Treatment options of Genovarum, Unicompartment Arthroplasty vs High Tibial Osteotomy H.Makhmalbaf MD. Knee surgeon Ghaem Hospital Medical School

Osteotomy about the knee Coventry :UTO for treatment of arthritis with associated limb malalign. Realignment osteotomy to transfer WB forces from the arthritic portion to a healthier location of the knee Redistribution of mechanical forces to increase the life span of the knee

The goals of osteotomy Pain relief Functional improvement Ability to meet heavy functional demands Careful patient selection Skillful surgical technique

Patient selection The ideal candidate for osteotomy is Thin active individual In the 5 th or 6 th decade of life With localized, activity-related Unicompartmental knee pain No PFJ OA

Patient selection A stable knee Full extension With flexion of at least 90 deg No narrowing of lateral compartment Medial bone loss less than 2-3mm

Patient selection: Historical Age : chronological, physiological Patient’s desired activity level Pain: location, character, PFJ ? Rhumatological status Prior menisectomy Infection history

Examination; Malalignment: magnitude, direction Prior incisions, body habitus ROM: total arc, flexion contracture Ligamentous deficiencies PF mechanics Adductor thrust

Radiological : Anatomic axis Mechanical axis Severity of OA Magnitude of deformity Tibiofemoral subluxation

Radiological: Status of other compartments Joint space opening Amount of articular cartilage loss CPPD, osseous defects Deformities away from the joint Joint line obliquity

Contraindications: Diffuse, nonspecific knee pain Patellofemoral pain primary complaint Moderate or severe lig. Instability Menisectomy in comp. intended for WB OA in: # # # # Underlying diag. Of inflammatory dis. No Good ROM

Counseling: Discuss all treatment alternatives No normal joint with TKA / Osteotomy Long term results, rehabilitation, pain relief & durability of TKA Or Osteotomy Longer post op. recovery after osteotomy Results of TKA after osteotomy

TKA vs Osteotomy Arthroplasty provides more complete pain relief & shorter rehab. Period & is more reliable than osteotomy in most individuals older than 60 yrs. Insall JN

Long Term Outcome of high Tibial Osteotomy A 10 to 20-year follow-up S. Akiziki et al. Japan JBJS 90 B May 2008 UTO is more accepted in Japan UTO & fixation with plate no POP 94 patients (118 knees) 16.4 yr follow-up Good result in 73.7% Risk factors: BMI> 27.5 & ROM<100

Unicompartment Arthroplasty Indications Unicompartment OA Good range of movement Ligament stability An intact ACL Normal PFJ

UKA vs UTO Higher initial success rate & Fewer early complications Could be done bilaterally at the same time Full recovery within 3 months With MIS techniques Less blood loss, less pain & Quicker recovery

Patient selection Osteotomy is the procedure of choice in young active male with unicomp.OA Pain during rest & poor ROM is a contraindication to UTO Subluxation & extreme angular deformity are contraindications to both UTO & UKR Ideal candidate for UKR are middle aged patients with OA

Advantages of UKR Reliable initial result Anatomic realignment Retention of both ligaments And easy salvage Quicker surgery, less blood loss Less expensive Decision should be made at surgery UKA or TKR

Unicompartment knee arthroplasty with Oxford prosthesis in patients with medial compartment arthritis H. Emerson Jr MD et al JBJS 90-A Jan 2008 / 55 patients Mobile bearing Oxford UKR optimizes PE wear Mechanical limb alignment without lig. Release Progression of OA in the lat. Compt., the most commen reason for final failure

Cementless Oxford UKR shows reduced radiolucency at one year H. Pandit et al Nuffield Orthopaedic Centre, Oxford, England JBJS B Feb patients / 62 knees 32 cemented, 30 cementless Radiolucency around the cementless tibial component diminishes at one year

Medial UKR in the under 50s S Parratte et al JBJS 91-B March 2009 France 35 knees, 31 patients 12 year survival was 80.6% The problems were PE wear Consider UKR to bridge the gap between UTO & TKR

The advantages of UKR over TKR Retention of the cruciate ligaments Preservation of bone stock And better functional results

What is being done? In the West : UK, USA In Iran My experience with UKR, UTO, TKR Young patients with deformity & no OA

UKR contraindications OA in other compartments of the knee Severe deformity Ligament instability Limitation of ROM RA

Complications of UKR Tibial component loosening PE wear OA of other compartments

Thank you