The Evaluation of External Fixator with Medial Open Wedge High Tibial Osteotomy in the Treatment of Medial Compartment Arthrosis

Öz

The patients diagnosed with medial compartment arthrosis were treated with high tibial osteotomy with circular external fixator and high tibial osteotomy with medial open wedge osteotomy in October 2003 and December 2011 in Gaziosmanpaşa University Medical Faculty Hospital, orthopedics and traumatology clinic are evaluated. The study consist of 66 knees of 64 patient. Patients treated with high tibial osteotomy with external fixator consist of Group 1. There are 31 knees of 29 patient (1 male, 28 female). Average age was 51.6 years (distribution: 42-61) in terms of the date of operation. High tibial osteotomy with external fixator was applied to 11 right knees and 20 left knees. Average length of follow-up after operation in Group 1 was 129.6 months (distribution: 70:156 months). Group 2 included the patients treated with high tibial osteotomy with medial open wedge osteotomy. 35 knees of 35 patients were subjected to surgery and the average age in terms of the date of operation 49,1 years (distribution: 37-61 years). Right knee of 15 patients and left knee of 20 patients were treated with high tibial osteotomy with medial open wedge osteotomy. Average length of follow-up after operation in Group 2 was 69.9 months (distribution: 60-96 months) Knee score in the analysis in Group 1 conducted according to HSS score, is 60.1 (distribution: 47-67) in average in pre-operation period. It is found out as 90.0 (distribution: 70-97) in post-operation period. Results as excellent for 30 (96,7%) of the knees and good for 1 (3.3%) of the knees were obtained. HSS score for Group 2 in pre-operation period was averagely 60.8 (distribution: 49-74). In post-operation period it was 87.3 (distribution:78-94) in average. Excellent results for 26 (74,2%) of the patients and good results for 9 (25,88%) of patients were obtained (p:0,03). According to KSS scoring, average knee score in Group 1 before operation 58,2 (distribution:48-68). After operation it was found out averagely 89,8 (distribution:83-95). Excellent results for 26(83.8%) of the patients and good results for 5 (16.2%) of the patients were obtained (p value:0,02). Average KSS functional score in pre-operation period was 56.9 (distribution:45-65) and it is found out averagely 90.4 (distribution:80-95) after operation. It was concluded with excellent results for 30 (96.7%) of the patients and good results for 1 (3.3%) of patients (p:0,02). Average knee score in Group 2 before the operation was 55.9 (distribution:48-68). It is found out as 86.9 (distribution:75-95) in post- operation period. It was concluded with excellent results for 24 (68.5%) of the patients and good results for 11 (31.5%) of patients. (p value: 0,01 p<0,05 significance level). KSS functional score was 61.4 (distribution:50-75) before the operation. And it is found out as 90 (distribution:80-100) after operation. It was concluded with excellent results for 34 (97.1%) of the patients and good results for 1 (2.9%) of patients (p:0,03). The most frequently encountered complications are infection and delay in healing. Pin site infection encountered in Group 1 treated with antibiotherapy. In group 2, infection was encountered for 5 patients and delay in healing was seen on 2 patients, and infection was treated with debridman andantibiotherapy, delay in healing was treated with grefonaj. The portion of the good and very good knees is 89,67% when all the patients are taken into consideration. It is possible to obtain successful results in patients with medial compartment arthrosis, in the long term with selection of patient correctly by taking into consideration the advantages and disadvantages of both technics.

Medial Kompartman Artrozu Tedavisinde Eksternal Fiksatör İle Medial Açık Kama Yüksek Tibial Osteotominin Değerlendirilmesi

Öz

Bu çalışmada Gaziosmanpaşa Üniversitesi Tıp Fakültesi Hastanesi Ortopedi ve Travmatoloji Kliniğinde Ekim 2003 ve Aralık 2011 tarihleri arasında medial kompartman artrozu tanısı ile sirküler eksternal fiksatörle yüksek tibial osteotomi ve medial açık kama osteotomi ile yüksek tibial osteotomi yapılan hastalar değerlendirilmiştir. Toplam 64 hastanın 66 dizi çalışmaya alınmıştır. Eksternal fiksatör ile yüksek tibial osteotomi yapılan hastalar Grup 1’i oluşturdu. Bu grupta 29 hastanın 31 dizi (1 erkek, 28 kadın)  mevcut idi. Ameliyat tarihindeki ortalama yaş; 51.6 yıl(dağılım:42-61 yıl) idi. 11 sağ dize, 20 sol dize eksternal fiksatör ile yüksek tibial osteotomi uygulandı. Grup 1’de ameliyat sonrası ortalama takip süresi 129.6 ay (dağılım:70-156 ay) idi.

