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Intervention Review

Osteotomy for treating knee osteoarthritis

  1. Reinoud W. Brouwer1,*,
  2. Tom M van Raaij1,
  3. Sita MA Bierma-Zeinstra2,
  4. Arianne P Verhagen3,
  5. Tijs T.S.C. Jakma1,
  6. Jan AN Verhaar4

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 30 APR 2007

DOI: 10.1002/14651858.CD004019.pub3


How to Cite

Brouwer RW, van Raaij TM, Bierma-Zeinstra SMA, Verhagen AP, Jakma TT, Verhaar JAN. Osteotomy for treating knee osteoarthritis. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004019. DOI: 10.1002/14651858.CD004019.pub3.

Author Information

  1. 1

    Erasmus Medical Centre Rotterdam, Orthopaedic surgery, Rotterdam, Netherlands

  2. 2

    Erasmus University Medical Centre, Department of General Practice, Rotterdam, Netherlands

  3. 3

    Erasmus Medical Centre University, Department of General Practice, Rotterdam, Netherlands

  4. 4

    Erasmus MC, Orthopaedic Department, Rotterdam, Netherlands

*Reinoud W. Brouwer, Orthopaedic surgery, Erasmus Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, Netherlands. r.w.brouwer@mzh.nl ; rwbrouwer69@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Patients with unicompartmental osteoarthritis of the knee can be treated with a correction osteotomy. The goal of the correction osteotomy is to transfer the load bearing from the pathologic to the normal compartment of the knee. A successful outcome of the osteotomy relies on proper patient selection, stage of osteoarthritis, achievement and maintenance of adequate operative correction. This is an update of the original review published in Issue 1, 2005.

Objectives

To assess the effectiveness and safety of an osteotomy for treating osteoarthritis of the knee.

Search methods

Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE (Current contents, Health STAR) up to October 2002 in the original review and in the update until May 2007. Reference lists of identified trials were screened.

Selection criteria

Randomised and controlled clinical trials comparing a high tibial osteotomy or a distal femoral osteotomy in patients with unicompartmental osteoarthritis of the medial or lateral compartment of the knee.

Data collection and analysis

Two review authors independently selected trials, extracted data and assessed trial quality. Due to heterogeneity of the studies, pooling of outcome measures was not possible.

Main results

Thirteen studies involving over 693 people were included; 11 studies were included in the first version and two studies and one longer follow-up study were included in this update. All studies concerned a valgus high tibial osteotomy (HTO) for medial compartment osteoarthritis of the knee. Six studies, in which two studies were included in this update, compared two techniques of HTO. One study compared HTO alone versus HTO with additional treatment. Four studies compared within the same type of HTO, different peri-operative conditions (two studies) or two different types of post-operative treatment (two studies). Two studies, including the longer follow up, compared HTO with unicompartmental joint replacement. No study compared an osteotomy with conservative treatment.
Most studies showed improvement of the patient (less pain and improvement of function scores) after osteotomy surgery, but in the majority of the studies there was no significant difference with other operative treatment (other technique of HTO/ unicompartmental joint replacement). Overall, the methodological quality was low.

Authors' conclusions

Based on 13 studies, we conclude that there is 'silver' level evidence (www.cochranemsk.org) that valgus HTO improves knee function and reduces pain. There is no evidence whether an osteotomy is more effective than conservative treatment and the results so far do not justify a conclusion about effectiveness of specific surgical techniques.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Osteotomy for treating knee osteoarthritis

This summary of a Cochrane review presents what we know from research about the effect of an osteotomy for osteoarthritis of the knee. The review shows that:

In people with osteoarthritis of the inside of the knee,
- an osteotomy can improve pain and function
- it is not known which techniques are better and which should be used
- some osteotomy techniques may lead to more complications
- it is not known whether an osteotomy (valgus high tibial osteotomy) is better than no surgery at all
But there is not enough evidence to be certain of these results.

What is osteoarthritis of the knee and what is an osteotomy?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling and can change the alignment of joints.

There are three main types of surgery for osteoarthritis of the knee: a total knee replacement (arthroplasty), partial knee replacement (minimally invasive), and an osteotomy. An osteotomy is surgery in which the bones are cut and reshaped. An osteotomy changes the position of the knee so that the bones bear on an area of the knee that is not diseased. By 'unloading' the bear to a better part of the knee, it is thought that an osteotomy may decrease pain, improve function, slow damage in the knee, and possibly delay the need for partial or total knee replacement surgery.

What are the effects of an osteotomy?
The studies included in this review did not compare an osteotomy to no surgery at all. All of the studies tested a 'valgus high tibial osteotomy' (HTO) for osteoarthritis on the inside of the knee.

All studies showed that people had less pain and improved function in the knee 2 months to 7½ years after any type of HTO.

Some of the studies compared HTO to HTO with another procedure such as using a tourniquet, abrasion and overcorrection. Some compared HTO to HTO plus electromagnetic stimulation, and a plaster cast to a hinged-cast brace after surgery. Improvements in pain and function may not be any different between these different techniques. But there is not enough evidence to be certain.

