Demmer, A. (2014) Progressie van artrose, fysiek functioneren en overleving na een High Tibial Osteotomy. thesis, Medicine.
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Abstract
Background: Osteoarthritis of the knee is a common condition of the musculoskeletal system. Osteoarthritis can affect any or all compartments of the knee; the lateral, medial or patellofemoral compartment. Varus alignment of the knee is associated with the development of osteoarthritis of the medial compartment. Also, it increases the risk of progression of medial compartment osteoarthritis. A valgus high tibial osteotomy (HTO) transfers the mechanical axis and load-bearing to the non-arthritic, lateral compartment of the knee. The aim of an HTO is to reduce pain and to stop the progression of osteoarthritis in the medial compartment of the knee. Most patients with medial compartment osteoarthritis are relatively young. An HTO may delay the need for a TKP and is therefore preferred as a primary solution in the younger, more active patient. The primary objective of this study is to investigate whether an HTO in young patients with varus alignment can stop progression of osteoarthritis in the medial compartment of the knee. Also, physical function, pain, and survival, the latter is defined as time to TKP conversion or HTO revision, will be investigated. Patients and methods: A cohort of 134 patients (158 knees, respons rate 92.4%), who underwent a closing-wedge HTO at the department of Orthopaedics of the Martini Hospital between January 2006 and December 2008 for symptomatic osteoarthritis of the medial compartment of the knee, are analysed prospectively. The mean follow-up of this study is 6.6 years (5-8 years). For the follow-up a radiograph of the knee joint is obtained, to compare with with preoperative radiographs. The patients are subsequently seen at a clinical appointment at the department of Orthopaedics. The degree of osteoarthritis is assessed by measuring the minimum joint space width (mJSW) at the medial compartment of the knee and by using the Kellgren Lawrence (KL) classification. Progression of osteoarthritis is defined as narrowing of the mJSW and progression to a higher KL score. To evaluate physical function after an HTO the Western Ontario and McMaster Universities Arthritis Index (WOMAC) was assessed, together with the Visual Analogue Scale (VAS) for pain. The HTO survival has been illustrated by using the Kaplan-Meier survivorship. Results: No significant difference (p = 0.87) was found between the preoperative and follow-up mJSW-scores. The mean KL-scores were higher (p = 0.001) at time of follow-up. In half of the patients the KL-score remained the same at time of follow-up, while the other half had moderate progression of the KL-scores. Compared to the preoperative WOMAC-scores, the follow-up WOMAC-scores were significantly lower, which means that patients experienced less pain, less stiffness and a better physical function of the knee. The mean VAS went from 7,2 (SD 1.7) preoperatively to 3.2 (SD 2.3) at the follow-up. The mean survival of this cohort was 90,4 months (7.5 year) (SD 1.2 months). The 1- and 5-years survival were respectively 100% and 93%. Conclusion: An HTO seems to delay progression of the medial compartment osteoarthritis of the knee at an average follow-up of 6.6 years. Furthermore this study has shown that patients had a better physical function after an HTO. With an mean 5-years survival of 93% an HTO seems to be an effective intervention for delaying a TKP.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Reininga, Dr. I.H.F. |
| Supervisor name: | Brouwer, Dr. R.W. and Huizinga, Drs. M.R. and Martini ziekenhuis Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/222 |
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