Grup 2 ise medial açık kama osteotomisi ile yüksek tibial osteotomi yapılan hastalardan oluşturuldu. 35 hastanın 35 dizi ameliyat edildi ve ameliyat tarihindeki ortalama yaş; 49.1 yıl  (dağılım:37-61 yıl) idi. 15 hastanın sağ dizi 20 hastanın sol dizine medial açık kama osteotomisi ile yüksek tibial osteotomi uygulandı. Grup 2’de ameliyat sonrası ortalama takip süresi ise 69.9 ay (dağılım:60-96 ay) idi.

Grup 1’de HSS skoruna göre yapılan değerlendirmede diz skoru, ameliyat öncesi dönemde ortalama 60.1 (dağılım:44-67) idi. Ameliyat sonrası dönemde ise ortalama 90.0 (dağılım:70- 97) olarak bulundu. Dizlerin 30’unda (%96,7) mükemmel, birinde (%3.3) ise iyi sonuç elde edildi. Grup 2’de ameliyat öncesi dönemde HSS skoru ortalama 60.8 (dağılım:49-74) idi. Ameliyat sonrası dönemde ise ortalama 87.3 (dağılım:78-94) olarak bulundu. Hastaların 26’sında (%74,2) mükemmel, 9’unda (%25,88) iyi sonuç elde edildi (p:0,03)

KSS skorlamasına göre yapılan değerlendirmede grup 1’de ameliyat öncesi ortalama diz skoru 58,2 (dağılım:48-68) idi. Ameliyat sonrası dönemde ise ortalama 89,8 (dağılım:83-95) olarak bulundu. Hastaların 26’ünde (%83.8) mükemmel, 5’sinde(%16.2) iyi sonuç elde edildi (p:0,02).  KSS fonksiyonel skoru, ameliyat öncesi dönemde ortalama 56.9 (dağılım:45-65) idi. Ameliyat sonrası dönemde ise ortalama 90.4 (dağılım:80-95) olarak bulundu. Hastaların 30’ünde (%96.7) mükemmel, 1’sinde(%3.3) iyi sonuç elde edildi (p:0,02). 

Grup 2’de ameliyat öncesi dönemde ortalama diz skoru 55.9 (dağılım:48-68) idi. Ameliyat sonrası dönemde ise ortalama 86.9 (dağılım:75-95) olarak bulundu. Hastaların 24’ünde (%68.5) mükemmel, 11’inde (%31.5) iyi sonuç elde edildi (p:0,01). KSS fonksiyonel skoru, ameliyat öncesi dönemde ortalama 61.4 (dağılım:50-75) idi. Ameliyat sonrası dönemde ise ortalama 90 (dağılım:80-100) olarak bulundu. Hastaların 34’ünde (%97.1) mükemmel, 1’inde (%2.9) iyi sonuç elde edildi (p:0,03).

En sık karşılan komplikasyonlar enfeksiyon ve kaynama gecikmesiydi. Grup 1’de pin dibi enfeksiyonu görülürken antibiyoterapi ile tedavi edilmiştir. Grup 2’de ise 5 hastada enfeksiyon ve 2 hastada kaynama gecikmesi görülmüş; enfeksiyon debritman ve antibiyoterapi ile tedavi edilirlen kaynama gecikmesi grefonajla tedavi edilmiştir.

Tüm hastalar dikkate alındığında iyi ve çok iyi dizlerin oranı %89,67’dir. Medial kompartman artrozu olan hastalarda her iki tekniğin avantaj ve dezavantajları göz önünde bulundurularak uygun hasta seçimi ile birlikte uzun dönemde başarılı sonuçlar elde etmek mümkündür.

Anahtar Kelimeler

• medial kompartman artrozu

Kaynakça

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