Purpose
The aim of the present study was to examine changes in radiological variables in a prospective randomized study comparing opening wedge (OW) and closing wedge (CW) techniques of high tibial ...osteotomy (HTO). Our hypothesis was that there would be no differences in joint line angles or correction accuracy between the two groups, that patellar height would increase after CW HTO and decrease after OW HTO, and that leg length and posterior tibial slope would decrease after CW HTO and increase after OW HTO.
Methods
Radiological data were collected from 70 patients participating in an ongoing prospective randomized clinical trial comparing OW and CW HTOs. Digital standing hip–knee–ankle (HKA) radiographs as well as lateral radiographs in 30° of flexion were obtained preoperatively and at 6 months for each patient. Joint line angles, HKA angle, leg length, Insall–Salvati index, Miura–Kawamura index and posterior tibial slope were measured using medical planning software. The complete preoperative radiological examinations of the first 50 patients were used in a study of intra- and inter-rater reliability of the measurements.
Results
The mean posterior slope was reduced by 2.5° in CW HTO, whereas it remained unchanged in OW HTO (
p
< 0.001). Mean leg length decreased 5.7 mm in CW HTO and increased 3.1 mm in OW HTO (
p
< 0.001). Changes in joint line angles, patellar height indexes and the correction accuracy showed no significant differences comparing the two techniques. Frontal plane reliability measurement intra- and inter-rater intraclass correlation coefficient (ICC) varied from 0.81 to 0.99. Sagittal plane intra- and inter-rater ICC varied from 0.60 to 0.87. Posterior tibial slope intra- and inter-rater ICC showed the lowest values (0.70 and 0.60, respectively) corresponding to a smallest real difference of 4.5° and 5.5°, respectively.
Conclusions
Posterior tibial slope and leg length changes were significantly different in CW compared to OW HTOs. We recommend that possible alterations in tibial slope and leg length are considered when the technique of HTO is to be chosen. Landmark-based medical planning software shows good reliability and can be used in preoperative planning and postoperative evaluations of HTOs.
Level of evidence
I.
Abstract Objectives To investigate recovery of physical functioning in patients during the first year after total hip arthroplasty (THA), and to predict postoperative walking distance outcomes from ...preoperative measures. Design A longitudinal prospective design was used. Data were analyzed by repeated-measures analysis of variance and multivariate regression analyses. Setting Two hospitals. Participants Patients with hip osteoarthritis were consecutively included and assessed preoperatively (n=88), at 3 months (n=88), and at 12 months (n=64) after THA. Interventions Not applicable. Main Outcome Measures Physical functioning was assessed by objective measures—the 6-minute walk test (6MWT), stair climbing test, Index of Muscle Function, figure-of-eight, and active hip range of motion—and the subjective measures by Harris Hip Score and Hip dysfunction and Osteoarthritis Outcome Score. Results In objective measures, improvements were found from preoperatively to 3 months in 6MWT ( P <.01) and stair climbing test ( P <.05) scores, while all measures had improved from 3 to 12 months ( P ≤.001). In contrast, all the subjective measures showed substantial improvements at 3 months, but small further improvements from 3 to 12 months ( P <.001). Age, sex, preoperative 6MWT distance, and hip range of motion predicted 6MWT outcomes at 3 and 12 months ( P ≤.01). Conclusions The objective measures of physical functioning improved gradually during the first postoperative year, while the subjective measures showed large early improvements, but little further improvements. Younger age, male sex, and better scores of walking distance and hip flexibility before surgery predicted better score in walking distance at both 3 and 12 months after surgery.
Objective
To investigate the effect of a 12‐session walking skill training program of weight‐bearing activities on physical functioning and self‐efficacy initiated in patients 3 months after total ...hip arthroplasty (THA).
Methods
Sixty‐eight patients with THA, 35 women and 33 men, with a mean age of 66 years (95% confidence interval 95% CI 64, 67 years), were randomized to a training group (n = 35) or a control group without physiotherapy (n = 33). Assessments were performed before the intervention at 3 months (pretest), at 5 months (posttest 1), and at 12 months (posttest 2) after surgery. The primary outcome was the 6‐minute walk test (6MWT). The secondary outcomes were the stair climbing test (ST); figure‐of‐eight test; Index of Muscle Function (IMF); active hip range of motion (ROM) in flexion, extension, and abduction; Harris Hip Score (HHS); self‐efficacy; and Hip Dysfunction and Osteoarthritis Outcome Score.
