Document Detail


Clinical results and radiographical evaluation of opening wedge high tibial osteotomy for spontaneous osteonecrosis of the knee.
MedLine Citation:
PMID:  19165468     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We evaluated the clinical outcomes, in terms of early weight bearing, of using opening wedge high tibial osteotomy (OWHTO) to treat spontaneous osteonecrosis of the medial femoral condyle of the knee (SONK) using TomoFix and artificial bone substitute. Damaged cartilage tissue was removed and drilling of the necrotic area followed by OWHTO was performed in 30 knees from 30 patients with an average age of 71 years (range 58-82) at the time of operation. Patients were allowed to undertake partial weight-bearing exercises 1 week after the osteotomy procedure, with all patients performing full weight-bearing exercise at 2 weeks post-surgery. The mean follow-up period was 40 months (range 24-62). All of the SONK patients could walk with a full weight-bearing load, using only a T-cane, at 2 weeks after undergoing OWHTO. Clinical assays, including the mean American Knee Society Score and Function Score, showed significant improvements from 51 to 93 points, and 58 to 93 points, respectively. Prior to surgery, the average femoro-tibial angle (FTA) during standing was 181 (1 degree anatomical varus) and had significantly changed to 170 (10 degrees valgus) at the time of follow-up. There were no cases of non-union, or implant failure in any of our patients. In addition, none of the patients could sit in the Japanese style prior to surgery, but 21 of 30 patients (70%) could do so after treatment. Arthroscopic findings could be observed in 24 out of 30 cases at implant removal. Necrotic area in each case was covered with fibrous cartilage-like tissue completely. Drilling of the necrotic area followed by OWHTO with TomoFix and artificial bone substitute is an effective treatment for SONK as it results in pain alleviation and regeneration of the fibrous cartilage tissue over the necrotic legion. In addition, an early weight-bearing exercise program is possible after this procedure and full weight-bearing can be achieved at two weeks after surgery.
Authors:
Ryohei Takeuchi; Masato Aratake; Haruhiko Bito; Izumi Saito; Ken Kumagai; Riku Hayashi; Yohei Sasaki; Yasuhsi Akamatsu; Hiroyuki Ishikawa; Eishyun Amakado; Yoichi Aota; Tomoyuki Saito
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-01-23
Journal Detail:
Title:  Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA     Volume:  17     ISSN:  1433-7347     ISO Abbreviation:  Knee Surg Sports Traumatol Arthrosc     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-31     Completed Date:  2009-07-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9314730     Medline TA:  Knee Surg Sports Traumatol Arthrosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  361-8     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan. take0822@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Knee Joint / physiopathology*,  radiography,  surgery*
Male
Middle Aged
Osteonecrosis / surgery*
Osteotomy / methods*,  rehabilitation
Range of Motion, Articular
Recovery of Function
Tibia / radiography,  surgery*
Treatment Outcome
Weight-Bearing

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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