Pathak Chandan, Chattaraj Anjan, Hazra Sunit, Saha Rwivudeep, Kumar Sanjay, Chandra Mainak
Department of Orthopaedics, Howrah Orthopaedic Hospital, Eastern Railway, Howrah, India.
Department of Orthopaedics , Howrah Orthopaedic Hospital, Eastern Railway, Howrah, India.
Indian J Orthop. 2024 May 29;58(8):1079-1091. doi: 10.1007/s43465-024-01158-8. eCollection 2024 Aug.
Advanced osteoarthritis of knees with varus deformity consists of attenuation of lateral structures with contracture of the posteromedial structures and formation of medial osteophytes. The conventional step-wise medial and posteromedial release with measured resection may sometimes hinder achievement of perfectly balanced flexion and extension gaps with maintenance of flexion stability, without the use of a constrained prosthesis. Medial femoral epicondylar sliding osteotomy tailors the balancing to the need of the kinematics of the native knee and precludes the use of a constrained implant.
15 patients with Ahlbäck Grades III through V osteoarthritic changes at Howrah Orthopaedic Hospital were included in a prospective cohort case series with a minimum period of follow-up being 12 months. Physical examination, clinical questionnaire and radiographic evaluation were done post-operatively for objectification by functional Knee Society and Oxford Knee Scores respectively.
The mean post-operative femorotibial angulation ameliorated to a value of 3.73 ± 1.58° from 18.67 ± 4.2° in the pre-operative stage. The mean overall Range of Motion of operated knee was 109.87 ± 6.86° with no residual frontal laxity and/or laxity in the coronal plane. The mean amount of resection of tibial plateau in patients with severe varus deformity was kept to a minimum, 6.56 mm from the least deficient portion of the lateral condyle. There were no complications as regards component loosening and/or surgical-site infection.
The main objective of balancing a severely varus-afflicted knee is to preserve as much of the Medial Collateral Ligament as possible, to retain its check rein function and not jeopardise the stability. This is ensured by distalisation and posteriorizing the medial epicondyle by an incomplete osteotomy in addition to modest tibial resection fetching a non-isometric point of knee flexion. All osteotomies united by bony union and restoration of kinematic alignment. The limitation of this study however includes the lack of long-term results, such as late instability and polyethylene wear.
伴有内翻畸形的晚期膝骨关节炎包括外侧结构的减弱、后内侧结构的挛缩以及内侧骨赘的形成。传统的逐步内侧和后内侧松解并进行测量切除，有时可能会妨碍在不使用限制性假体的情况下实现完美平衡的屈伸间隙并维持屈曲稳定性。股骨内侧髁滑动截骨术根据天然膝关节的运动学需求进行平衡调整，避免使用限制性植入物。
将豪拉骨科医院15例患有阿尔贝克III至V级骨关节炎改变的患者纳入前瞻性队列病例系列，随访期至少12个月。术后分别通过膝关节协会功能评分和牛津膝关节评分进行体格检查、临床问卷调查和影像学评估以客观化结果。
术后平均股胫角从术前的18.67±4.2°改善至3.73±1.58°。手术膝关节的平均总活动范围为109.87±6.86°，冠状面无残余额状面松弛和/或松弛。严重内翻畸形患者胫骨平台的平均切除量保持在最低水平，距外侧髁最不缺损部分6.56毫米。未出现假体松动和/或手术部位感染等并发症。
平衡严重内翻膝关节的主要目标是尽可能保留内侧副韧带，保留其制动功能且不损害稳定性。这通过不完全截骨使内侧髁向远侧和后方移位以及适度的胫骨切除获得非等距屈膝点来确保。所有截骨均通过骨愈合实现联合并恢复运动学对线。然而，本研究的局限性包括缺乏长期结果，如晚期不稳定和聚乙烯磨损。
