Load distribution in early osteoarthritis

Abstract

Total knee replacement is an accepted standard of care for the treatment of advanced knee osteoarthritis with good results in the vast majority of older patients. The use in younger and more active populations, however, remains controversial due to concerns over activity restrictions, implant survival, and patient satisfaction with the procedure. It is in these younger patient populations that alternatives to arthroplasty are increasingly being explored. Historically, osteotomy was utilized to address unicompartmental pain from degeneration and overload, for example, after meniscectomy. Utilization rates of osteotomy have fallen in recent years due to the increasing popularity of partial and total knee arthroplasty. This article explores the indications and outcomes of traditional unloading osteotomy, as well as newer options that are less invasive and offer faster return to function.

Intraoperative validation of quantitative T2 mapping in patients with articular cartilage lesions of the knee

“…Moreover, targeted evaluation of cartilage before and after corrective osteotomy may also be viable with T2 mapping. Further treatment alternatives are being explored that could delay or even avoid the need for knee arthroplasty in younger active patients 34 . However, further evaluations are needed in order to determine 'cut-off values' for the reproducible assessment of cartilage status that could be used to define the appropriate time points for intervention and thus lead to improved treatment outcomes.…”

Two-Year Results of the PHANTOM High Flex Trial: A Single-Arm Study on the Atlas Unicompartmental Knee System Load Absorber in Patients With Medial Compartment Osteoarthritis of the Knee

“…Biologically, the loss of hyaline cartilage increases compartmental loading, which, in turn, leads to the presence of bone marrow lesions, inflamed synovium, development of osteophytes, and further structural damage. 2,7,8 This may also cause a redistribution of mechanical loads to other joint regions, including an overloaded medial compartment. 7 Conservative treatments for medial knee OA include lateral wedge insoles, unloader knee braces, and intra-articular injections (hyaluronic acid or corticosteroid).…”

“…3,4,13 The procedure is also contraindicated in those with malalignment based purely on degenerative changes. 8,15 Joint distraction has also been investigated, but the distraction fixator can cause discomfort, pin site infection, and osteomyelitis 2,15 ; in comparison, no infections occurred during this trial. A strength of this study was the strict eligibility criteria and rigorous protocol, which ensured that the sample included the targeted patient population and treatments effects could only beat tributed to the investigation device.…”

A Novel Implant System for Unloading the Medial Compartment of the Knee by Lateral Displacement of the Iliotibial Band

“…However, due to the invasiveness of the procedure, postsurgical complications (eg, bone nonunion, delayed union, and loss of alignment), and extended rehabilitation, it is not a commonly performed procedure. 12 Additionally, a high tibial osteotomy also increases the technical difficulty of performing a subsequent total knee replacement. 37 …”