[Orthopod] Re: Where would you draw the line?


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[Orthopod] Re: Where would you draw the line?

mangalparihar at gmail
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Feb 7, 2008, 1:56 AM

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[Orthopod] Re: Where would you draw the line?	Can't Post

Sir,

preoperative arthroscopy has no role to play in assessing whether it is an
appropriate case for HTO.

I could find only these articles (old) on directly dealing with this topic.

I would be happy to be shown any literature to the contrary.

Mangal

J Bone Joint Surg Am. 1983 Jan;65(1):36-42.Related Articles, Links
High tibial osteotomy in the treatment of osteoarthritis of the knee. The
role of preoperative arthroscopy.

Keene JS, Dyreby JR Jr.

Sixty osteoarthritic knees that were evaluated by arthroscopic,
radiographic, and clinical (Insall knee-rating scale) examination prior to
high tibial valgus osteotomy were re-evaluated radiographically and
clinically after a minimum follow-up of two years. After two and three
years, the clinical scores of the knees with bicompartmental and
tricompartmental osteoarthritis (including exposed subchondral bone in the
lateral compartment) were the same as the scores of the knees with
unicompartmental disease. The scores of the knees with 5 to 13 degrees of
valgus alignment at two years were significantly higher (p less than 0.01)
than the scores of the knees with less than 5 degrees of valgus angulation,
regardless of the arthroscopy scores. Based on the results after two to
three years, the arthroscopic findings prior to osteotomy appeared to have
little, if any, predictive value in evaluating patients for this procedure.

PMID: 6848533 [PubMed - indexed for MEDLINE]

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2: Clin Orthop Relat Res. 1989 Jun;(243):157-65.Related Articles, Links
Evaluation of patients for high tibial osteotomy.

Keene JS, Monson DK, Roberts JM, Dyreby JR Jr.

Division of Orthopedic Surgery, University of Wisconsin Clinical Science
Center, Madison.

Fifty-one osteoarthritic knees evaluated by arthroscopic, roentgenographic,
and clinical examinations prior to high tibial valgus osteotomy were
reevaluated roentgenographically and clinically after a minimum follow-up
period of five years (average, 6.2 years; range, 5-8.3 years). The number of
good and excellent results decreased over time but was unrelated to the
preosteotomy condition of the lateral and patellofemoral compartments as
documented by arthroscopy. Knees with 7 degrees to 13 degrees of valgus
angulation at the follow-up evaluation had significantly better results than
knees with less than 7 degrees of valgus, regardless of the arthroscopic
findings. Preosteotomy arthroscopic findings had no predictive value in
evaluating patients for this procedure.

PMID: 2721055 [PubMed - indexed for MEDLINE]

-----Original Message-----
From: orthopod@googlegroups.com [mailto:orthopod@googlegroups.com] On Behalf
Of veeyemeye@bsnl.in
Sent: 07 February 2008 12:42
To: orthopod@googlegroups.com
Cc: Dr Mangal Parihar
Subject: [Orthopod] Re: Where would you draw the line?

Dear Mangal,
I am not an arthroplasty surgeon, but do attend meetings often to keep
updated. Dr george's reply seems logical how even without patellar
resurfacing TKR patients do well.

I have done HTO in cases similar to the one shown by you. I would do an
arthroscopy first to ensure that the lateral compartment is good and then do
the HTO.

V M Iyer
--
Prof V M Iyer, Consultant Iyer Orthopaedic Centre Retd HOD orthopaedic
surgery. Govt medical college. Solapur.
India.413001. 91 9822394597

---- Dr Mangal Parihar <mangalparihar@gmail.com> wrote:
>
> Dear all,
>
> I would appreciate your thoughts on this.
>
> The attached pictures are of a 56 year old lady, overweight, with
> varus bilaterally.
>
> She walks with a stiff legged gait, no obvious lateral ligament laxity.
>
> Her only complaint is pain on weightbearing. Pain is on the medial
> side. She has no pain on flexion movements in an unloaded position,
> inspite of the radiological PF arthritis.
>
> Despite the severity of the wear on the medial side, her lateral
> compartment is quite ok.
>
> Needless to say, all conservative measures have been exhausted.
>
> I believe that she will benefit by an HTO - fixator assisted. I have
> warned them that I cannot "guarantee" the longevity of the result, but
> that I believe that 5-7 years would not be an unrealistic minimum.
>
> She is from a higher economic stratum and can well afford a TKR.
>
> My reasoning on HTO and PF arthritis is thus - "there are so many
> arthroplasty surgeons who do not resurface the patella and it
> continues to be a hotly debated topic even today in arthroplasty meetings.
> If resurfacing of the patella is not mandatory in a knee replacement,
> then could it be that the PF arthritis on xray (in the absence of
> symptoms) is just a smokescreen and not a true contraindication to an
> HTO. Would it then be reasonable to extend the relative indications of
> an HTO to include patients with PF arthritis as long as their symptoms
> are consistent with medial overloading"
>
> What do you think - would you consider an HTO in this case?
>
> If no - why ? (actually, even if yes, I would be interested in your
> take on the issue)
>
> All thoughts (ESPECIALLY CRITICISMS) welcome.
>
> With regards
>
> Mangal Parihar
>
> >

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