Return to sports and quality of life after high tibial osteotomy in patients under 60 years of age.

INTRODUCTION: Since knee osteoarthritis is unicompartmental in most cases, a knee osteotomy is the most logical solution to limit degeneration of the arthritic compartment, thereby delaying knee arthroplasty. Younger patients have high functional demands. The purpose of this study was to evaluate the return to sports and quality of life after high tibial osteotomy (HTO) in athletic patients less than 60 years of age. The hypothesis was that patients can return to sports within 1 year of HTO. MATERIALS AND METHODS: A single-centre, retrospective study was performed of 30 patients under 60 years of age with medial tibiofemoral osteoarthritis and no history of surgery or trauma who underwent HTO between January 2014 and August 2015. The primary endpoint was the return to sport at 1 year based on the Tegner score. Secondary endpoints were the subjective IKDC score, Lysholm score and SF-36. RESULTS: The mean follow-up was 1.3 years [1-1.5] and no patients were lost to follow-up. All the patients had returned to sports at 1 year: 73.3% at their pre-surgery level (before the pain started) and 23.3% at a higher level. Their quality of life was significantly improved according to the SF-36 questionnaire: 65.3% pre-operatively compared with 72.5% postoperatively (P=0.01). The preoperative and 1-year postoperative scores were comparable for the Tegner (P=0.167), IKDC (P=0.093) and Lysholm (P=0.061). CONCLUSION: HTO allows patients to resume their sports activities within 1 year of surgery and significantly improves their quality of life. LEVEL OF EVIDENCE: Level IV - Retrospective cohort study.

Beta-tricalcium phosphate for orthopedic reconstructions as an alternative to autogenous bone graft.

Autogenous bone graft (autograft) remains the gold standard in the treatment of many orthopedic problems. However, graft harvest can lead to perioperative morbidity and increased cost. We tested the hypothesis that an osteoconductive matrix, beta-tricalcium phosphate (ß-TCP), would be a safe and effective alternative to autograft alone. Beta-tricalcium phosphate (ß-TCP) is considered as one of the most promising biomaterials for bone reconstruction. This study analyzes the outcomes of patients who received ß-TCP as bone substitutes in orthopedic surgery. METHODS: A total of 50 patients were enrolled in a controlled, non-inferiority clinical trial to compare the safety and efficacy of ß-TCP (25 patients) with those of autograft (25 patients) in indications requiring usually autograft. These 50 patients were categorized according to the etiology and morphology of the 54 bone defects resulting from elective surgical procedures, such as 34 open-wedge high tibial osteotomies, and 20 osteonecrosis treatments with core decompression. Radiographic (healing process with or without integration of ß-TCP), clinical (no other surgical procedure), functional outcomes and safety (with or without complications) were assessed through fifty-two weeks postoperatively. RESULTS: With regard to the primary endpoint (radiographic evolution), the fusion rate of the 34 open-wedge osteotomies was 100% (17 among 17) for patients in the group with ß-TCP compared with 94% (16 among 17) for patients in the autograft group. For the 20 cavitary defects (osteonecrosis), the radiographic union rates, as determined by the presence of osseous bridging, were 100% for patients in the group with ß-TCP and 100% for those in the autograft group. Clinically at one year, all quality-of-life and functional outcome data supported non-inferiority of ß-TCP compared with autograft, and patients in the ß-TCP group were found to have less pain and an improved safety profile. CONCLUSIONS: Treatment with ß-TCP resulted in comparable fusion rates, less pain and fewer side effects as compared with treatment with autograft. This study established clinical parameters where the ß-TCP alone can successfully support the osteogenic process.

Failure of high tibial varus osteotomy for lateral tibio-femoral osteoarthritis with<10° of valgus: Outcomes in 19 patients.

BACKGROUND: Osteotomy is a rational approach to slowing knee osteoarthritis progression by modifying loads, thereby avoiding joint replacement in younger individuals. Varus femoral osteotomy is recommended only in patients with more than 10° of valgus. The objective here was to assess outcomes of tibial varus osteotomy in patients with lateral compartment tibio-femoral osteoarthritis and less than 10° of valgus. The hypothesis was that high tibial varus osteotomy produces satisfactory and long-lasting improvements. MATERIAL AND METHODS: A single-centre retrospective study was conducted in 19 consecutive patients managed by high tibial varus osteotomy between January 2005 and May 2012. Mean age was 54.5years. The clinical IKS knee and function scores and radiological parameters were determined pre-operatively then after 6 and 12months and at last follow-up. The primary outcome measure was the global IKS score. Failure was defined as a global IKS score <140 or total knee arthroplasty (TKA). Secondary outcome measures were a post-operative hip-knee-ankle (HKA) angle between 180° and 183° and less than 10° of joint line obliquity. The hypothesis was that high tibial varus osteotomy produced satisfactory and long-lasting improvements in lateral compartment tibio-femoral osteoarthritis. RESULTS: After the mean follow-up of 4.3years (range, 2-9years), 10/19 patients had a global IKS score <140. Among them, 7 underwent TKA after a mean of 5.0±2.7years. Varus tibial osteotomy was followed by significant improvements in the IKS knee and function scores from baseline to last follow-up (P<0.05). A global IKS<140 predicted TKA. Mean HKA angle values were 186.3±2.9° pre-operatively and 181.3°± 3.9°at last follow-up (P<0.05); the HKA angle was within the 180°-183° range in 8 (42.1%) patients. Mean post-operative joint line obliquity was 7.8±3.0°. An HKA angle outside the 180-183° range and joint line obliquity >10° were associated with poor outcomes. DISCUSSION: High tibial varus osteotomy produces unsatisfactory medium-term outcomes, with an overall failure rate of 52%. At present, high tibial varus osteotomy has no role in the management of lateral compartment tibio-femoral osteoarthritis with <10° of valgus. LEVEL OF EVIDENCE: IV, retrospective cohort study.