Staged medial opening wedge high tibial osteotomy for bilateral varus gonarthrosis: biomechanical and clinical outcomes.

Détails

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Etat: Public
Version: Final published version
ID Serval
serval:BIB_0189DF2F08FA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Staged medial opening wedge high tibial osteotomy for bilateral varus gonarthrosis: biomechanical and clinical outcomes.
Périodique
Knee Surgery, Sports Traumatology, Arthroscopy
Auteur⸱e⸱s
Sischek E.L., Birmingham T.B., Leitch K.M., Martin R., Willits K., Giffin J.R.
ISSN
1433-7347 (Electronic)
ISSN-L
0942-2056
Statut éditorial
Publié
Date de publication
2014
Volume
22
Numéro
11
Pages
2672-2681
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Résumé
PURPOSE: (1) To evaluate the effect of staged bilateral medial opening wedge high tibial osteotomy (HTO) on established biomechanical risk factors for disease progression and on validated measures of pain and function and (2) To compare outcomes in patients having the second surgery staged within or beyond 12 months of the first surgery.
METHODS: Thirty-seven patients with bilateral varus alignment and medial compartment osteoarthritis underwent staged bilateral medial opening wedge HTO (21 within and 16 beyond 12 months). Patients underwent full-limb standing anteroposterior radiographs to determine frontal plane alignment (mechanical axis angle) and three-dimensional gait analysis to estimate the distribution of load across the tibiofemoral compartments (external knee adduction moment). Patients also completed the Knee Injury and Osteoarthritis Outcomes Scores (KOOS), the Lower Extremity Functional Scale, the Short Form Health Survey and the six-minute walk test (6MWT). Patients (both limbs) were evaluated before and approximately 6, 12 and 24 months after each surgery.
RESULTS: There were statistically and clinically significant changes in both limbs that were of similar magnitudes and that remained relatively stable over time postoperatively. Mean (95% CI) improvements in outcomes were as follows. Mechanical axis angle: 9.4° (8.4°, 10.4°) (i.e. average change of both limbs), peak knee adduction moment: -1.7%BW*Ht (-2.1, -1.4 %BW*Ht) (i.e. average change of both limbs), 6MWT: 36.7 m (19.4, 54.0 m), SF-12 Physical Component Summary: 12.0 (8.5, 15.5) and KOOS Pain: 25.4 (19.6, 31.2). Other than the shorter time period to reach maximum benefit of both surgeries, there were no remarkable differences at final assessment between patients having surgeries staged within or beyond 12 months.
CONCLUSIONS: The present findings demonstrate that patients with bilateral varus gonarthrosis experience marked improvements in established biomechanical risk factors for disease progression bilaterally (mechanical axis angles and external knee adduction moments), as well as clinically important improvements in patient-important outcomes, after staged medial opening wedge HTO. Current findings suggest no difference in outcomes for patients who have the second surgery staged within or beyond 12 months of the first surgery.
LEVEL OF EVIDENCE: IV.
Mots-clé
Adult, Arthralgia/diagnosis, Disease Progression, Female, Humans, Kinetics, Knee Injuries/surgery, Knee Joint/surgery, Male, Middle Aged, Osteoarthritis, Knee/physiopathology, Osteoarthritis, Knee/surgery, Osteotomy/methods, Prospective Studies, Risk Factors, Tibia/surgery
Pubmed
Web of science
Création de la notice
19/01/2016 9:06
Dernière modification de la notice
20/08/2019 12:23
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