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Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi ve UnikondilerDiz Artroplastisinin Karşılaştırılması

Year 2017, Volume: 9 Issue: 4, 235 - 249, 01.12.2017

Murat Aşcı Orhan Balta M. Burtaç Eren Recep Kurnaz Taner Güneş

Abstract



İzole medial kompartman artrozunun cerrahi
tedavisinde; unikompartmantal diz artroplastisi (UDP), yüksek tibial osteotomi
(YTO) ve bazen de total diz artroplastisi (TDP) alternatif yöntemlerdir. Bu
çalışmada benzer endikasyonları olan YTO ve UDP sonuçları klinik ve yaşam
kalitesi açısından karşılaştırmalı olarak değerlendirilmiştir. Temmuz 2003 ve
Şubat 2010 tarihleri arasında medialkompartman artrozu tanısı ile sirküler
eksternalfiksatörle yüksek tibialosteotomi ve unikondiler diz artroplastisi
yapılan toplam 47 hastanın 51 dizi çalışmaya alınmıştır. 31 hastanın (2 erkek,
29 kadın) 35 dizine sirküler eksternalfiksatörle YTO, 16 hastanın(16 kadın) 16
dizine UDP yapıldı. Hastalar; yaş, artroz derecesi, preoperatif ve postoperatif
diz KSS, HSS ve SF-36 skorları açısından karşılaştırıldı. Ameliyat öncesi ve
ameliyat sonrası değerler karşılaştırıldığında SF-36, HSS ve KSS skorlamaları
açısından anlamlı farklılık saptanmadı. Her iki grubun ameliyat sonrası
skorlarında anlamlı iyileşme elde edilirken, iyileşme miktarlarında iki grup
arasında anlamlı fark saptanmadı. UDP grubunda (YTO grubuna göre) SF-36’nın
ağrı ve emosyonel rol parametrelerinde daha hızlı ve daha fazla iyileşme elde
edildiği görüldü.



Klinik ve yaşam kalitesi
değerlendirmelerinin sonuçları dikkate alındığında medial kompartman osteoartritinin
tedavisinde her iki tekniğin de efektif ve memnuniyet verici olduğu
görülmüştür.






