Agrawal Alok C, Sarkar Santu, Sakale Harshal, Rojasara Jayesh, Saigal Ajit, S Lohitesh, Rai Alok
Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, Raipur, IND.
Department of Orthopaedics and Traumatology, All India Institute of Medical Sciences, Raipur, Raipur, IND.
Cureus. 2024 Dec 1;16(12):e74913. doi: 10.7759/cureus.74913. eCollection 2024 Dec.
Knee pain in patients often involves varus deformity and unicompartmental osteoarthritis (OA). High tibial valgus osteotomy (HTO) is increasingly recognized as an effective treatment, as it realigns the knee's mechanical axis towards the healthier lateral compartment, delaying degenerative changes in the medial compartment and reducing the need for joint replacement. This case report discusses two patients with bilateral knee arthritis and varus deformity who underwent medial opening-wedge high tibial osteotomy (MOWHTO) using Dr. Saigal's plate (Nebula Surgical Pvt. Ltd., Gujarat, India). The first patient, a 45-year-old male with a BMI of 29.3 kg/m², had a good range of motion (ROM) and no ligamentous laxity. The second patient, a 36-year-old female with a BMI of 30 kg/m², also exhibited good knee ROM and no ligamentous laxity. Initial evaluation included comprehensive radiological assessments via four X-rays: anteroposterior (AP) view in 30-degree flexion, lateral view, skyline view for the patellofemoral joint, and a standing orthosonogram view from the hip to the toes. The surgical technique aimed to correct varus angulation with valgus overcorrection. Preoperative preparation followed the Miniaci Method, involving a weight-bearing AP orthoscan of the entire leg to determine the corrective angle. Postoperatively, a protocol focused on fixation rigidity allowed toe-touch walking after six weeks. Suture removal occurred on the 14th day with no NSAIDs administered. Data were collected preoperatively, intraoperatively, and at three, six, and twelve months postoperatively. Primary outcomes included the Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and ROM. Secondary measures assessed mechanical axis deviation (MAD), correction of varus angulation, pain levels, and complications using the Modified RUST criteria for osteotomy site evaluation. At the final follow-up, both patients showed excellent clinical outcomes with pain-free joint motion and optimal limb alignment. No complications such as infection, hardware failure, or need for total knee replacement were reported. The mean preoperative OKS significantly improved, indicating the procedure's effectiveness in enhancing function and quality of life. The WOMAC pain and functional subscores also improved consistently over the year. Although there was a temporary decrease in knee ROM initially, it rebounded by the final assessments. Overall, the intervention was safe and successful, with no deep infections, deep vein thrombosis, lateral hinge fractures, varus collapse, or implant failures reported.
患者的膝关节疼痛常伴有内翻畸形和单髁骨关节炎（OA）。高位胫骨外翻截骨术（HTO）越来越被认为是一种有效的治疗方法，因为它能将膝关节的机械轴重新调整至更健康的外侧间室，延缓内侧间室的退变，并减少关节置换的需求。本病例报告讨论了两名患有双侧膝关节炎和内翻畸形的患者，他们接受了使用赛加尔博士钢板（印度古吉拉特邦星云外科私人有限公司）的内侧开放楔形高位胫骨截骨术（MOWHTO）。第一名患者是一名45岁男性，体重指数为29.3kg/m²，膝关节活动范围（ROM）良好，无韧带松弛。第二名患者是一名36岁女性，体重指数为30kg/m²，膝关节ROM也良好，无韧带松弛。初始评估包括通过四张X线片进行全面的影像学评估：30度屈曲位前后位（AP）片、侧位片、髌股关节天际线片以及从髋部到脚趾的站立位正位超声片。手术技术旨在通过外翻过度矫正来纠正内翻角度。术前准备采用Miniaci方法，包括对整条腿进行负重AP正位扫描以确定矫正角度。术后，一个注重固定稳定性的方案允许患者在六周后进行脚尖触地行走。术后第14天拆线，未使用非甾体抗炎药。在术前、术中以及术后三个月、六个月和十二个月收集数据。主要结局指标包括牛津膝关节评分（OKS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及ROM。次要指标使用改良的RUST标准评估截骨部位，以评估机械轴偏差（MAD）、内翻角度矫正、疼痛程度和并发症。在最终随访时，两名患者均显示出极佳临床结局，关节活动时无痛且肢体对线良好。未报告感染、内固定失败或全膝关节置换等并发症。术前平均OKS显著改善，表明该手术在改善功能和生活质量方面有效。WOMAC疼痛和功能子评分在这一年中也持续改善。尽管最初膝关节ROM暂时下降，但在最终评估时有所反弹。总体而言，该干预措施安全且成功，未报告深部感染、深静脉血栓形成、外侧铰链骨折、内翻塌陷或植入物失败。
