PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 16316607

[Opening-wedge osteotomy of the proximal tibia].

R Prix
View original source ↗Export metadata ↓

Abstract

PURPOSE OF THE STUDY: The aim of this study was to evaluate the accuracy of correction and short-term outcomes of treatment by opening-wedge tibial osteotomy with the use of allograft and a modified Puddu plate fixation. MATERIAL: Between February 2001 and March 2003, 33 operations on 30 patients, at an average age of 54 years, with gonarthrosis and varus deformity were evaluated. Grade III arthritis was diagnosed in 24 knees (73 %) and grade II in nine knees (27 %). METHODS: The preoperative planning as well as intraoperative correction were based on the limb mechanical axis, as shown on an X-ray image of the whole lower extemity. Tibial osteotomy was performed from the medial approach and the position was fixed, in contrast to the original method, with an allograft and a T-plate. The corrrection was planned so that the mechanical limb axis should intersect the articular space at 62 % of its length laterally. The limb was postoperatively immobilized for 4 weeks in a knee brace allowing walking. Limited weight bearing was recommended from the third week. The outcome of treatment was evaluated at 11 months of follow-up by the Lysholm scoring system. RESULTS: Correction of the limb mechanical axis involved the axis intersecting the plane of the joint space on average at 60.2 % of its length, as against the planned 62 %; the average deviation from the planned correction was 2.1 degrees. Lysholm scores improved on average by 23 points. Improvement by 20 points was regarded as a good outcome and was achieved in 31 joints (94 %). Two joints (6 %) showed poor outcomes due to associated complications. The complications included a fissure of the lateral tibial plateau in one knee, failed stabilization with subsequent loss of correction and pseudoarthrosis development in one joint, prolonged healing with a partial loss of correction (5 degrees) in one patient, and superficial infection in one patient. DISCUSSION: In patients with knee arthritis and varus deformity, the achievement of optimal correction of the mechanical limb axis is the prerequisite for a long-term good outcome. Optimal correction, as characterized by Puddu, is attained when the mechanical axis intersects the joint space at 62 % of its length laterally. Hernigou et al. define the hip-knee-ankle angle in the range of 183 degrees -186 degrees as an optimal postoperation correction. In our experience, osteotomy combined with our modification of fixation is an exact method for correcting the axis; in addition, it is simple and is associated with a low occurrence of postoperative complications. In view of a possible total knee arthroplasty, there is less disturbance in the tibial plateau-diaphysis alignment and the tibial tuberosity level is preserved. CONCLUSIONS: Opening-wedge tibial osteotomy with the use of a Puddu plate and allograft in our modification is an effective, exact and simple method of correcting the lower extremity axis, and is associated with few complications. We do not recommend this method for interventions planned to achive corrections of more than 16 degrees, because these have a higher occurrence of complications. The use of allograft seems to have good prospects; another option for achieving large correction includes application of an LCP plate.

Explore related subjects

AdultAgedBone PlatesFemaleHumansJoint Deformities, AcquiredKnee JointMaleMiddle AgedOsteoarthritis, KneeOsteotomyPostoperative ComplicationsRadiographyTibiaJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

R Prix. 2005. [Opening-wedge osteotomy of the proximal tibia].. https://pubmed.ncbi.nlm.nih.gov/16316607/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2026

[Analysis of clinical phenotypes and pathogenicity of a c.4476+5G>T variant of SCN1A gene in a Chinese pedigree affected with Genetic epilepsy with febrile seizures plus].

OBJECTIVE: To explore the pathogenicity and characteristics of a heterozygous splicing variant of SCN1A gene in a Chinese pedigree affected with Genetic epilepsy with febrile seizures plus (GEFS+). METHODS: A retrospective analysis was carried out on the clinical data and results of genetic testing of a GEFS+ pedigree consisting of 5 members who had visited the First Affiliated Hospital of Zhengzhou University on July 1, 2024. Pathogenicity of the splicing variant of the SCN1A gene was validated with a minigene splicing assay. This study was approved by the Medical Ethics Committee of the the First Affiliated Hospital of Zhengzhou University (Ethics No.: KS-2018-KY-36). RESULTS: The proband, a 24-year-old female, presented with FS in conjunct with focal seizures, and both of her younger brothers had Dravet syndrome. All of the three patients had carried a c.4476+5G>T variant of the SCN1A gene, which was unreported previously. Minigene experiment verified that the variant could cause loss of the first 7 bps of exon 24 and 138 bps from exon 23 of the SCN1A gene, resulting in alteration p.V1447_1495delfs*6 and affecting splicing. Based on the guidelines from American College of Medical Genetics and Genomics (ACMG), the variant was predicted as likely pathogenic (PVS1+PM2_Supporting). CONCLUSION: The c.4476+5G>T variant at an intronic site of the SCN1A gene probably underlay the pathogenesis of GEFS+ in this pedigree.

