL),Posterior tibial slope(PTS)and Caton-Deschamps index(CDI)were compared between the two groups.Visual analogue scale(VAS)scores and Hospital for Special Surgery(HSS)scores were recorded to evaluate knee pain and function before surgery and after surgery at 3 months and 12 months.Results:All 75 patients were followed up for more than 12 months,the ranged from 12-26(18.74±6.21)months.Three lateral cortical fractures in the conventional group and no fracture in PSI group.The lateral cortical fracture rate,time of intraoperative X-ray exposure,intraoperative blood loss,operative time in PSI group were lower than those in conventional group(p敿0.05).WBL in two groups were significantly improved after surgery(p敿0.05),and PTS,CDI were no statistically improved after surgery(p>0.05).While there was no statistically significant difference with WBL,PTS and CDI between two groups(p>0.05).At 1 months,3 months and 12 months after surgery;VAS and HSS scores in both groups were significantly improved compared with that before surgery(p0.05),and were no statistically significant difference between two groups.Conclusion:3D printed patient-specific instrumentation assisted DTT-HTO has significant clinical efficacy,and effectively standardized surgical procedures,meanwhile reduced the time of intraoperative X-ray exposure,intraoperative blood loss and risk of lateral cortical fracture.
文摘Main intention of the research is to understand about significance of techniques associated with HTO. This research reviewed the techniques of high tibial osteotomy namely high tibial osteotomy, open wedge high tibial osteotomy, closedhigh tibial osteotomy. Patients who are suffering from knee arthritis, high tibial osteotomy assists to prevent or delay the requirement for total or partial replacement of knee to preserve damaged tissue of joint. High tibial osteotomy technique is mainly suitable for active and young patients with knee osteoarthritis. Age plays a main factor in success rate of high tibial osteotomy technique. It could be done in open wedge or closed wedge high tibial osteotomy. For some cases, surgery could be done in combined method (open wedge and closed wedge high tibial osteotomy). When compared with clinical outcomes of closed wedge high tibial osteotomy and open wedge high tibial osteotomy, open wedge high tibial osteotomy performs well in reducing the pain, duration of weight-bearing and return to normal life as soon as possible.
文摘Introduction: Recently, new plates with locking screws have been developed and used for medial open-wedge high tibial osteotomy (HTO). The purpose of this study was to evaluate and compare biomechanical properties of different internal fixations in open-wedge HTO using the two currently available locking plates. Methods: Eight paired fresh-frozen cadaveric lower extremities were vertically embedded in steel boxes. The axial compression load was applied to the legs using the mechanical testing machine. The axial compression load test from 0 N to 550 N and the failure test were performed before and after HTO. One side of the leg of a specimen was fixed with the Puddu locking plate and the other side was fixed with the TomoFix plate to compare the two plates using the same specimen. A mode of failure and vertical displacement of the medial and lateral parts of the tibia at the osteotomy gap was recorded using a video camera in the failure test. The load–displacement data were analyzed to calculate stiffness, failure load, and displacement at failure. Results: The mean failure load was 1471.4 N and 1692.3 N and total vertical displacement at failure was 3.1 mm and 2.9 mm with the Puddu and TomoFix plates, respectively. During axial compression loading, displacements mainly occurred at the lateral osteotomy gap, while the medial gap was well preserved. No significant differences were observed in the failure load, displacement, or mode of failure between the two plates. Conclusions: The Puddu and TomoFix plates had similar biomechanical properties in open-wedge HTO. The results indicated reliable stability after open-wedge HTO without fibular osteotomy.
