Abstract
High tibial osteotomy generally helps patients to postpone the TKA or even stay in peace for rest of their life, but sometimes these procedures enhance the process of osteoarthritis (1) several reasons like unhealthy lateral compartment of the knee or age or weight or concomitant debilitating diseases could be included in account.
In this study we focused on those patients that were selected properly with correct procedure but still shows the knee OA enhancement.
Hypothesis: probably bone bruise around the site of osteotomy as trauma of surgery can make a bad condition.
As a RCT study between 2 groups with different technique of osteotomy especially the distance of osteotomy site from the joint line of proximal tibia was our main reason to choose the different procedures.
We did a randomized clinical trial with not more than a year follow up and mostly emphasis in geometry of bone bruise around osteotomy site.
Group A: 50 knees, open wedge and plate technique.
Group B: reversed-v MIS the same 50 other knees (FM)
Method: All patient asked for MRI before and in 1st 10 days post surgery from their target knees.
Those with positive bone bruise sign before surgery were excluded. In post op MRIs we measured the geometry of bone bruise.
1- Our finding shows upward-downward length of bone bruise in MIS (F.M) reversed-v = 14–40 mm and in open wedge = 14–37 mm
Depth (Medial-lateral) and AP diameter almost the same.
2- To omit the bias of bone bruise around the open wedge technique we ignored this part.
Result and conclusion:
Group A: had 14 – 40 mm bone bruise that in 61% reached to sub chondral bone (distance of osteotomy's site from sub chondral bone).
Area was (17−4mm).
Group B: because of the distance of osteotomy site from joint line were 60–70 mm. in no one bone bruise was closer than 26mm to sub chondral bone.
So, our Iatrogenic bone bruise from joint line in reversed - v is in safer zone than open wedge and plating with p. value of 0.0001.
In future we need to follow our patients to be sure if bone bruise makes any hazard for the knees.
