Nikose Sunil Sheshrao, Nikose Devashree, Kekatpure Aditya L, Jain Shashank, Saoji Kiran, Reddy Sridhar M
Department of Orthopedic and Trauma Surgery, Jawaharlal Nehru Medical College, Wardha 442001, Maharashtra, India.
General Doctor, NKP Salve Institute of Medical Sciences, Nagpur 440019, Maharashtra, India.
World J Orthop. 2020 Dec 18;11(12):606-614. doi: 10.5312/wjo.v11.i12.606.
Most populations worldwide, who are used to squatting and sitting cross-legged for their activities of daily living, largely comprise the lower socioeconomic strata, thus making them candidates for exclusion for total knee arthroplasty. Proximal/high tibial osteotomy (HTO) is a preferred strategy for clinically symptomatic osteoarthritis (OA) with genu varum due to painful medial compartment OA which is not amenable to conservative measures.
To evaluate the outcomes of medial open-wedge HTO along with autologous bone grafting and buttress plate for the treatment of genu varum due to OA of the knee in a rural population of central India.
A total of 65 knees in 56 patients with a mean age of 58.22 ± 5.63 years with genu varum due to intractable painful knee OA were treated with medial open-wedge HTO along with autologous bone grafting and buttress plate osteosynthesis from June 2015 to May 2018. The mean preoperative radiological angle of genu varum was 13.4°. Clinical outcomes were assessed by the range of movement, knee scores, pain scores, and functional scores. Radiographic studies were performed preoperatively and at regular intervals during the follow-up period.
All patients reported pain relief immediately after the osteotomy and during the long-term analysis covering between one to three years. The genu varum angle was overcorrected to approximately four degrees in all patients. There was a loss of reduction by approximately three degrees in all patients at around six weeks postoperatively. Preoperative knee movements were restored in all patients. No major perioperative complications were noted during surgery and postoperative follow-up and the clinical scores were significantly improved during the final analysis which revealed good pain relief.
Medial open-wedge HTO is a reliable, safe, practical, physiological, and feasible treatment for populations who are used to increased activity in their occupation and lifestyle and is associated with excellent short-term and long-term results for OA in genu varum knees.
全球大多数习惯于在日常生活中蹲坐和盘腿的人群，大多属于社会经济地位较低的阶层，因此他们可能不适合进行全膝关节置换术。近端/高位胫骨截骨术（HTO）是治疗因内侧间室疼痛性骨关节炎导致的膝内翻且临床症状明显、保守治疗无效的骨关节炎（OA）的首选策略。
评估在印度中部农村人群中，采用内侧开放楔形HTO联合自体骨移植及支撑钢板治疗膝骨关节炎所致膝内翻的疗效。
2015年6月至2018年5月，对56例平均年龄58.22±5.63岁、因顽固性疼痛性膝骨关节炎导致膝内翻的患者的65个膝关节进行了内侧开放楔形HTO联合自体骨移植及支撑钢板内固定治疗。术前膝内翻的平均放射学角度为13.4°。通过活动范围、膝关节评分、疼痛评分和功能评分评估临床疗效。术前及随访期间定期进行影像学检查。
所有患者在截骨术后及长达1至3年的长期分析中均报告疼痛缓解。所有患者的膝内翻角度均过度矫正至约4度。术后约6周时，所有患者的矫正丢失约3度。所有患者术前的膝关节活动均得以恢复。手术及术后随访期间未发现重大围手术期并发症，最终分析显示临床评分显著改善，疼痛缓解良好。
内侧开放楔形HTO对于那些在职业和生活方式中活动量增加的人群来说是一种可靠、安全、实用、符合生理且可行的治疗方法，并且对于膝内翻膝骨关节炎具有优异的短期和长期疗效。
