Abstract
Introduction: High tibial osteotomy (HTO) is a well-established procedure for treatment of unicompartmental osteoarthritis of knee. HTO is a favoured choice of treatment for isolated unicompartment arthritis in patients who are aged less than 60 years. The biomechanical rationale for HTO in patients with unicompartmental osteoarthritis of knee is unloading of the involved joint compartment by correcting the malalignment and redistributing the stresses on the knee joint .The factors associated with good long-term results include: tibiofemoral angle > 8 valgus, body weight no > 132% of ideal body weight, age < 60 years, purely unicompart mental arthrosis, ligmantous stability, pre-operative range of motion knee > 900&Ahlbak's grade 1 & 2.
Method: This prospective study of 32 patients was conducted in the department of orthopaedics at govt. Medical college, Jammu from May 2016 to December 2018, who satisfy the inclusion criteria.
Result: In our study 13 patients (40.63%) had excellent results, 18 (56.25%) had good results and 1(3.12%) had fair results. None of the patients in our study had poor results. Out of 32 patients 7 (21.88%) were males and 25 (78.12%) were females, the age of patients ranged from 42 to 57 years. the average range of motion of the involved knee in pre-operative period was 131.56 degree with range of 100-150 degree, With improvement in ROM at the final follow-up was 133.9 degrees with a range from 110 to 150 degrees. The pre-operative HSS score ranged from 56-72 with a mean of 63.312, at follow-up of 9 months HSS ranged from 69-89 with a mean of 83.46. There was an average increase of 20.01 in the score at final follow-up.
Conclusion: High tibial osteotomy is a safe, reliable procedure in unicompartmental osteoarthritis of knee. There is significant improvement in the pain and function which allows the patient to squat and sit cross legged which is very important in our community for social and religious activities. It is a valuable option in our community where majority of patients are unwilling for unicompartment or total knee arthoplasty.
References
- Aglietti P, Buzzi R , Vena LM , Baldini A , Mondaini A. The Journal of Knee Surgery [01 Jan 2003, 16(1):21-26.
- Alex E, Staubli Carlo, De Simoni, Reto Babst, Phillip Lobenhoffer. Department of orthopaedics Luzern, Switzerland. Injury 2003, vol.34,suppl.2
- Amendola A. And Bonasia D. E. Results of high tibial osteotomy: review of literature. International orthopaedics. Volume 34, Number 2/ February,2010.
- Brinkman JM, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ. Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br. 2008; 90(12):1548-57.
- Billing A, Scott DF,CamargoMP,Hofmann AA,. High tibial osteotomy with a calibrated osteotomy guide,rigid internal fixation and early
- Conventry MB (1965). Osteotomy of the upper portion of tibia for degenerative arthritis of knee: a preliminary report . JBJS Am 47:984
- Dabov G. D. Miscellaneous Nontraumatic Disorders. Campbell’s Operative Orthopa- edics. 11th P999 – 1019 ;Crockarell JR jr, Guyton JL. Arthroscopy of the Knee. Campbell’s Orthopaedics. 11thed. P 241- 299. 21.\
- Gomol AH, Angele P, Condello V, et al . Load distribution in early osteoarthritis, Knee surg sports TraumatolArthrosc 2016;24;1815-25.motion .Long term followup.JBJS Am 2000;82;70-9. 20.
- Grazio S, Balen D. Obesity: Risk factor and predictors of osteoarthritis. LijecVjesn. 2009;131:22–6.
- Insall J, Shoji H, Mayer V (1974). High tibial osteotomy. A five year evaluation. J Bone Joint Surg Am 56:1397–1405
- Insall JM, Joseph DM, Msika C (1984) High tibial osteotomy for varusgonarthrosis: A long term follow-up study. JBJS Am 66:1040-1048.
- Karl Stoffel, Gwidon Stachowiak, Markus Kuster. November 2004Volume 19, Issue 9, Pages 944–950 - Clinical biomechanics, 2004 - Elsevier
- Mehmet Asik, Cengiz Sen, Bulent kilic et al. High tibial osteotomy with paddu plate for treatment of varusgonoarthrosis. Knee Surg Sports TraumatolArthrosc (2006)14;948-954
- Phafler, C Lutz, M Maier, J Housdorf. .Long term results of high tibialosteotomy.Actachirbelg ,2003,103,603-606.
- Phillip Niemeyer, MD, Wolfgang Koestler, MD; Christiankaehny, MD; et al. Result of open wedge high tibial osteotomy by medial plate fixater for medial compartment arthritis. The journel of Arthroscopic and related surgery, vol 24, no 7(July) 2008; pp. 796-804.
- Phillip Schuster, MD, Markus Geblein et al. Ten year results of medial open wedge high tibialosteotomy.The American journel of sports medicine;1-9vol xx ,no.x,xxxx.
- S Akizuki, A Shibakawa et al. Long term outcome of high tibialosteotomy.JBJS (Br) ;2008;90-B;592-6.
- Solomon L., Warwick D.J., Nayagam S. Apley’s System of Orthopaedics and Fractures. 8th ed. P77-86 & p472-473. 1. Felson DT: Epidemiology of knee and hip osteoarthritis. Epidemiol Rev 1988; 10: 1–28. 2) Das SK,
- Tomihisa Koshino, Takuji Yoshida, Yuki Ara.et al ; Fifteen to twenty years follow up results of high tibial osteotomy for osteoarthritic knee. The Knee 11 (2004) 439-444.
- Tarunkumar et al (2015). journel of indianorthopaedic rheumatology/july-august 2015 (1)(1) 6-11.
- Vojtassak J, Seliga J Bratisl Lek Listy 2001; 102 (10): 470-472 2nd Department of Orthopaedics, Faculty of Medicine, Comenius University and General Hospital Ruzinov, Bratislava High tibial osteotomy and debridement of the knee joint in treatment of varoticgonarthrosis. Address for correspondence: J. Vojtassak, MD, PhD, 2nd Dept of Orthopaedics, General Hospital Ruzinov, Ruzinovska 26, SL-826 06 Bratislava, Slovakia. Phone/Fax: +421.2.43338748 2nd Department of Orthopaedics, Faculty of Medicine, Comenius University and General Hospital Ruzinov, Bratislava, Slovakia.bll@ fmed.uniba.sk.
- Werner Kolb, MD; Hanno Guhlmann, MD; Christoph Windisch, MD; Klaus Kolb, MD; Heiko Koller, MD; Paul Grützner, MD.J Bone Joint Surg Am, 2009 Nov 01; 91 (11): 2581 -2588.
- Wright, John M. MD; Crockett, Heber C. MD; Slawski, Daniel P. MD; Madsen, Mike W. MD; Windsor, Russell E. MD. Journal of the American Academy of Orthopedic Surgeons: July/August 2005 - Volume 13 - Issue 4 - p 279–289.83.
- M. Robinson, M.C.Papana et al. High tibial osteotomy in medial compartment osteoarthritis and varus deformity using the taylor spatial frame.;Strat trauma limb Recon (2011)6;137-145.
Corresponding Author
Dr Malik Naseer Ahmad
Jr. Resident