文摘Background: Biplanar medial opening wedge high tibial osteotomy (MOWHTO) is a treatment method that allows adequate correction of symptomatic varus knee deformity. However, MOWHTO tends to decrease patellar height and increase the posterior tibial slope, which can affect the knee joint stability. Objective: The aim of this study was to describe the technique of biplanar MOWHTO and fixation by TomoFix plate, as well as to evaluate the accuracy of the planned correction and the postoperative tibial slope. Patients and Methods: This prospective cohort study was conducted on patients who presented with varus knee deformity and underwent biplanar MOWHTO and fixation by TomoFix plate during the period from March 2016 to March 2017. Assessment of patients included pre- and postoperative Knee and function scores, mechanical femorotibial angle (mFTA), posterior tibial slope angle (pTSA), range of motion (ROM) and radiological evaluation of the healing of the osteotomy site. Results: The recruited patients were 13 (8 men and 5 women), with average age 31.7 years old. The knee and functional scores improved from the preoperative mean of 45 and 41 to the postoperative mean of 85 and 72 points, respectively. The average knee flexion was 115 degrees, which at the final follow-up remained unchanged except for one case. The mean preoperative mFTA was 13.5°varus and decreased post-operatively to a mean of 3°valgus. The average postoperative follow-up period was 12 months (10 - 18 M). Conclusion: The biplanar MOWHTO allows preservation of posterior tibial slope while correcting the varus knee adequately.
基金the National Key Research and Development Program of China(No.2017YFB1104104)the Clinical Research Program of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine(No.JYLJ025)+6 种基金the Project of the Shanghai Collaborative Innovation Center for Translational Medicine(No.TM201814)the Technology and Innovation Fund(Chuang Ke)of the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine(No.CK2018011)the 3D Snowball Project of Shanghai Jiao Tong University School of Medicine(No.GXQ202007)the National Natural Science Foundation of China(No.81772425)the Science and Technology Commission of Shanghai Municipality(No.16441908700)Shanghai Jiao Tong University(No.YG2016MS11)the Science and Technology Project of Guangdong Province(No.201707010089)。
文摘Patient-specific instrumentation(PSI)enables a more accurate alignment of the lower limbs in a high tibial osteotomy(HTO)than in traditional surgery;however,the current design of commercial PSIs is not perfect.Therefore,we designed a new patient-specific surgical guide to improve the accuracy of the osteotomy and verified its reliability through a clinical operation.Here,we describe a patient with isolated medial-compartment bilateral knee osteoarthritis,accompanied by a varus deformity of the proximal tibia.The patient was treated with HTO using a patient-specific 3D-printed surgical guide.We concluded that the patient-specific 3D-printed surgical guide improved the accuracy of the osteotomy and the alignment of the lower limb.
文摘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. Results: 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.
文摘BACKGROUND High tibial osteotomy(HTO)is a well-known procedure for the correction of knee varus.The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques:acute opening wedge correction using a plate and gradual correction with a monolateral external fixator.AIM To compare of the radiological results of two different techniques:acute opening wedge correction(a plate and screw)and gradual correction(external fixator).METHODS A total of 43 patients with plates and 36 patients with external fixators were included.All patients had moderate uniplanar varus deformities.We measured radiographic parameters,including the mechanical axis deviation(MAD),medial proximal tibial angle(MPTA),Caton-Deschamps Index(CDI),posterior proximal tibial angle,and joint line obliquity angle(JLOA).The accuracy of MAD correction was calculated based on a correction goal of neutral or overcorrection for medial compartment arthritis.RESULTS Demographics including age,body mass index,sex,and preoperative deformities were similar between the groups.The MAD significantly improved from 23.6 mm medial to the midline(SD=8.2 mm)to 6.9 mm lateral to the midline(SD=5.4 mm)(P<0.001).The accuracy of MAD correction did not differ between the groups and was 96.1%(SD=8.1%)in the plate group and 98.2%(SD=5.2%)in the external fixator group(P=0.18).The MPTA significantly improved from 83.9°(SD=2.9°)to 90.9°(SD=3.3°)(P<0.001),and the change was similar between the groups.Differences were noted in patella height,with a CDI change of-19.2%(SD=13.7%)and 3.1%(SD=8.0%)for the plate and external fixator groups,respectively(P<0.001).The change in JLOA was 1.6 degrees(SD=1.1 degrees)and 0.9 degrees(SD=0.9 degrees)for the plate and external fixator groups,respectively(P=0.04).CONCLUSION Reliable correction of moderate varus alignment was achieved with both the acute opening wedge technique with a plate and the gradual monolateral external fixator technique.The patellar height decreased with the open wedge plate technique.Joint line obliquity decreased to a greater degree with the open wedge plate technique,perhaps as a result of medial collateral ligament release.The appropriate technique should be selected based on surgeon and patient preferences;however,external fixation may be a better choice when the preservation of patellar height is deemed important.
