High tibial valgus osteotomy using the Tomofix plate--medium-term results in young patients.

Proximal tibial valgus osteotomy is one of the treatment options for painful medial compartment osteoarthrosis and varus deformity of the knee in a young patient. We report our experience with medial opening wedge tibial osteotomy using the Tomofix plate in 46 patients (50 knees). The mean age was 39.5 years (range 30-49). All were male. Mean duration of follow-up was 60 months (36-72 months). There were no non-unions of the osteotomy site and the medial open-wedge healed without any need for bone graft or bone substitutes. There was functional improvement, as seen from the Oxford and Knee Society scores. Preoperative average knee flexion was 110 degrees (range, 90 - 125 degrees) which remained unchanged. The mean preoperative tibio-femoral angle (mechanical) was 7 degrees varus (range, 5-10 degrees); the postoperative angle was 6 degrees valgus (range 5 degrees-8 degrees). One knee was revised to total knee replacement after two years and was considered a failure. The Tomofix plate provided immediate stability, satisfactory healing of the osteotomy site without the need for bone graft or bone substitutes, and good functional results in young patients with isolated medial compartment degenerative disease.

Medium-term results with the Press Fit Condylar (PFC) Sigma knee prosthesis the Wrightington experience.

The PFC Sigma total knee was introduced in 1997, incorporating a number of design changes. We report the mid-term results of a consecutive series of PFC Sigma knee arthroplasties performed between November 1997 and December 1998. Out of a total of 156 patients (166 knees), 5 patients (5 knees) were lost to follow-up and 6 patients (6 knees) died of unrelated causes. This left 145 patients (155 knees), 90 female and 55 male, with a mean age of 70 years (range, 53-88) and an average follow-up of 90 months (range, 84-96). Posterior cruciate retaining components were used in 136 knees (88%) and posterior-stabilized in 19 (12%). The patella was resurfaced in 74 (48%) knees. Follow-up was at 3, 6 and 12 months, then yearly. Preoperative American Knee Society and Oxford scores were compared with follow-up scores. The Knee Society radiological score was used for radiographic assessment. One knee (0.6%) was revised due to aseptic loosening. One knee (0.6%) had superficial wound infection, which settled with oral antibiotics. Two knees became deeply infected. Of these, one resolved following early debridement, the other developed chronic infection. Using revision for any reason as the end-point our cumulative success rate was 99.4%. The mean preoperative Knee score improved from 45 (30-65) to 84 (45-92), Functional score from 38 (25-55) to 73 (50-95) and Oxford score from 43 (33-52) to 17 (14-29). Radiographic review showed radiolucent lines in 54 (35%) tibial and 17 (11%) femoral components. The Radiological Knee Society score was less than 4 in all except one tibia where the score was 7. Our study shows excellent clinical results with the PFC Sigma total knee replacement after almost eight years follow-up.