ABSTRACT
OBJECTIVE: To evaluate the effectiveness of various orthotic treatments for patients with isolated medial compartment osteoarthritis. DESIGN: Prospective cohort study with sequential interventions. SETTING: University-affiliated hospital, Hong Kong. PATIENTS: From December 2010 to November 2011, 10 patients with medial knee osteoarthritis were referred by orthopaedic surgeons for orthotic treatment. All patients were sequentially treated with flat insole, lateral-wedged insole, lateral-wedged insole with subtalar strap, lateral-wedged insole with arch support, valgus knee brace, and valgus knee brace with lateral-wedged insole with arch support for 4 weeks with no treatment break. Three-dimensional gait analysis and questionnaires were completed after each orthotic treatment. MAIN OUTCOME MEASURES: The Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analogue scale scores, and peak and mean knee adduction moments. RESULTS: Compared with pretreatment, the lateral-wedged insole, lateral-wedged insole with arch support, and valgus knee brace groups demonstrated significant reductions in WOMAC pain score (19.1%, P=0.04; 18.2%, P=0.04; and 20.4%, P=0.02, respectively). The lateral-wedged insole with arch support group showed the greatest reduction in visual analogue scale score compared with pretreatment at 24.1% (P=0.004). Addition of a subtalar strap to lateral-wedged insoles (lateral-wedged insole with subtalar strap) did not produce significant benefit when compared with the lateral-wedged insole alone. The valgus knee brace with lateral-wedged insole with arch support group demonstrated an additive effect with a statistically significant reduction in WOMAC total score (-26.7%, P=0.01). Compliance with treatment for the isolated insole groups were all over 90%, but compliance for the valgus knee brace-associated groups was only around 50%. Gait analysis indicated statistically significant reductions in peak and mean knee adduction moments in all orthotic groups when compared with a flat insole. CONCLUSIONS: These results support the use of orthotic treatment for early medial compartment knee osteoarthritis.
Subject(s)
Asian People/statistics & numerical data , Gait/physiology , Osteoarthritis, Knee/ethnology , Osteoarthritis, Knee/therapy , Range of Motion, Articular/physiology , Aged , Braces , Cohort Studies , Female , Foot Orthoses , Hong Kong , Hospitals, University , Humans , Male , Middle Aged , Orthotic Devices , Osteoarthritis, Knee/diagnostic imaging , Pain Measurement , Prognosis , Prospective Studies , Radiography , Severity of Illness Index , Treatment OutcomeABSTRACT
OBJECTIVE: To review the results of arthroscopic treatment of popliteal cysts in our centre and analyse outcomes including complications. DESIGN: Retrospective study. SETTING: University teaching hospital, Hong Kong. PATIENTS: From July 2007 to July 2009, 11 patients with symptomatic popliteal cysts were treated arthroscopically. All of them had preoperative magnetic resonance imaging to confirm the diagnosis, identify the valvular opening, and the associated intra-articular pathology. We used the Rauschning and Lindgren criteria for evaluation. RESULTS: Intra-articular pathology like cartilage degeneration and meniscus tear were commonly associated with popliteal cysts. All patients achieved symptomatic improvement after treatment and the recurrence rate was low. No major complications were encountered. We failed to identify (and correct) any valvular opening in one patient. CONCLUSION: From our experience, we conclude that arthroscopic treatment of popliteal cyst with correction of the valvular opening and treatment of associated intra-articular pathology is effective and safe.
Subject(s)
Arthroscopy/methods , Knee Joint/surgery , Popliteal Cyst/surgery , Aged , Arthroscopy/adverse effects , Female , Hong Kong , Hospitals, University , Humans , Knee Joint/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Popliteal Cyst/pathology , Postoperative Complications , Recurrence , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVES: To review the results of distraction osteogenesis in short-stature patients in our centre and analyse outcomes including complications. DESIGN: Retrospective study. SETTING: University teaching hospital, Hong Kong. PATIENTS: Eight patients with short stature (three had achondroplasia, three constitutional short stature, and two hypochondroplasia) operated on for limb lengthening using monolateral or circular external fixators between 1995 and 2006 were reviewed. RESULTS: The mean age at the time of surgery was 20 years (range, 9-39 years). The fixators used were either Ilizarov or Orthofix. The average gain in length per bone segment was 5.2 cm (range, 3.2-8.0 cm), and the average percentage lengthening was 21% (range, 7.9-40%). The mean time in frame was 8 months (range, 4-14 months), and the average healing index was 48 days per cm of lengthening (18-110 days per cm). Minor complications (pin tract infection and transient joint stiffness) were common, and after excluding the latter the overall complication rate was 0.6 per bone segment. CONCLUSION: In our series, limb lengthening of up to 40% of the initial length of the bone segment can be achieved without significant long-term sequelae. However, the procedures were complex and prolonged, and required a special psychological approach directed at both parents and the patients. Complications are quite common, for which patients have to be well prepared before starting the procedures.