Biomechanical and Functional Improvements Gained by Proximal Tibia Osteotomy Correction of Genu Varum in Patients with Knee Pain View Full Text


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Article Info

DATE

2019-03-19

AUTHORS

Rachael J. Da Cunha, Andrew P. Kraszewski, Howard J. Hillstrom, Austin T. Fragomen, S. Robert Rozbruch

ABSTRACT

Mechanical axis malalignment contributes to abnormal forces across the knee joint. Genu varum, or increased medial mechanical axis deviation (MAD), increases force transmission and contact pressures to the medial compartment. With increasing MAD and femoral-tibial mechanical axis angle (MAA), contact forces within the medial or lateral compartment of the knee significantly increase with increasing deformity. This may lead to knee pain, further deformity, and medial compartment degenerative joint disease, which can interfere with participation in sports and diminish quality of life. We sought to evaluate patients with knee pain with bilateral genu varum and determine the effect of bilateral proximal tibial osteotomies on knee biomechanics, deformity correction, and functional outcomes. This was a single-center, prospective study of eight limbs in four patients. Consecutive patients presenting with knee pain and bilateral genu varum originating from the proximal tibia were included. All patients underwent staged bilateral proximal tibial osteotomies with gradual deformity correction with an external fixator. Subjects underwent a three-dimensional (3D) instrumented motion analysis during level walking. A 3D lower extremity model was built and bilateral knee frontal plane kinematics and kinetics during the stance phase of gait were determined. Radiographic analysis was performed including assessment of MAD, MAA, and medial proximal tibial angle (MPTA). Functional outcomes were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS), the 36-item Short-Form Survey (SF-36), the Lower Limb Questionnaire (LLQ), and a visual analog scale (VAS) for pain. The average time in the external fixator for a single limb was 97 days. The average follow-up period was 310 days. All biomechanical outcomes significantly improved, including knee adduction angle (7.8° to 1.8°), knee adduction moments (first peak, − 0.450 to − 0.281 nm/kg, and second peak, − 0.381 to − 0.244 nm/kg), and knee adduction moment impulse (− 0.233 to − 0.150 nm s/kg). There was a significant improvement in MAA, MAD, and MPTA. All patients showed qualitative improvement in mean scores on VAS (11.8 to 0.0), LLQ (77 to 93), KOOS (64 to 84), and SF-36 (71 to 88). These findings suggest that bilateral proximal tibial osteotomy may be effective in improving knee biomechanics during gait and correcting mechanical alignment in patients with bilateral genu varum. Patients also demonstrated improvement in functional outcome scores. This technique should thus be considered in patients with varus knee osteoarthritis in the setting of genu varum to alleviate symptoms and potentially decrease further clinical deterioration. More... »

PAGES

1-9

References to SciGraph publications

  • 1999-09. External fixation in proximal tibial osteotomy: a comparison of three methods in INTERNATIONAL ORTHOPAEDICS
  • 2011-01. Comparison of PACS and Hard-copy 51-inch Radiographs for Measuring Leg Length and Deformity in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2001-05. Open wedge tibial osteotomy by hemicallotasis for medial compartiment osteoarthritis in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2003-05. The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow-up) in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2010-05. Does the Taylor Spatial Frame Accurately Correct Tibial Deformities? in CLINICAL ORTHOPAEDICS AND RELATED RESEARCH®
  • 2002-05. Valgus high tibial osteotomy in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2016-08. Courses of change in knee adduction moment and lateral thrust differ up to 1 year after TKA in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 1979-03. The effect of high tibial osteotomy on osteoarthritis of the knee in INTERNATIONAL ORTHOPAEDICS
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    http://scigraph.springernature.com/pub.10.1007/s11420-019-09670-6

    DOI

    http://dx.doi.org/10.1007/s11420-019-09670-6

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