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Speaker: New technology should not supplant use of knee osteotomy
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ORLANDO, Fla., USA — Although osteotomies may be falling out of favor with some orthopaedists, they can be effective for young and active patients with medial compartmental knee arthritis and constitutional malalignment, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting, here.
“I think [high tibial osteotomy] HTO, as of today, is a valuable tool in treating medial compartment arthritis in active patients. It is important to assess the level and the degree of deformity. It is not always on the tibia — and to correct on the right level. Finally, patient-specific guides can offer great advantages for biplanar correction,” Jan Victor, MD, PhD, said.
Arthroplasties replace osteotomies
Currently, orthopaedists prefer to perform arthroplasties on young, active patients with significant deformities despite evidence that shows disappointing results for knee arthroplasty in these patients. Osteotomies began to develop a poor reputation as a viable treatment in these patients because orthopaedists believed they provided poor fixation and jeopardized the possibility of a patient receiving a total knee arthroplasty in the future, according to Victor.
“That led some people to claim we should abandon HTO completely. They called these young, active patients with knee arthritis the ‘new arthritis’ patients, and (said) we should offer them an arthroplasty treatment option instead of an osteotomy,” Victor said.
Osteotomy, however, can be a more logical procedure for these patients, according to Victor, but it can make it challenging to achieve a predictable degree of correction.
Better technology, better outcomes
New technologies being developed should make knee osteotomies easier to do and more accurate. While most orthopaedists rely on 2-D radiographs for osteotomies, MRI and CT scans can support better outcomes, Victor noted during his presentation.
He discussed a study he and his colleagues conducted using image-based navigation and patient-specific cutting blocks for osteotomies around the knee.
“The first 14 patients showed very good results and encouraging results on accuracy,” he said. “We evaluated the alignment to the coronal and intersectional plane. The correction is then virtually performed and a guide is designed in order to have the correct level and correct amount of correction for these patients.”
The patients who responded best to HTO were those with a constitutional varus, which means an overall coronal varus of more than 3.5°, and the operation provides the best outcomes if early mobilization is achieved, good fixation occurs and the patient is not a smoker.
Victor noted in his abstract that techniques that use image-based navigation or patient-specific cutting blocks can help guide the osteotomy and subsequent fixation to within 2° of accuracy. – by Robert Linnehan
- References:
- Victor J, et al. Bone Joint J. 2013;doi:10.1302/0301-620X.95B11.32950.
- Victor J. Paper #75. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 10-13, 2014; Orlando, Fla., USA.
- For more information:
- Jan Victor, MD, PhD, can be reached at the Department of Orthopedic Surgery and Traumatology at Ghent University Hospital, St. Pietersnieuwstraat 33, 9000 Gent, Belgium; email: jan.victor@ugent.be.
Disclosure: Victor reports the Department of Orthopaedics at Ghent University Hospital receives institutional support from Materialise.