Keywords

Gonartroz Unikondiler diz protezi tibial osteotomi

References

  • 1. Poilvache P. Osteotomy for the arthritic knee, A European perspective, In: Surgery of the Knee, Insall JN, Scott NM (eds), Churchill Livingstone. 2001: 1466-1505.
  • 2. Mısırlıoğlu M. Proksimal tibia medial açık kama osteotomisinde üç farklı kamalı plagın T plak ile karşılaştırılması: Dana tibialarında biyomekanik çalısma (UzmanlıkTezi). Malatya, İnönü Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı; 2005
  • 3. Kılıç B. Varus Gonartrozunda Puddu Plağı ile Yüksek Tibial Osteotomi (Uzmanlık Tezi). İstanbul, İstanbul Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı; 2004.
  • 4. Iorio R, Healy WL. Unicompartmental Arthritis of the Knee: Current Concept Review. J Bone Joint Surg (Am)i 2003;85:1351-64.
  • 5. Michael G. Surgical Management of the Middle Age Arthritic Knee. Bulletin Hospital for Joint Diseases. 2004;61:3- 4.
  • 6. Dettoni F. High Tibial Osteotomy versus Unicompartmental Knee Arthroplasty for Medial Compartment Arthrosis of the Knee: A Review of the Literature. The Iowa Orthopaedic Journal.
  • 7. Insall JN. Osteotomy. In: Surgery of the Knee. Insall JM. Windsor RE, Scott WN, Kelly MA. Aglietti PA (eds). 2nd edition, New York, Churchill Livingstone. 1993:635-676
  • 8. Hernigou PH, Medevielle D, Debeyre J, Goutallier D. Proksimal Tibial Osteotomy for Osteoarthritis with Varus Deformity. J Bone Joint Surg. 1987;69:332-354.
  • 9. Tuncay İ. Medial Kompartman Gonartrozunda Unikompartmental Diz Protezi. Türk Ortopedi ve Travmatoloji Birliği Dergisi(TOTBİD). 2006; 5: 3-4
  • 10. Hanssen A. Osteotomy about the knee. American perspective, In: Surgery of the Knee, Insall JM, Scott NM (eds), Churchill Livingstone, 2001: 1447-146455, 56
  • 11. Jackson M, Sarangi PP, Newman JH. Revision total knee arthroplasty: Comparison of outcome following primary proximal tibial osteotomy or unicompartmental arthroplasty. J Arthroplasty. 1994;9:539-542.
  • 12. Sisto DJ, Blazina ME, Heskiaoff D, Hirsh LC. Unicompartment arthroplasty for osteoarthrosis of the knee. Clin Orthop. 1993;286:149-53.
  • 13. Lidgren L, Knutson K, Robertsson O. Swedish Knee Arthroplasty Register: Annual Report 2004 Lund: Swedish Knee Arthroplasty Register. 2004.
  • 14. Psychoyios V, Crawford RW, Murray DW, O’Connor JJ. Wear of congruent meniscal bearings in unicompartmental knee arthroplasty: a retrieval study of 16 specimens. J Bone Joint Surg Br. 1998; 80:976-982.
  • 15. Price AJ, Short A, Kellett C, et al. Ten-year in vivo wear measurement of a fully congruent mobile unicompartmental knee arthroplasty. J Bone Joint Surg Br. 2005;87-B:1493-7.
  • 16. Tabor OB Jr, Tabor OB, Bernard M, Wan JY. Unicompartmental knee arthroplasty: long-term success in middle-age and obese patients. J Surg Orthop Adv. 2005;14:59-63.
  • 17. Price AJ, Dodd CA, Svard UG, Murray DW. Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br. 2005;87:1488-1492.
  • 18. Ridgeway SR, McAuley JP, Ammeen DJ, ENgh GA. The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br. 2002;84-B:351-5.
  • 19. Steele RG, Hutabarat S, Evans RL, Ackroyd CE, Nevman JH. Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond ten years. J Bone Joint Surg Br. 2006;88-B:1164-8.
  • 20. Wada M, Imura S, Nagatani K. Relationship between gait and clinical results after high tibial osteotomy. ClinOrthop. 1998; 354:180
  • 21. Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis. 2002;61:617-22.
  • 22. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res. 1999;367:18-27.
  • 23. Holden DL, James SL, Larson RL, Slocum DB. Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study. J Bone Joint Surg [Am]. 1988;70:977-82.
  • 24. Koshino T, Yoshida T, Ara Y, Saito I, Saito T. Fifteen to twenty-eight years follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee. 2004;11:439-44.
  • 25. Flecher X, Parratte S, Aubaniac JM, Argenson JN. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006;452:91-6.
  • 26. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg [Br]. 2008;90:592-6.
  • 27. Nagi ON, Kumar S, Aggarwal S. Combined lateral closing and medial opening-wedge high tibial osteotomy. J Bone Joint Surg [Am]. 2007;89:542-9.
  • 28. Karpman RR, Volz RG. Osteotomy versus unicompartmental prosthetic replacement in the treatment of unicompartmental arthritis of the knee. Orthopedics. 1982;5(8):989-991.
  • 29. Broughton NS, Newman JH, Baily RAJ. Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg. 1986; 68-B:447-452.
  • 30. Ivarsson I, Gillquist J. Rehabilitation after high tibial osteotomy and unicompartmentalarthroplasty. Clin Orthop Relat Res. 1991; 266:139-144.
  • 31. Borjesson M, Weidenhielm L, Mattsson E, Olsson E. Gait and clinical measurements in patients with knee osteoarthritis after surgery: a prospective 5-year follow-up study. Knee. 2005; 12:121–127.
  • 32. Richmond JC. Surgery for osteoarthritis of the knee. Med Clin North Am. 2009;93(1): 213-22.

Comparison of Unicondylar Knee Arthroplasty and High Tibial Osteotomy In Treatment of Medial Compartment Arthrosis

Year 2017, Volume: 9 Issue: 4, 235 - 249, 01.12.2017

Murat Aşcı Orhan Balta M. Burtaç Eren Recep Kurnaz Taner Güneş

Abstract

The surgical treatment alternatives for isolated
medial compartmental knee osteoarthritis are high tibial osteotomy (HTO),
unicompartmental knee arthroplasty (UKA) and rarely total knee arthroplasty
(TKA). In this study results of UKA and HTO are compared in regard to clinical
results and quality of life.

Between July 2003 and February 2010, 51 knees of 47
patients were operated for medial osteoarthritis of the knee. 35 knees of 31
patients (2 male and 29 female) underwent high tibial osteotomy using circular
external fixator and 16 knees of 16 patients (16 female) underwent
unicompartmental knee arthroplasty. The groups were compared according to age,
degree of arthrosis, preoperative and postoperative HSS, KSS and SF-36 scores.

