Kumar Rahul

Abstract

Background: Osteoarthritis (OA) of the knee is an emerging cause of morbidity and indirect mortality encountered by the clinician. Failure to respond to conservative management is common and surgery is the usual outcome. Total Knee arthroplasty (TKA) and Unicondylar knee arthroplasty (UKA) have displayed dependable results but are demanding surgeries with a limited lifespan. High tibial osteotomy (HTO) corrects the alignment of the limb and improve knee function but is associated with a series of complications and difficult conversion. Recent studies on Proximal Femoral Osteotomy (PFO) in medial OA of the knee proclaim much relief in pain and correction of limb alignment. We conducted a prospective interventional study to evaluate the functional and radiological outcome of PFO in medial OA knee. Materials and Methods: 18 patients (30 knees) of medial OA knee with Kellgren Lawrence (KL) grade 2 and 3 disease underwent PFO after written informed consent and institutional review board clearance. The patients were followed up at 3 months, 6 months and 1 year and Femoro-Tibial angle (FTA), Visual Analogue Score (VAS), Knee injury and Osteoarthritis Outcome score (KOOS) and Oxford Knee Score (OKS) were documented pre-operatively and at each follow up. Result: The mean age in our study was 64 years. The mean VAS score was 6.86 pre-operatively while 3-month VAS was 6.96 and its 12 month value was 7.26 The mean pre-operative OKS was 34.26 which decreased to 33.36 at 3 months and 32.26 at 12 months. The mean pre-operative KOOS was 52.99 while it was 51.88 at 3 months and worsened to 50.98 at the final follow up. The mean FTA pre operatively was 182.96 degree and at 1 year follow up it deteriorated to 183.26 degree. 3 patients (10%) informed paresthesias and weakness in the foot which resolved on medical management. Conclusion: We did not observe relief in pain and function after PFO. The limb alignment did not improve at 1 year follow up. The authors conclude that more evidence needs to be gathered before validating PFO as an established treatment modality in medial OA knee.   Keywords: Arthritis, Knee, Osteoarthritis, PFO, Osteotomy.

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Abstract

Objective: Distal tibia extra articular fractures amount to nearly 10-13% of all tibial fractures. Precarious vascularity, propensity for open fractures and poor soft tissue coverage over these fractures make them particularly vulnerable for infection and non-union and surgical site complications.We evaluated the shortterm functional outcome of fracture distal tibia fibula treated by single stage external fixation using Joshi’s External stabilizing system (JESS). Methods: In a non-control prospective interventional study on 30 patients with extra articular distal tibia fractures we used the JESS fixator as a definitive treatment modality. Fibula was internally fixed using a nail or plate when fractured. After achieving temporary fracture reduction, two pins were inserted each in tibia and calcaneum and were connected by JESS rods using clamps. In case of open fractures wound was managed by serial debridement and dressings as required. The patients were followed up for a minimum of 12 months. Results: There were 20 male and 10 females. The mean age was 39.1 years (range 18-60 years). There were 18 open and 12 closed fractures. According to the AO/OTA classification of extra articular distal tibia fractures 20 belonged to type A1, 3 in type A2 and 7 in type A3. The mean time to union was 15 weeks and the average duration of surgery was 35 minutes. At the final follow up all fractures united except one and the mean AOFAS score was 83.13. There were 2 cases of pin track infections, one non-union and one mal-union. One patient had ankle arthritis managed conservatively till last follow up. Conclusions: Definitive fixation of distal tibia extra- articular fractures with JESS is a simple procedure with good functional outcome and avoids complications associated with open reduction and internal fixation. Keywords: Distal tibia, JESS, Plating, ORIF, Fixator.

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