Results
The training group had larger improvements than the control group at posttest 1 on the 6MWT with an adjusted mean difference of 52 meters (95% CI 29, 74 meters; P < 0.001) and on the ST of −1 second (95% CI −2, 0 seconds; P = 0.01).There were also improvements on the figure‐of‐eight test (P = 0.02), IMF (P = 0.001), active hip ROM in extension (P = 0.02), HHS (P = 0.05), and self‐efficacy (P = 0.04). The difference between the groups persisted at posttest 2 on the 6MWT of 52 meters (95% CI 24, 80 meters; P < 0.001) and on the ST of −1 second (95% CI −3, 0 seconds; P = 0.05).
Conclusion
The walking skill training program was effective, especially in improving walking both immediately after the intervention and 1 year after THA surgery.
Background: Traumatic articular cartilage injuries heal poorly and may lead to development of osteoarthritis at a young age. This study
estimates the number of patients who may benefit from one of ...the surgical methods of cartilage repair.
Methods: All patients undergoing knee arthroscopy during a 6-month period at three collaborating hospitals were consecutively evaluated
according to the International Cartilage Repair Society (ICRS) knee form. The material consists of 993 consecutive knee arthroscopies
in patients with median age of 35 years.
Results: Preoperative radiographs demonstrated degenerative changes in 13% of the knees. Articular cartilage pathology was found in
66% and a localized cartilage defect was found in 20% of the knees. A localized full-thickness cartilage lesion (ICRS grade
3 and 4) was observed in 11% of the knees. Of the localized full-thickness lesions, 55% (6% of all knees) had a size above
2 cm 2 .
Conclusion: Eleven percent of all knee arthroscopies show cartilage defects that may be suitable for cartilage repair procedures. However,
the natural history of these lesions and the number of patients that will benefit from a cartilage repair procedure are so
far unknown.
Keywords:
articular cartilage lesions
knee
arthroscopy
cartilage defect score
Single-group, repeated-measures prospective study.
To analyze changes in impairments and disabilities among patients with anterior cruciate ligament (ACL) reconstruction and to assess the ...relationships between the impairment and disability outcome measures from 3 months to 2 years following ACL reconstruction.
Outcomes after ACL reconstruction can be categorized as impairments or disabilities. The relationship between impairments and disabilities may be crucial to understanding physical therapy interventions and predicting long-term outcome.
Sixty patients who had undergone ACL reconstruction participated in the study. Impairment measures were range of motion, pain, knee-joint laxity, and muscle performance using isokinetic muscle tests. Disability measures were the Cincinnati knee score and lower limb performance using the triple-jump and stair-hop tests. Follow-up times were 3 and 6 months and 1 and 2 years after surgery.
The Cincinnati knee score results show significant improvement 1 year after surgery (84.2 +/- 13.6) compared with 6 months (76.8 +/- 13.7) and 3 months (67.4 +/- 16.3) after surgery. Quadriceps total work (percentage of normal leg) significantly improved 2 years after surgery (92.6 +/- 14.1%) compared with 1 year after surgery (81.6 +/- 16.8%). Between 37 and 75% of the variability in the Cincinnati knee score could be explained by variation in the impairment variables, and quadriceps muscle performance and pain were the most significant predictors of disability. Extension deficit and pain at 3 months were significantly related to the Cincinnati knee score at the 2-year follow-up.
Up to 2 years may be needed to regain normal quadriceps muscle performance following ACL reconstruction. Pain and quadriceps muscle performance explained most of the variability in the Cincinnati knee score.
High tibial osteotomy for unilateral medial knee osteoarthritis unloads the osteoarthritic area, gives pain relief, and may prevent later osteoarthritis if performed for the ideal indications. The ...risk of conversion of high tibial osteotomy to total knee arthroplasty is higher if osteoarthritis has advanced too far and for overweight persons, cigarette smokers, older patients, female patients, patients with a high level of comorbidity, and patients with under-correction of the varus malalignment.
Objective: Serious knee injuries have ruined many skiing careers. The purpose of this study is to report the knee function of five Norwegian world cup skiers 30 years after a serious knee injury.
...Methods: The five skiers with anterior cruciate ligament (ACL) and concomitant serious knee injuries were treated at Oslo University Hospital in the period 1989-92. The median age at the time of injury was 25 (19-26) years. Three of the alpine skiers regained their world cup ranking. About 30 years after their injuries, the skiers were asked about later injuries, competition activity and evaluated by Tegner activity scale and the knee injury and osteoarthritis outcome score (KOOS).
Results: The skiers participated in median 4 (0-5) world cup seasons after their knee injuries and did not suffer new acute knee injuries. Thirty years after the knee injury the tegner score was higher (more activity) and the KOOS score was lower (more symptoms) than those of a normal population of corresponding age group.
Conclusion: Thirty years after a serious knee knee injury the five world cup skiers are still living an active life with higher tegner and lower KOOS scores than the normal population. Functional knee scores should therefore be related to the degree of activity.
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