There was no significant diffirence between the HTO
and UKA groups in regard to SF-36, HSS and KSS parameters in preoperative and
postoperative periods. Within each group there was significant increase in all
parameters in the postoperative period, but there was no diffirence between the
two groups. In UKA group the increase in pain and emotional role parameters of
SF-36 were more prominent and rapid.

In conclusion, in regard to clinical results and
quality of life results both treatment modalities were effective and
satisfactory in the treatment of medial compartmental knee osteoarthritis.

Keywords

Gonarthrosis Unicondylar Knee Prosthesis Tibial Osteotomy

References

  • 1. Poilvache P. Osteotomy for the arthritic knee, A European perspective, In: Surgery of the Knee, Insall JN, Scott NM (eds), Churchill Livingstone. 2001: 1466-1505.
  • 2. Mısırlıoğlu M. Proksimal tibia medial açık kama osteotomisinde üç farklı kamalı plagın T plak ile karşılaştırılması: Dana tibialarında biyomekanik çalısma (UzmanlıkTezi). Malatya, İnönü Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı; 2005
  • 3. Kılıç B. Varus Gonartrozunda Puddu Plağı ile Yüksek Tibial Osteotomi (Uzmanlık Tezi). İstanbul, İstanbul Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı; 2004.
  • 4. Iorio R, Healy WL. Unicompartmental Arthritis of the Knee: Current Concept Review. J Bone Joint Surg (Am)i 2003;85:1351-64.
  • 5. Michael G. Surgical Management of the Middle Age Arthritic Knee. Bulletin Hospital for Joint Diseases. 2004;61:3- 4.
  • 6. Dettoni F. High Tibial Osteotomy versus Unicompartmental Knee Arthroplasty for Medial Compartment Arthrosis of the Knee: A Review of the Literature. The Iowa Orthopaedic Journal.
  • 7. Insall JN. Osteotomy. In: Surgery of the Knee. Insall JM. Windsor RE, Scott WN, Kelly MA. Aglietti PA (eds). 2nd edition, New York, Churchill Livingstone. 1993:635-676
  • 8. Hernigou PH, Medevielle D, Debeyre J, Goutallier D. Proksimal Tibial Osteotomy for Osteoarthritis with Varus Deformity. J Bone Joint Surg. 1987;69:332-354.
  • 9. Tuncay İ. Medial Kompartman Gonartrozunda Unikompartmental Diz Protezi. Türk Ortopedi ve Travmatoloji Birliği Dergisi(TOTBİD). 2006; 5: 3-4
  • 10. Hanssen A. Osteotomy about the knee. American perspective, In: Surgery of the Knee, Insall JM, Scott NM (eds), Churchill Livingstone, 2001: 1447-146455, 56
  • 11. Jackson M, Sarangi PP, Newman JH. Revision total knee arthroplasty: Comparison of outcome following primary proximal tibial osteotomy or unicompartmental arthroplasty. J Arthroplasty. 1994;9:539-542.
  • 12. Sisto DJ, Blazina ME, Heskiaoff D, Hirsh LC. Unicompartment arthroplasty for osteoarthrosis of the knee. Clin Orthop. 1993;286:149-53.
  • 13. Lidgren L, Knutson K, Robertsson O. Swedish Knee Arthroplasty Register: Annual Report 2004 Lund: Swedish Knee Arthroplasty Register. 2004.
  • 14. Psychoyios V, Crawford RW, Murray DW, O’Connor JJ. Wear of congruent meniscal bearings in unicompartmental knee arthroplasty: a retrieval study of 16 specimens. J Bone Joint Surg Br. 1998; 80:976-982.
  • 15. Price AJ, Short A, Kellett C, et al. Ten-year in vivo wear measurement of a fully congruent mobile unicompartmental knee arthroplasty. J Bone Joint Surg Br. 2005;87-B:1493-7.
  • 16. Tabor OB Jr, Tabor OB, Bernard M, Wan JY. Unicompartmental knee arthroplasty: long-term success in middle-age and obese patients. J Surg Orthop Adv. 2005;14:59-63.
  • 17. Price AJ, Dodd CA, Svard UG, Murray DW. Oxford medial unicompartmental knee arthroplasty in patients younger and older than 60 years of age. J Bone Joint Surg Br. 2005;87:1488-1492.
  • 18. Ridgeway SR, McAuley JP, Ammeen DJ, ENgh GA. The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br. 2002;84-B:351-5.
  • 19. Steele RG, Hutabarat S, Evans RL, Ackroyd CE, Nevman JH. Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond ten years. J Bone Joint Surg Br. 2006;88-B:1164-8.
  • 20. Wada M, Imura S, Nagatani K. Relationship between gait and clinical results after high tibial osteotomy. ClinOrthop. 1998; 354:180
  • 21. Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis. 2002;61:617-22.
  • 22. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The Install Award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year followup study. Clin Orthop Relat Res. 1999;367:18-27.
  • 23. Holden DL, James SL, Larson RL, Slocum DB. Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study. J Bone Joint Surg [Am]. 1988;70:977-82.
  • 24. Koshino T, Yoshida T, Ara Y, Saito I, Saito T. Fifteen to twenty-eight years follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee. 2004;11:439-44.
  • 25. Flecher X, Parratte S, Aubaniac JM, Argenson JN. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop Relat Res. 2006;452:91-6.
  • 26. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg [Br]. 2008;90:592-6.
  • 27. Nagi ON, Kumar S, Aggarwal S. Combined lateral closing and medial opening-wedge high tibial osteotomy. J Bone Joint Surg [Am]. 2007;89:542-9.
  • 28. Karpman RR, Volz RG. Osteotomy versus unicompartmental prosthetic replacement in the treatment of unicompartmental arthritis of the knee. Orthopedics. 1982;5(8):989-991.
  • 29. Broughton NS, Newman JH, Baily RAJ. Unicompartmental replacement and high tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg. 1986; 68-B:447-452.
  • 30. Ivarsson I, Gillquist J. Rehabilitation after high tibial osteotomy and unicompartmentalarthroplasty. Clin Orthop Relat Res. 1991; 266:139-144.
  • 31. Borjesson M, Weidenhielm L, Mattsson E, Olsson E. Gait and clinical measurements in patients with knee osteoarthritis after surgery: a prospective 5-year follow-up study. Knee. 2005; 12:121–127.
  • 32. Richmond JC. Surgery for osteoarthritis of the knee. Med Clin North Am. 2009;93(1): 213-22.
There are 32 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Murat Aşcı