文摘BACKGROUND Tibial tubercle osteotomy(TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty(RTKA). However, several reports have described potential osteotomy-related complications such as nonunion, tibial tubercle migration and fragmentation, and metalware related pain.AIM To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and complications.METHODS MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication rate.RESULTS Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases,respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were reported.CONCLUSION The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.
文摘BACKGROUND Femoral and tibial stress injuries are commonly found in long distance running athletes.Stress fractures have rarely been reported in athletes performing high intensity interval training(HIIT)exercise.The objective of this study was to report a case of a patient who presented with medial tibial stress syndrome and femoral neck stress fracture after performing HIIT exercises.CASE SUMMARY A 26 year old female presented with bilateral medial tibial pain.She had been performing HIIT exercise for 45 min,five times weekly,for a seven month period.Her tibial pain was gradual in onset,and was now severe and worse on exercise,despite six weeks of rest.Magnetic resonance imaging(MRI)revealed bilateral medial tibial stress syndrome.As she was taking norethisterone for birth control,a dual energy X-ray absorbitometry scan was performed which demonstrated normal bone mineral density of her lumbar spine and femoral neck.She was managed conservatively with analgesia and physiotherapy,but continued to exercise against medical advice.She presented again six months later with severe right hip pain.MRI of her right hip demonstrated an incomplete stress fracture of her subtrochanteric region.Her symptoms resolved with strict rest and physiotherapy.CONCLUSION HIIT may cause stress injury of the tibia and femur in young individuals.
文摘Infantile Blount's disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone(genu varum) will result in persistence of the internal tibial torsion(the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blount's disease. Both coronal and axial deformities were corrected in this patient. We propose this combination(rather than the lateral growth modulation alone) as the method of treatment for early stages of Blount's disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy.
文摘From March 1988 to March 1992, a total of 40 high tibial osteotomies(HTO) were performed according to Koshino technique in 35 patients, suffering fromosteoarthritis of knee joints. There were 9 male and 26 female patients. The right kneeand left knee were involved in 15 cases each and both knees involved in 5 cases. The ageof the patients ranged from 33 to 75 years with an average of 58. 6 years. Allosteoarthritis of knee joint were primary except 4 patients with secondary disease due toupper tibiai fracture in the past. According to the classification of knee osteoarthritis ofthe Yokohama City University in Japan, all our patients suffered from medialpatellofemoral type of knee osteoarthritis. On the basis of the pre-operative evaluation ofknee function with the Yokohama City University criteria, the patients had from 40 pointsto 65 points with an average of 53 points. The femoro-tibial angles (FTA) before opera-tion wcre from 178°to 192°with an average of 185.1°±4.7°. The size of bone wedgeto be removed was accurately calculated so as to produce a femoro-tibial angle of 170°after operation, giving 10°of valgus. In severe cases the exposed bone and cartilage ero-sion were found during the operation. In knees with deformity adequately corrected,marked relief of pain was obtained and walking resumed by 4-6 months after operation.The post-operative follow-up ranged from 6 months to 2 years and 3 months with an av-erage of 14.2 months. Out of the 40 patients 17 had their implant removed over a year.Early complications, such as wound infection, hematoma, joint adhesion, deep-veinthrombosis or non-union of bone, did not occur. The post-operative FTA ranged from166°to 177°with an average of 170.3°±3.7°. Post-operative evaluating showed kneefunction from 75 points to 95 points with an average of 88 points, implying good func-tional results. We consider that the Koshino technique of high tibial osteotomy has manyadvantages. It is suited to medial and medial patello-femoral osteoarthritis of the kneejoint.
文摘We report a case of acquired genu recurvatum treated with a proximal tibial flexion osteotomy. A partial growth arrest at the anterior portion of the proximal tibial physis following a conservatively treated Meyers-McKeever type II injury of the tibial eminence. This is a reliable method in the correction of genu recurvatum. By using tricortical autogenous iliac crest graft, the osteotomy may be made very stable intra-operatively circumventing the need for fixation.
