Fukuhara Daisuke, Inoue Hiroaki, Nakagawa Shuji, Arai Yuji, Takahashi Kenji
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Kyoto 602-8566, Japan.
Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465, Kajiicho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, Kyoto 602-8566, Japan.
Case Rep Orthop. 2021 Oct 29;2021:6443618. doi: 10.1155/2021/6443618. eCollection 2021.
We report a case of tibial condylar valgus osteotomy (TCVO) for ipsilateral knee osteoarthritis (OA) after hip arthrodesis. A 58-year-old woman developed right purulent hip arthritis at one month of age and underwent right hip fusion at 16 years old. She visited our department at the age of 57 because her right knee joint pain worsened. The range of motion for her right knee was 80° and -5° of flexion and extension, respectively, and she experienced medial weight-bearing pain. A plain X-ray image showed that the right knee joint had end-stage knee OA with a bone defect inside the tibia, and the tibial plateau shape was the pagoda type. There was a marked instability in her right knee with a valgus of 9° and varus of 7° on stress photography. She underwent TCVO on her right knee and was allowed full load four weeks after surgery. Computed tomography imaging showed bone union nine months after surgery. Two years after the operation, there was no correction loss, and she could walk independently without pain. In general, total knee arthroplasty (TKA) is indicated for end-stage knee OA; however, there are problems, such as early loosening due to the increased mechanical load on the knee after hip OA. In this case, since a good course was obtained, TCVO is considered a treatment option for terminal knee OA after hip arthrodesis.
我们报告一例髋关节融合术后同侧膝关节骨关节炎（OA）行胫骨髁外翻截骨术（TCVO）的病例。一名58岁女性在1个月大时患右侧化脓性髋关节炎，16岁时接受了右侧髋关节融合术。她57岁时因右膝关节疼痛加重前来我院就诊。她右膝关节的活动范围分别为屈曲80°和伸展-5°，并伴有内侧负重疼痛。X线平片显示右膝关节为终末期膝OA，胫骨内有骨缺损，胫骨平台形状为宝塔型。应力摄影显示她右膝关节明显不稳定，外翻9°，内翻7°。她接受了右膝关节TCVO手术，术后4周允许完全负重。计算机断层扫描成像显示术后9个月骨愈合。术后两年，无矫正丢失，她可以独立行走且无疼痛。一般来说，终末期膝OA需行全膝关节置换术（TKA）；然而，存在一些问题，比如髋关节OA后膝关节机械负荷增加导致早期松动。在本病例中，由于取得了良好的治疗效果，TCVO被认为是髋关节融合术后终末期膝OA的一种治疗选择。