Adult↗
PubMed2026

Polygenic risk scores and lifestyle factors predicting new onset of type 2 diabetes in the Japanese general population.

PURPOSE: This study investigated the association of polygenic risk scores (PRS) and lifestyle factors with type 2 diabetes mellitus development in Japanese populations and evaluated whether PRS can improve diabetes risk prediction beyond traditional risk factors. METHODS: We conducted a cross-sectional and a longitudinal study using the Shika resident cohort (n = 895) and the Toshiba worker cohort (n = 7019), respectively. Participants were categorized into low, intermediate, and high genetic risk groups using PRS constructed with genome-wide association study data from East Asian populations. We defined diabetes based on hemoglobin A1c, fasting blood glucose, self-reported diagnosis, or medication use. The associations of PRS and lifestyle factors with diabetes development were analyzed using multivariate logistic regression and Cox proportional hazards models. RESULTS: Higher PRS were associated with increased diabetes risk in both cohorts (resident cohort: odds ratio 4.51, 95% CI 2.53-8.04; worker cohort: hazard ratio 1.50, 95% CI 1.23-1.83 for high vs low PRS), which remained consistent across age, body mass index, and comorbidities. Regular exercise, absence of hypertension, and absence of dyslipidemia were associated with lower diabetes risk, particularly in the high PRS group. The addition of PRS to conventional prediction models improved the discrimination of diabetes risk. MAIN CONCLUSION: PRS are associated with diabetes risk in Japanese general populations, independent of traditional risk factors. Nonetheless, healthy lifestyle habits may reduce diabetes risk even among genetically susceptible individuals, which support the utility of PRS for personalized diabetes risk assessment and prevention strategies.

Adult↗
PubMed2026

Efficacy and safety of mitapivat in adults with transfusion-dependent α-thalassaemia or β-thalassaemia (ENERGIZE-T): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial.

BACKGROUND: The absence of disease-modifying therapies for patients with α-thalassaemia and oral disease-modifying therapies for patients with β-thalassaemia has been a substantial unmet need in these patients. We assessed the efficacy and safety of mitapivat, an oral allosteric activator of pyruvate kinase, in adults with transfusion-dependent thalassaemia. METHODS: ENERGIZE-T is a global, double-blind, randomised, placebo-controlled, phase 3 trial, conducted across 19 countries in North America, Europe, Asia-Pacific, South America, and the Middle East. Patients aged 18 years or older with transfusion-dependent α-thalassaemia or β-thalassaemia were randomly allocated (2:1) with a central interactive response technology system, stratified by geographical region and thalassaemia genotype, to receive 100 mg mitapivat or placebo orally twice a day for 48 weeks. The primary endpoint was transfusion reduction response (TRR), defined as a reduction of at least 50% in transfused red blood cell units with a reduction of at least two units in any consecutive 12-week period until week 48 compared with baseline. Efficacy was analysed in the full analysis set, comprising all randomly allocated patients. Type, severity, and relationship of adverse events and serious adverse events were assessed in patients who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov (NCT04770779) and is active but not recruiting. FINDINGS: Between Nov 30, 2021 and May 2, 2023, 305 patients were screened, of whom 258 were randomly allocated (median age 33·5 years [IQR 27·0-44·0]; 136 [53%] female and 122 [47%] male participants). Of 258 patients allocated, 238 (92%) completed the double-blind treatment period. All patients were required to have a safety follow-up approximately 4 weeks after the final dose of study drug, regardless of completion of the double-blind period or continuation into the open-label extension period. In the full analysis set, TRRs occurred in 52 (30%) of 171 patients in the mitapivat group and 11 (13%) of 87 in the placebo group (adjusted difference 18 percentage points [95% CI 8-27]; two-sided p=0·0003). The safety analysis set comprised 172 patients in the mitapivat group (including one patient allocated to the placebo group who received one dose of mitapivat in error) and 85 in the placebo group. Adverse events were reported in 155 (90%) patients treated with mitapivat and 71 (84%) treated with placebo; the most common events with mitapivat were headache, upper respiratory tract infection, initial insomnia, diarrhoea, and fatigue. Serious adverse events were reported in 19 (11%) patients treated with mitapivat and 13 (15%) treated with placebo. Ten (6%) patients who received mitapivat and one (1%) who received placebo discontinued study treatment due to adverse events. No deaths were reported. INTERPRETATION: Mitapivat significantly reduced the transfusion burden and was generally well tolerated, showing a favourable benefit-risk profile. These findings support mitapivat as the first oral disease-modifying therapy for adults with transfusion-dependent α-thalassaemia or β-thalassaemia, providing a new treatment option to reduce transfusion burden in this patient population. FUNDING: Agios Pharmaceuticals, Inc.

Adult↗