Mirouse G, Dubory A, Roubineau F, Poignard A, Hernigou P, Allain J, Flouzat Lachaniette C H
Département de chirurgie orthopédique et traumatologie, groupe hospitalier Henri-Mondor, AP-HP, université Paris-Est Créteil, 94000 Créteil, France; Service de chirurgie orthopédique et traumatologie du sport, clinique Saint-Privat, 34500 Béziers, France.
Département de chirurgie orthopédique et traumatologie, groupe hospitalier Henri-Mondor, AP-HP, université Paris-Est Créteil, 94000 Créteil, France.
Orthop Traumatol Surg Res. 2017 Oct;103(6):953-958. doi: 10.1016/j.otsr.2017.03.020. Epub 2017 May 17.
Osteotomy is a rational approach to slowing knee osteoarthritis progression by modifying loads, thereby avoiding joint replacement in younger individuals. Varus femoral osteotomy is recommended only in patients with more than 10° of valgus. The objective here was to assess outcomes of tibial varus osteotomy in patients with lateral compartment tibio-femoral osteoarthritis and less than 10° of valgus. The hypothesis was that high tibial varus osteotomy produces satisfactory and long-lasting improvements.
A single-centre retrospective study was conducted in 19 consecutive patients managed by high tibial varus osteotomy between January 2005 and May 2012. Mean age was 54.5years. The clinical IKS knee and function scores and radiological parameters were determined pre-operatively then after 6 and 12months and at last follow-up. The primary outcome measure was the global IKS score. Failure was defined as a global IKS score <140 or total knee arthroplasty (TKA). Secondary outcome measures were a post-operative hip-knee-ankle (HKA) angle between 180° and 183° and less than 10° of joint line obliquity. The hypothesis was that high tibial varus osteotomy produced satisfactory and long-lasting improvements in lateral compartment tibio-femoral osteoarthritis.
After the mean follow-up of 4.3years (range, 2-9years), 10/19 patients had a global IKS score <140. Among them, 7 underwent TKA after a mean of 5.0±2.7years. Varus tibial osteotomy was followed by significant improvements in the IKS knee and function scores from baseline to last follow-up (P<0.05). A global IKS<140 predicted TKA. Mean HKA angle values were 186.3±2.9° pre-operatively and 181.3°± 3.9°at last follow-up (P<0.05); the HKA angle was within the 180°-183° range in 8 (42.1%) patients. Mean post-operative joint line obliquity was 7.8±3.0°. An HKA angle outside the 180-183° range and joint line obliquity >10° were associated with poor outcomes.
High tibial varus osteotomy produces unsatisfactory medium-term outcomes, with an overall failure rate of 52%. At present, high tibial varus osteotomy has no role in the management of lateral compartment tibio-femoral osteoarthritis with <10° of valgus.
IV, retrospective cohort study.
截骨术是一种通过改变负荷来减缓膝关节骨关节炎进展的合理方法，从而避免年轻患者进行关节置换。仅建议在外翻超过10°的患者中进行股骨内翻截骨术。本研究的目的是评估外翻小于10°的外侧胫股关节骨关节炎患者行胫骨内翻截骨术的疗效。假设是高位胫骨内翻截骨术能产生满意且持久的改善效果。
对2005年1月至2012年5月期间接受高位胫骨内翻截骨术治疗的19例连续患者进行单中心回顾性研究。平均年龄为54.5岁。术前、术后6个月、12个月及末次随访时测定临床IKS膝关节和功能评分以及放射学参数。主要结局指标是IKS总体评分。失败定义为IKS总体评分<140或全膝关节置换术（TKA）。次要结局指标是术后髋 - 膝 - 踝（HKA）角在180°至183°之间且关节线倾斜度小于10°。假设是高位胫骨内翻截骨术能使外侧胫股关节骨关节炎产生满意且持久的改善。
平均随访4.3年（范围2 - 9年）后，19例患者中有10例IKS总体评分<140。其中7例在平均5.0±2.7年后接受了TKA。从基线到末次随访，胫骨内翻截骨术后IKS膝关节和功能评分有显著改善（P<0.05）。IKS总体评分<140预测会进行TKA。术前平均HKA角值为186.3±2.9°，末次随访时为181.3°±3.9°（P<0.05）；8例（42.1%）患者的HKA角在180° - 183°范围内。术后平均关节线倾斜度为7.8±3.0°。HKA角超出180 - 183°范围以及关节线倾斜度>10°与预后不良相关。
高位胫骨内翻截骨术产生的中期疗效不理想，总体失败率为52%。目前，高位胫骨内翻截骨术在治疗外翻小于10°的外侧胫股关节骨关节炎中没有作用。
IV级，回顾性队列研究。
