Management of Osteoarthritis Knee by Graduated Open Wedge High Tibial Osteotomy in 40-60 Years Age Group Using Limb Reconstruction System: A Clinical Study

Abstract

Background: With i ncrease in elderly population, osteoarthritis has become major concern nowadays. Knee joint is most commonly affected joint. A number of methods have been developed in the last few years which help in treating the osteoarthritis knee, which includes non pharmacological, pharmacological and surgical methods. Among the most promising techniques with renewed interest for osteoarthritis knee with deformity is the use of high tibial osteotomy. Uni-compartmental osteoarthritis knee with deformity especially in relatively younger age group (less than 60 years) constitutes the main indication.

Aim: The aim of present study was to evaluate management of osteoarthritis knee by graduated open wedge high tibial osteotomy in 40-60 years age group using limb reconstruction system.

Materials and methods: Medial Opening Wedge High Tibial Osteotomy leaving the lateral cortex intact which acts as a hinge, was done in 30 patients and stabilized by Limb Reconstruction System. Distraction was started at 7(th) day at the rate of 1 mm/day and continued till proper alignment was achieved.

Results: Medial Opening Wedge High Tibial Osteotomy stabilized by unilateral external fixator is a good method for unicompartmental osteoarthritis knee with deformity as it gives precise control over final limb alignment and its ability to perform a residual correction. Deformity correction can be quantified at the time of correction as it is not acute correction. Gradual deformity correction can be done over time by distraction histogenesis with the help of unilateral external fixator. It is also a good method in young patients requiring large correction.

Conclusion: Medial Opening Wedge High Tibial Osteotomy is having many benefits over closed wedge osteotomy and stabilization by unilateral external fixator also has its added benefits. It is less invasive, no internal hardware present and safer in terms of neurovascular complications.

Keywords: Distraction histogenesis; High tibial osteotomy; Limb reconstruction system; Unicompartmental.

[Table/Fig-1]:

Preoperative radiograph

[Table/Fig-2]:

Scannogram of the patient showing Mechanical Axis of the limb

[Table/Fig-3]:

Intraoperative osteotomy site

[Table/Fig-4]:

Clinical picture of LRS application

[Table/Fig-5]:

At 12 weeks follow up showing Radiological Union

[Table/Fig-7]:

Pre and postoperative walking distance

[Table/Fig-8]:

Showing excellent end result

[Table/Fig-9]:

Showing postoperative deformity correction