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      The Short-term Follow-up Results of Open Wedge High Tibial Osteotomy with Using an Aescula Open Wedge Plate and an Allogenic Bone Graft: The Minimum 1-Year Follow-up Results

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          Abstract

          Background

          This study examined the results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft as a surgical technique for the patients who suffer from osteoarthritis of the knee with a genu varum deformity.

          Methods

          From March 2007 to August 2007, 33 patients (37 cases) with osteoarthritis of the knee and a genu varum deformity underwent a high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft. The patients were followed up for more than 1 year. Before and after surgery, the correction angle of the genu varum was measured by the lower extremity scannogram and the posterior tibial slope, the joint space distance and the time to bone union were evaluated. The functional factors were evaluated using the Knee Society Score.

          Results

          The average knee score and function score improved from 52.19 ± 11.82 to 92.49 ± 5.10 and 52.84 ± 6.23 to 89.05 ± 5.53, respectively ( p < 0.001). According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 ± 2.76°, and the average correction angle at the last follow-up was 10.93 ± 2.50° ( p < 0.001). The tibial posterior slope before surgery and at the last follow-up were 8.20 ± 1.80° and 8.04 ± 1.30°, respectively ( p = 0.437). The joint space distance increased from 4.05 ± 1.30 mm to 4.83 ± 1.33 mm ( p < 0.001). The average time to complete bone union was 12.69 ± 1.5 weeks.

          Conclusions

          An open wedge high tibial osteotomy using an Aescula open wedge plate and an allogeneic bone graft to treat osteoarthritis of the knee with a genu varum deformity showed good results for the precision of the correction angle, the time to bone union and the functional improvement.

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          Most cited references25

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          The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints.

          1. Arthroscopic findings in repair of articular surfaces and the operation's effect on healthy components made it clear that the ideal correction method is to align the mechanical axis to pass through a point 30 to 40 per cent lateral to the midpoint. 2. If ideal correction was obtained, it was observed by arthroscopy that repair of the ulcerated region was initiated by the surviving cartilage in the affected area and the cartilage bordering the affected area. 3. About one and one-half to two years after osteotomy it was observed that the ulcerated region was thoroughly covered with fibrous and membranous tissue. 4. In some cases in which correction was ideal, repair of the ruptured meniscus was observed arthroscopically.
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            Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared.

            Anterior tibial translation was measured in both knees using the radiological Lachman test and the lateral monopodal stance tests in 281 patients with unilateral anterior cruciate ligament (ACL) rupture. Measurements of translation in the medial compartment were more useful than those in the lateral compartment. Measurement of anterior tibial translation in the medial compartment using the radiological Lachman test showed ACL rupture in 92% of cases compared with 70% for the lateral monopodal stance test. In normal and in ACL-ruptured knees the monopodal stance test showed that every 10 degrees increase in posterior inclination of the tibial plateau was associated with a 6 mm increase in anterior tibial translation; the radiological Lachman test showed a 3 mm increase for every 10 degrees increase in tibial slope.
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              High tibial osteotomy for varus gonarthrosis. A long-term follow-up study.

              We evaluated the results in eighty-three patients (ninety-five knees) who had had a high tibial osteotomy for either unicompartmental osteoarthritis or osteonecrosis. The operations were performed between 1965 and 1976. The mean length of follow-up was 8.9 years (range, five to fifteen years). The early results were promising: at two years 97 per cent and at five years 85 per cent of the knees had either an excellent or a good result. At subsequent follow-up, however, only sixty knees (63 per cent) had an excellent or good result, and in the remainder recurrent pain had developed. Twenty-two knees (23 per cent) had been revised to a total knee arthroplasty because of pain. The alignment obtained by the osteotomy was not as important in determining the long-term result as we had previously believed. Although recurrent varus deformity was observed in more than one-quarter of the knees, it was not necessarily associated with an unsatisfactory result. The passage of time was the most important factor in determining the result, as only fifteen (37 per cent) of the knees that had been followed for more than nine years were pain-free. We now believe that total knee arthroplasty is a more suitable operation for patients who are more than sixty years old and that high tibial osteotomy should be reserved for patients who have a strenuous occupation or who wish to continue to participate in sports activities.
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                Author and article information

                Journal
                Clin Orthop Surg
                CIOS
                Clinics in Orthopedic Surgery
                The Korean Orthopaedic Association
                2005-291X
                2005-4408
                March 2010
                04 February 2010
                : 2
                : 1
                : 47-54
                Affiliations
                Department of Orthopedic Surgery, Mok-dong Himchan Hospital, Seoul, Korea.
                Author notes
                Correspondence to: Chang Hyun Nam, MD. Department of Orthopedic Surgery, Mok-dong Himchan Hospital, 404-3 Mok-dong, Yangcheon-gu, Seoul 158-806, Korea. Tel: +82-2-3219-9114, Fax: +82-2-3219-9126, changcape@ 123456naver.com
                Article
                10.4055/cios.2010.2.1.47
                2824095
                20191001
                c36d70fb-38ca-4207-8c61-08df40df3085
                Copyright © 2010 by The Korean Orthopaedic Association

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 December 2008
                : 09 March 2009
                Categories
                Original Article

                Surgery
                genu varum,aescula open wedge plate,high tibial osteotomy,allogenic bone graft,osteoarthritis

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