Objective To assess the efficacy of medial wedged proximal tibial osteotomy for treating knee osteoarthritis with varus deformity. Methods From July 1996 to September 1999, 19 patients with knee osteoarthritis accompanied by varus deformity were treated by medial wedged proximal tibial osteotomy combined with internal fixation. Full-length anteriorposterior radiographs were taken preoperatively, 8 weeks and 2 years postoperatively. The parameters including the femorotibial angle, the tibial angle, the femoral angle, the femoral condyletibial plateau angle, and the medial joint space, were measured from these radiographs. The function of knee was evaluated according to the 100point rating scale standard of knee.Results Themean postoperative score had been significantly improved from 48.6±16.6 pointsto 81.7±14.8 points after 2 years of operation. The medial joint spacehad been increased from 2.2±1.6mm to 4.9±1.5 mm and the femoral condyle-tibial anglehad been decreased from 7.4°±3.1° to 1.7°± 3.1°. There were complications in 3 cases: 2 casesof superficial wound infections and 1 case of intraarticular fracture. There were no delayed union and recurrence of varus deformity. Conclusion Medial wedged proximal tibial osteotomy combined with internal fixation provides an efficacious approach to treat knee osteoarthritis with varus deformity.
The osteoarthritis of knee is a common disorder but no always to be treated satisfactorily. Between 1988 and 1992, the method, a high tibial osteotomy to correct the genu varum combined with autogenous periosteal or perichondrial graft to deal with the chondromalacia patella was used. Thirty-two patients (51 knees) were treated by this method and the patients were followed up for an average of 5.1 years. The excellent and good results were obtained in 90.2%. This method was obviously better than any other simple high tibial osteotomy. Therefore, this method was considered to be effective for treatment of osteoarthritis of knee with varum deformity and chondromalcia patella.
【Abstract】 Objective To make the young patients with osteoarthritis and genu varum of knee delay total knee arthroplasty,to observe the cl inical effect of mosaicplasty of femoral medial condyle, patellar-plasty and high tibial osteotomy inthe treatment of osteoarthritis of knee with varum. Methods From June 2004 to February 2006, 8 patients with osteoarthritisof knee with varum(10 knees) were treated with combined operation such as mosaicplasty of femoral medial condyle, patellarplastyand high tibial osteotomy. There were 2 males with 3 knees, and 6 females with 7 knees,with an average age of 50 years(42-56 years). The left knees and right knees were involved in 3 cases respectively and bilateral knees in 2 cases. All patients hadknee ache after walk or long-time standing. The X-ray showed hyperosteogeny at peri-patella and circum ferential femur-tibialjoint，especially in the medial. The gap between patella and femur narrowed or disappeared，especially in the medial femurtibialjoint. The femoral tibial angel (FTA) was 185-200°(mean 190°). The HSS score of knee was 55-75(mean 60). The history ofknee ache was 1-12 years(mean 5 years). Results All patients were followed up for 7-24 months (mean 15 months). All theincisions healed by first intention, no early compl ication occurred. The cl inical bone heal ing time was 8-11 weeks(mean 9 weeks).Rectification of FTA was 15-30°(mean 20°). Normal weight-loading al ignment was recovered. The valgus angle of knee was 10°.The range of motion of knee was 100-120° after operation, increasing by 5-20° (mean 10°) when compared with preoperation.The X-ray of postoperation showed that genu varum was corrected obviously and that no displacement, loosening and breakageoccurred. The mean score of HSS was 80 (75-88), increasing by 20 when compared with preoperation. Conclusion Mosaicplastyof femoral medial condyle can make articular cartilage repair in certain degrees, patellar-plasty can rel ieve ache of fore region of knee effectively, and high tibial osteotomy can recover normal weight-loading al ignment. The curative effect is good withthe combined methods.
Objective To investigate the impact of the bone mass and volume of the low-density area under the tibial plateau on the lower limb force line by finite element analysis, offering mechanical evidence for preventing internal displacement of the lower limb force line in conjunction with knee varus in patients with knee osteoarthritis (KOA) and reducing bone mass under the tibial plateau. Methods A healthy adult was selected as the study subject, and X-ray film and CT imaging data were acquired. Mimics 21.0 software was utilized to reconstruct the complete knee joint model and three models representing low-density areas under the tibial plateau with equal volume but varying shapes. These models were then imported into Solidworks 2023 software for assembly and verification. Five KOA finite element models with 22%, 33%, 44%, 55%, and 66% bone mass reduction in the low-density area under tibial plateau and 5 KOA finite element models with 81%, 90%, 100%, 110%, and 121% times of the low-density area model with 66% bone mass loss were constructed, respectively. Under physiological loading conditions of the human lower limb, the distal ends of the tibia and fibula were fully immobilized. An axial compressive load of 1 860 N, following the lower limb force line, was applied to the primary load-bearing area on the femoral head surface. The maximum stress within the tibial plateau, as well as the maximum displacements of the tibial cortical bone and tibial subchondral bone, were calculated and analyzed using the finite element analysis software Abaqus 2022. Subsequently, predictions regarding the alteration of the lower limb force line were made based on the analysis results. Results The constructed KOA model accorded with the normal anatomical structure of lower limbs. Under the same boundary conditions and the same load, the maximum stress of the medial tibial plateau, the maximum displacement of the tibial cortical bone and the maximum displacement of the cancellous bone increased along with the gradual decrease of bone mass in the low-density area under the tibial plateau and the gradual increase in the volume of the low-density area under tibial plateau, with significant differences (P<0.05). ConclusionThe existence of a low-density area under tibial plateau suggests a heightened likelihood of knee varus and inward movement of the lower limb force line. Both the volume and reduction in bone mass of the low-density area serve as critical initiating factors. This information can provide valuable guidance to clinicians in proactively preventing knee varus and averting its occurrence.
