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In 53 patients with a mean age of 38 (17-73) years, 71 high tibial osteotomies were performed. Twenty-three patients had no radiological signs of osteoarthrosis (Ahlbäck grade 0), whereas 26 patients had primary and 22 patients secondary osteoarthritis. Follow-up was 10.5 (5.8-16.6) years. The patients without radiological osteoarthrosis achieved almost exclusively good or very good scores using the Lysholm-Gillquist (96%) and the Insall scale (83%). By contrast, only 29% of the patients with radiological osteoarthritis achieved good or very good scores. Whether the patient had primary or secondary osteoarthrosis was of no influence. Neither was the preoperative axial deviation.
Studying knee osteoarthrosis proprioceptive deficits play a growing role. However, the methods for the detection of these deficits using joint position sense measurements have been criticized recently. Therefore, we developed a new method for the measurement of knee-joint kinaesthesia. At 5 different angular velocities of passive knee movement both movement and stop detection were tested. Tests were performed both in 25 patients with osteoarthrosis of the knee and in a control group of 20 age related normal subjects. In addition to the measurements of movement detection and stop-detection thresholds, a specific detection-failure analysis was performed in our study. In addition to a significant improvement of proprioceptive abilities with increasing angular velocities, detection failure analysis brought about significant differences between patients with knee osteoarthrosis and normal subjects yielding a significant proprioceptive deficit in osteoarthrosis of the knee. In contrast, in case of correct movement detection or stop-detection there were no significant differences in the detection-threshold values between normal and ostheoarthrotic knees. In conclusion, both the lack of differences in detection thresholds between the arthrosis and the control-groups and the increased detection failure rates in arthrosis patients gave evidence for these proprioceptive differences being a result of central nervous dysregulation in knee osteoarthrosis.
In osteoarthritis (OA) of the knee, arthrogenous muscle inhibition (AMI) is considered to be one of the reasons of quadricep muscle weakness. Its influence on functional impairment such as gait alterations, however, still remains unclear. Fourty-seven patients with knee OA (mean age 64 +/- 5.2 years, 36 women, 11 men) and 47 age- and gender-matched healthy controls were investigated for voluntary activation (VA) and maximum voluntary contraction (MVC) of the quadricep muscle. In addition, these two parameters of AMI have been correlated with the extent of gait alterations. Measurement of VA and MVC were performed by a twitch interpolation technique; for gait analysis an optoelectronic motion analysis system (ELITE, Italy) was used. Quadricep MVC and VA were significantly lower in OA than in control knees. Moreover, in addition to reduced walking velocity and step cadence, gait analysis revealed significantly lower stance phase re-extension angles in OA patients (mean 2.7 degrees +/- 2.6) than in control knees (mean 10.7 degrees +/- 4.9). Hereby, in OA knees there was a significant correlation between MVC and VA deficits and the reduction of re-extension angles. The work shows that knee OA is characterized by severe alterations of the quadricep motor function due to arthrogenous muscle inhibition. Hereby, quadricep AMI represents one major reason for functional impairment in knee OA.
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In this study, we clinically and radiographically evaluated open reduction with shortening of the femur in children more than 1 year old with refractory congenital dislocation of the hip. In 19 children (aged 1-4 years), 22 joints were operated on. The patients were followed-up for an average of 8.7 years (range, 2-13 years). Functional results were satisfactory in all joints, and differences in limb length were not significant. Radiographically, good results (grades I and II) were obtained in 16 of the 22 joints, according to Severin's criteria. This surgical procedure may be indispensable for treating refractory congenital dislocation of the hip in children over 1 year old.
From January 1976 to December 1990, 66 high tibial osteotomies for medial gonarthrosis were performed in 59 patients. Thirty knees of 26 patients (18 women and 8 men) were reviewed after a mean follow-up period of 15.3 years (range, 10-24 years). The mean age of these 26 patients was 59 years at the time of operation and 75.5 years at the latest follow-up. The average femoro-tibial angle changed, from 187 degrees before surgery to 170 degrees after surgery, and to 174 degrees at the latest follow-up. Progression of osteoarthritic changes was observed in 87% for the medial and in 90% for the lateral compartment of the knee. Clinical results, assessed according to the Japanese Orthopaedic Association (JOA) knee score, showed improvement with a score of 65 points before surgery, and a score of 81 points at the latest follow-up. The overall clinical results were satisfactory for 60% of the knees. The results of this long-term follow-up study show that high tibial osteotomy for medial compartment osteoarthritis can be effective for as long as 15 years.
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Seven patients presenting between 1992 and 1999 with osteoarthritic knee symptoms in consequence of old malunited femoral shaft fractures, were treated by open femoral shaft osteotomy. The osteotomies were sited at the apex of the deformity and were fixed by locked intramedullary nailing. The patients were followed up until osteotomy union and reviewed clinically and radiologically with particular emphasis on symptoms and function. The mean age at presentation was 48 years and the mean time from fracture was 28 years. The mean time to osteotomy union was 28 months. Five of the seven patients reported excellent pain relief and functional improvement. These patients presented a difficult management problem at an age that would be worryingly young for total knee replacement. Arthroplasty has been avoided in all but one of this cohort, and is still far from imminent in the remainder, after a mean follow-up period of 5 years.
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