Some studies also compared HTO to a partial knee replacement, the benefits may not be different between these surgeries. But there is not enough evidence to be certain.

When comparing HTO techniques with each other, some techniques may lead to complications, such as pin-track infections or more revisions when a total knee replacement is done in the future. But there is not enough evidence to be certain.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

截骨矯正術治療膝部退化性關節炎

單一腔室膝退化性關節炎可以截骨矯正術治療,目標為轉移負重由病側到正常腔室側。成功的截骨矯正術治療取決於適當選擇病人、退化性關節炎分期,維持及達到手術矯正。本文為2005第一期回顧之更新。

目標

研究截骨矯正術治療膝退化性關節炎的效果及安全性。

搜尋策略

搜尋包括Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE (Current contents, Health STAR) (直到2002年10月)。在這個更新中搜尋至2007年5月,同時審查所有試驗的參考文獻

選擇標準

所有隨機對照試驗及擬隨機對照試驗比較高位脛骨截骨矯正術或遠端股骨截骨術於內或外單一腔室退化性膝關節炎患者。

資料收集與分析

兩位作者使用預定條件獨立進行資料摘錄,並對每篇試驗研究的品質進行評估。因研究間有異質性無法進行統合分析。

主要結論

包括了13個研究含693例病患。前版的研究包括了11項研究,本次更新增加了2項研究及一項較長的追蹤研究,所有研究討論膝外翻高位脛骨截骨矯正術於內側腔室退化性膝關節炎患者。6篇研究包括了2項新的研究比較兩種高位脛骨截骨矯正術,1篇比較只做高位截骨矯正術與高位截骨矯正術加上另外治療。4篇比較同一種高位截骨矯正術,其中2篇手術中狀況不同,2篇術後治療不同。2篇包括較久追蹤,比較高位脛骨截骨矯正術與單側關節置換。無截骨矯正術與保守療法比較的研究。大部分研究顯示,截骨矯正術後改善疼痛及功能進步,但大多研究顯示與其它手術(其他高位脛骨截骨矯正技術或單側關節置換術)未有顯著差異。整體而言研究品質低。

作者結論

根據13個研究膝外翻高位脛骨截骨矯正術改善疼痛及功能﹝銀等級證據 www.cochranemsk.org﹞。未有證據顯示截骨矯正術比保守治療更有效,且無法結論何種手術方式較佳。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

截骨術治療膝退化性關節炎。此概要介紹了Cochran 回顧中我們所知道有關截骨術治療膝蓋退化性關節炎的效果。回顧表明:在退化性關節炎患者的膝關節內使用截骨術可以改善疼痛和功能,目前還不知道哪一種技術較好,哪一種術式應該被使用?有些截骨術可能導致更多的併發症,目前還不知道是否截骨術(外翻高位脛骨截骨)優於不開刀,但都沒有足夠的證據可以肯定這些成果。 什麼是膝蓋退化性關節炎,什麼是截骨術? 退化性關節炎(OA)是最常見的關節炎形式,會影響手,髖部,肩膀和膝蓋。在退化性關節炎OA患者,保護兩端的骨頭的軟骨破損,導致疼痛和腫脹,並且改變關節的排列。主要有三種類型的手術治療膝退化性關節炎:全膝關節置換術,部分膝關節置換術(微創),和截骨術。截骨術是一種外科手術,把骨切割和重塑。截骨術改變膝蓋的位置,讓膝蓋骨未患病的區域承受壓力。通過‘卸下’壓力到膝蓋較健康部份,截骨術被認為可減少疼痛,改善功能,延緩膝關節損傷,並可能拖延至需要部分或全膝關節置換手術的時間。 截骨術的效果如何? 在這次的回顧中的研究並沒有比較截骨術與不開刀。所有的研究測試了關節內退化性關節炎使用‘外翻脛骨高位截骨術’(HTO)。所有的研究表明,做完任何外翻高位脛骨截骨術(HTO)後,患者在2個月至7年內會減少疼痛和改善膝蓋功能。一些研究比較外翻高位脛骨截骨術(HTO)與外翻高位脛骨截骨術HTO加另一個步驟,如使用止血帶,磨除損和過度矯正過度。一些研究比較外翻高位脛骨截骨術(HTO)與外翻高位脛骨截骨術(HTO)加電磁刺激,以及術後使用石膏支架。但這些不同技術改善疼痛和功能的效果沒有不同。沒有足夠的證據能肯定結論。一些研究還比較了外翻高位脛骨截骨術(HTO)與部分膝關節置換術,發現這些手術間好處並沒有不同。但也沒有足夠的證據能肯定。當比較外翻高位脛骨截骨術(HTO)間彼此的優缺點,有些技術可能會引起併發症,如入外固定器感染或未來作全膝關節置換後需要更多再置換。但也沒有足夠的證據能肯定這些結論。