ObjectiveTo explore the short-term effectiveness of medial open wedge high tibial osteotomy (OWHTO) combined with posterior slope angle of tibial plateau correction to treat the osteoarthritis of limited flexion knee with varus deformity.MethodsThe data of 18 cases (18 knee) with osteoarthritis of limited flexion knee with varus deformity between January 2014 and July 2016 were analyzed retrospectively. There were 6 males and 12 females with an average age of 54.9 years (range, 48-64 years). There were 8 cases of left knee and 10 cases of right knee. The varus of knee ranged from 7.45 to 15.52° (mean, 10.63°). According to Kellgren-Lawrence grading standard, there were 4 cases of grade Ⅱ and 14 of grade Ⅲ. OWHTO was used to adjust the varus deformity, and the posterior slope angle of tibial plateau was adjusted to solve the limited flexion.ResultsThe thickness of osteotomy was 10-19 mm (mean, 14.91 mm). The operation time was 1.2-2.0 hours (mean, 1.4 hours). All incisions healed by first intension. All patients were followed up 1.0-2.5 years, with an average of 1.5 years. At last follow-up, the range of knee flexion and Lysholm score, Hospital for Special Surgery (HSS) score, and International Knee Documentation Committee (IKDC) score were significantly higher than preoperative ones, showing significant differences (P<0.05). X-ray films showed that the osteotomy healed at 3- 7 months (mean, 3.6 months) after operation. At last follow-up, the limb alignment by the relative position of tibial plateau and the posterior slope angle of tibial plateau were significantly improved, showing significant differences when compared with preoperative ones (P<0.05).ConclusionThe OWHTO combined with posterior slope angle of tibial plateau correction can significantly improve the range of flexion and functional score in short-term.
Objective To investigate whether different degrees of primary varus knee affect joint function and stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods A clinical data of 160 patients with primary varus knee, who were admitted between January 2020 and December 2021 and met the selection criteria, was retrospectively analyzed. All patients underwent primary ACL reconstruction using autologous single-bundle hamstring tendon. Patients were divided into three groups based on the hip-knee-ankle angle (HKA): group A (64 patients with HKA 0°-3°), group B (55 patients with HKA 3°-6°), and group C (41 patients with HKA 6°-9°). Except for the significant difference in HKA among the three groups (P<0.05), baseline data such as age, gender, affected side, body mass index, interval between injury and operation, Kellgren-Lawrence grading, posterior tibial slope, proportion of combined meniscal injuries, Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) objective score, anterior drawer test, Lachman test, pivot shift test, and the results of KT1000 (side-to-side difference, SSD) showed no significant difference (P>0.05). At last follow-up, joint stability was assessed through the anterior drawer test, Lachman test, pivot shift test, and SSD; joint function was evaluated using the Tegner score, Lysholm score, and IKDC objective score. Results All incisions in the three groups healed by first intention after operation. All patients were followed up 24-31 months, with an average of 26 months; there was no significant difference in the follow-up time among the three groups (Z=0.675, P=0.714). At last follow-up, the knee stability and functional assessment indicators in each group significantly improved when compared to preoperative ones (P<0.05); there was no significant difference among the three groups (P>0.05) in terms of the anterior drawer test, Lachman test, pivot shift test, IKDC objective scores, and the changes of the Lysholm scores and Tegner scores. The Kellgren-Lawrence grading and HKA at last follow-up were consistent with preoperative results in the three groups. ConclusionVarying degrees of primary varus knee do not affect early knee joint stability and functional recovery after ACL reconstruction, and there is no significant difference in effectiveness between different degrees of varus knee.
Objective To analyze formation of the varus angle of the knee dueto osteoarthritis and to explore techniques of the soft tissue balance in the total knee arthroplasty(TKA). Methods One hundred patients with145 varus knees (18 males, 25 varus knees; 82 females, 120 varus knees) underwent TKA from January 1999 to December 2003. Their ages averaged 62.4 years (range, 45.80 years), and their HSS（hospital of special surgery）scores were 38.0±3.2 points. Before operation，all the patients were measured in the alignment of the lower extremity, accurate bonecutting was performed, and their static alignment was achieved. Then, the soft tissue release was made. The release performance consisted of 3 steps: release before the bone-cutting, release during the bone-cutting, and release after the bonecutting. Release of themedial ligament and capsule, elimination of the osteophytes, and release of thelateral patellar retinaculum were more important. Results The varus angles in these patients were 9.2±3.1° before operation. Among them,the varus angles caused by the soft tissue imbalance accounted for 53.2%，and caused by the bone structure accounted for 46.8%； and the latter caused by thetibia varus, 22.8%, and by the tibia plateau destruction, 24.0%. There was nosignificant difference between the varus angles caused by the soft tissue imbalance and the varus angles caused by the bone structure deformity (P＞0.05). According to the postoperative imaging studies, the correction degree for the varus angles by the bone-cutting was 4.3°, which represented 27.9% of the total corrected angles, and the correction degree for the varus angles corrected by the soft tissue balance was 10.7°, which represented 72.1% of the total corrected angles. The HSS scores were 87.0±4.5 points after operation, and the difference between preoperation and postoperation was significant. Conclusion The varus knee due to osteoarthritis results from the varus angle in the bone structure and the angles caused by the imbalance of the collateral ligaments and the soft tissues around the knee. The latter causative factor is more important in the formation of the varus knee and should only be corrected through the soft tissue release. The more important part to be released isthe attachments of the medial ligament and the posterior capsule. The release performance should be followed by the principles, i.e., step by step, tests at all the time, and avoidance of the excessive release.