Osteotomy of the Upper Portion of the Tibia for Degenerative Arthritis of the Knee

Coventry, Mark B.

doi:10.2106/00004623-200109000-00021

Cited by 146 publications

(205 citation statements)

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“…A Coventry 26 type closing wedge high tibial osteotomy was done. The use of special instrumentation improved the precision of the bone cuts and application of the Giebel blade plate that was used to internally fix the osteotomy.…”

Section: Methodsmentioning

confidence: 99%

Histological and scanning electron microscopy analyses of bone/implant interface using the novel Bonelike® synthetic bone graft

Gutierres

Hussain

Lopes

et al. 2006

Journal Orthopaedic Research

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Synthetic bone grafts provide an alternative to autografts and allografts. Bonelike 1 is a patented synthetic bone graft that mimics the mineral composition of bone. The aim of the present work was to assess the biological behavior of Bonelike 1 graft in humans, before using the material in orthopedic applications of bone regeneration, for example, in opening wedge high tibial osteotomies for medial knee osteoarthritis. Bonelike 1 granules were implanted in cortical bone of 11 patients undergoing osteotomies, and new bone formation, osteoconductive properties, and resorption characteristics of the granules were analyzed. The granules ranged from 500 to 1000 mm and were implanted in the lateral aspect of the tibia. The patients' mean age was 59 years (range 48 to 70 years); there were eight women and three men, all suffering from medial compartment osteoarthritis of the knee. At surgery, a 1 Â 1 Â 1-cm cortical defect was created 3 cm distal to the entry point of the screws, in line with the long axis of tibia. The implanted Bonelike 1 graft sample was extracted for analysis during removal of the metallic prosthesis after implantation times of 6, 9, and 12 months. Radiological follow-up, scanning electron microscopy, histological analysis, and histomorphometric measurements were conducted on the retrieved samples to assess bone regeneration in the defect area. Osteoconductive capacity was demonstrated by extensive mature bone formation around the implanted granules and high levels of percentage bone-to-graft contact (from 67-84%). Bonelike 1 acted as an excellent bioactive scaffold, allowing the migration, proliferation, and differentiation of bone cells on its surface, and therefore regeneration of the defects was achieved in a rapid, controlled manner. Our results suggest that Bonelike 1 graft is an excellent candidate for orthopedic applications where rapid new bone formation is a fundamental requirement. ß

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Section: Methodsmentioning

confidence: 99%

Histological and scanning electron microscopy analyses of bone/implant interface using the novel Bonelike® synthetic bone graft

Gutierres

Hussain

Lopes

et al. 2006

Journal Orthopaedic Research

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“…High tibial osteotomy typically results in pain relief and improved knee function in 80-90 % of patients [3,10,21]; however, osteoarthritis progression often leads to deterioration of results with the passage of time [13,14,18,22,24]. When symptomatic progression occurs, total knee arthroplasty (TKA) is frequently performed.…”

Section: Introductionmentioning

confidence: 99%

Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy

Bastos

Magnussen

Duthon

et al. 2013

International Orthopaedics (SICOT)

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Purpose High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial openingwedge versus lateral closing-wedge) has not been explored. The purpose of this study was to evaluate the influence of HTO technique on the performance and results of TKA. Methods A total of 141 TKA's performed in 118 patients with prior HTO (24 opening wedge and 117 closing wedge) were reviewed at a mean follow-up of two years. Reviewed data included intra-operative factors (tourniquet time, the need for additional exposure, and intra-operative complications), clinical results (International Knee Score (IKS)) and radiographic assessment of limb alignment. Results The average IKS knee and function scores improved from 54.0 and 60.3 to 87.0 and 79.5 (p< 0.0001). There was no significant difference in IKS scores based on osteotomy technique. There was a trend toward an increased need for tibial tubercle osteotomy in the closing wedge group. There was an increased need for extensive medial release in the opening wedge group and extensive lateral release in the closing wedge group. No differences in tourniquet time, complication rates, or hip-knee-ankle angle were noted between the two groups. Conclusions Radiographic limb alignment, patient-reported outcomes, and complication rates are equal in patients undergoing TKA after opening and closing wedge HTO.

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“…The treatment goal in varus knee OA, by means of surgical (eg, high tibial osteotomy) [16,22,61] and nonsurgical methods (eg, wedging foot orthoses, unloading knee braces) [10,42,58], is to reduce deviation of the mechanical axis of the lower extremity from the knee joint center. However, the 'mechanical axis' is a static 2-D radiographic measurement that varies with foot position [32] and weightbearing status (eg, single versus doublelimb support) [70], and it might not always correlate with complex 3-D loading or dynamic function of the knee [2,28,40].…”

Section: Discussionmentioning

confidence: 99%

Are Joint Structure and Function Related to Medial Knee OA Pain? A Pilot Study

Zifchock

Kirane

Hillstrom

2011

Clinical Orthopaedics &Amp; Related Research

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Background Although the severity of knee osteoarthritis (OA) usually is assessed using different measures of joint structure, function, and pain, the relationships between these measures are unclear. Purpose Therefore, we: (1) examined the relationships between the measures of knee structure (flexion-extension range of motion, radiographic tibiofemoral angle, and medial joint space), function (Knee Osteoarthritis Outcome Scores [KOOS], peak adduction angle, and moment), and pain (visual analog scale [VAS]); and (2) identified variables that best predicted knee pain. Methods We assessed 15 patients with medial knee OA using VAS pain, KOOS questionnaire, 3-D gait analysis, and radiographic examination. Parameter relationships were assessed using Pearson correlation, and variables most predictive of knee pain were determined using a stepwise multiple regression. Results Subjective measurements correlated (|r| C 0.54) with one another, as did most of the objective measurements (|r| C 0.56) except for adduction moment which did not correlate with any variable. All variables correlated (|r| [ 0.54) with VAS knee pain except peak adduction moment. Medial joint space and peak adduction angle best predicted knee pain, accounting for approximately threequarters of the model variance (r 2 = 0.73).

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Osteotomy of the Upper Portion of the Tibia for Degenerative Arthritis of the Knee

Cited by 146 publications

References 0 publications

Histological and scanning electron microscopy analyses of bone/implant interface using the novel Bonelike® synthetic bone graft

Histological and scanning electron microscopy analyses of bone/implant interface using the novel Bonelike® synthetic bone graft

Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy

Are Joint Structure and Function Related to Medial Knee OA Pain? A Pilot Study

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