Abstract

AN INEXPENSIVE AND INNOVATIVE CORRECTION OF MEDIAL COMPARTMENTAL OSTEOARTHRITIS KNEE JOINT BY HIGH TIBIAL LATERAL CLOSED WEDGE OSTEOTOMY IN A RURAL SET UP

Author(s):Prasad DV,*Arun AA, Tushar Chaudhari, Sagar Jawale, Shakthi Panda, Abhinav Jadhav, Deepak Dathrange

Osteoarthritis of Knee joint with Varus deformity causes considerable disability. Operative treatment aims at shifting the mechanical load bearing axis to the less affected compartment of the knee to relieve the symptoms. Exclusion Criteria: Non-walkers due to generalized arthropathies / medical comorbidities, Flexion deformity > 10 degrees, Range of motion < 90 degrees, Active rheumatoid arthritis, Infection, Lateral compartment involvement, >1cm lateral subluxation in standing A-P X rays of both knees. Methodology: 32 (12 Males and 20 Females) cases of Medial compartment osteoarthritis presenting in our OPD between 2008-2012 were treated by HTOand cortical screw and SS wire fixation (TBW Technique). Results: Evaluation of results was done based on knee rating scale by Japanese orthopaedic association. 22 cases were Excellent, 8 cases were good. One case of failure, an iatrogenic intracondylar fracture of Tibia, and another secondary haematoma under the suture line, aspirated and complete healing was achieved. Patients had good range of motion, were able to squat and sit cross legged comfortably. Conclusion: HTO by Closed Medial wedge osteotomy and fixation with cortical screw and SS wire provides a good alternative to unicompartmental knee Arthroplasty and even Total knee Arthroplasty (may be up to 10-15 years) in patients with Medial compartmental osteoarthritis. It is a cost effective technique with the use of minimum hardware and early postoperative mobilization in patients who cannot afford Knee Arthroplasty in a Rural set up.

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