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Casestudies  >  Osteoarthritis of knee joint  >  Focal Dome High Tibial osteotomy

 
Osteoarthritis of knee joint
 
 

                 56 yr old Orthopaedic surgeon suffered from pain in the knee due to varus bowing or bending deformity of the knee joint                           on single legged stance or on walking the varus gets exaggerated and is called a Lateral Thrust or dynamic varus--this contributes to the severe pain and arthritis.                            full length xray shows that the mechanical axis ---which is a line passing from the centre of the hip to centre of the ankle---is passing significantly inner to the knee joint. This increases the stress on the cartilage of the inner compartment and causes the arthritis.

56 year Orthopaedic surgeon suffered from severe pain in the knee and had tried all kinds of conservative treatment without avail. He was skeptical of advise given to him to undergo Total knee replacement due to his relative young age.

The varus deformity is present on standing and on walking a Lateral Thrust with increased dynamic varus is clearly visible. The varus deformity is repsonsible for making the mechanical axis passing very medial to the knee joint. Due to this the articular cartilage gets worn out and results in pain and arthritic symptoms.

                                    ilizarov fixator permits walking and resuming activities as this surgeon could resume his consulting practise                                      xrays show osteotomy is in good contact and compression and has corrected varus to the extent that lateral thrust is compensated for

Being an Orthopaedic Surgeon he was convinced that he was an ideal candidate for osteotomy treatment. He had an Ilizarov fixator which allowed him to walk on the second day after surgery and resume his consulting practise in 3 weeks. The ilizarov fixator permitted a very accurate correction of the varus and also compensate for the Lateral thrust or the dynamic varus.

The xray shows a good compression and contact of  the osteotomy.
Osteotomy is a time tested procedure and assures pain relief  for as long as the mechanical axis is accurately corrected. The ilizarov focal dome osteotomy is done below the tibial tuberosity through hard diaphyseal bone and hence whatever angulation is corrected stays corrected for 10 to 15 years and longer.

        excellent correction of varus bending deformity while standing              full correction even on single leg stance --nullifies the lateral thrust                full knee bending after high tibial osteotomy                   full length xrays show the mechanical axis is passes through the centre of the        knee joint--hence pain relief is likely to be long lasting

The correction of varus or bowing deformity in the knee is very good on standing as well as on one legged stance. His knee bending is also full and function of the knee is fully retained. The post-op x-ray shows that the mechanical axis is passing through the exact centre of the knee joint. Hence he will be assured of long term pain relief.

Bibliography & References:

 

1)      Full scientific brochure on an exclusive conference devoted to High Tibial Osteotomy organized by Dr Milind Chaudhary at Jaslok Hospital, Mumbai in April 2010.

{ pls link this sentence to       http://www.asamiindia.org/pdf/admin_ModernHTOBooklet.pdf}      

2)      A relationship between gait & clincal changes following HTO

  Prodromos, Andriacchi, Galante, JBJS A (67) : 1985 : 1188-1194.

3)      Relationship between gait & clincal results after HTO Wada, Imura, et.al.

CORR 354 1998

4)      The Influence of Walking Mechanics & Time on Results of HTO Wang, Kuo,    

            Andriacchi & Galante

      JBJS - A 1990 (72) : 905 to 909.

5)      The role of ambulatory mechanics in the initiation & progression of knee   

      osteoarthritis: Andriachi, T., Mundermann, A.

      Curr Opin Rheumatology 2006 (18) : 514-518

6)      Maquet, P.: Biomechanics of the knee & surgical possibilities of healing

      osteoarthritic knee joints.

      CORR, 146: 102-110,1980.

7)      Coventry, M. B.: Osteotomy about the knee for degenerative and rheumatoid

      arthritis. Indications, operative technique, and results.

      J. Bone and Joint Surg., 55-A: 23-48, Jan. 1973.

8)      Paley, D.; Maar, D. C.; and Herzenberg, J. E.: New concepts in high tibial

osteotomy for medial  compartment osteoarthritis.

Orthop. Clin. North America, 25: 483-498, 1994.

9)      Yasuda, K.; Majima, T.; Tsuchida, T.; and Kaneda, K.: A 10-15-year follow-up

observation of high tibial   osteotomy in medial compartment osteoarthrosis.

      Clin. Orthop., 282: 186-195, 1992.