Orhan Balta This is me

M. Burtaç Eren This is me

Recep Kurnaz This is me

Taner Güneş This is me

Publication Date December 1, 2017
Published in Issue Year 2017 Volume: 9 Issue: 4

Cite

APA Aşcı, M., Balta, O., Eren, M. B., Kurnaz, R., et al. (2017). Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi ve UnikondilerDiz Artroplastisinin Karşılaştırılması. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi, 9(4), 235-249.
AMA Aşcı M, Balta O, Eren MB, Kurnaz R, Güneş T. Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi ve UnikondilerDiz Artroplastisinin Karşılaştırılması. Gaziosmanpaşa Tıp Dergisi. December 2017;9(4):235-249.
Chicago Aşcı, Murat, Orhan Balta, M. Burtaç Eren, Recep Kurnaz, and Taner Güneş. “Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi Ve UnikondilerDiz Artroplastisinin Karşılaştırılması”. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi 9, no. 4 (December 2017): 235-49.
EndNote Aşcı M, Balta O, Eren MB, Kurnaz R, Güneş T (December 1, 2017) Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi ve UnikondilerDiz Artroplastisinin Karşılaştırılması. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi 9 4 235–249.
IEEE M. Aşcı, O. Balta, M. B. Eren, R. Kurnaz, and T. Güneş, “Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi ve UnikondilerDiz Artroplastisinin Karşılaştırılması”, Gaziosmanpaşa Tıp Dergisi, vol. 9, no. 4, pp. 235–249, 2017.
ISNAD Aşcı, Murat et al. “Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi Ve UnikondilerDiz Artroplastisinin Karşılaştırılması”. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi 9/4 (December 2017), 235-249.
JAMA Aşcı M, Balta O, Eren MB, Kurnaz R, Güneş T. Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi ve UnikondilerDiz Artroplastisinin Karşılaştırılması. Gaziosmanpaşa Tıp Dergisi. 2017;9:235–249.
MLA Aşcı, Murat et al. “Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi Ve UnikondilerDiz Artroplastisinin Karşılaştırılması”. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi, vol. 9, no. 4, 2017, pp. 235-49.
Vancouver Aşcı M, Balta O, Eren MB, Kurnaz R, Güneş T. Medial Kompartman Artrozlu HastalarınTedavisinde Yüksek Tibial Osteotomi ve UnikondilerDiz Artroplastisinin Karşılaştırılması. Gaziosmanpaşa Tıp Dergisi. 2017;9(4):235-49.

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