ABRASION ARTHROPLASTY WITH HIGH TIBIAL OSTEOTOMY
Abrasion Arthroplasty with High Tibial Osteotomy for treatment of severe osteoarthritis – a follow up subjective study.
Since 1980 we have started treatment of advanced osteoarthritis knee by abrasion under arthroscopic guidance. But since 1985 we have started the combination of Arthroscopic Abrasion Arthroplasty (AAA) and High Tibial Osteotomy (HTO).
Aim of the study
To present the follow up results of AAA and HTO performed to patients with advanced varus osteoarthritis knee; who are candidates for Total Knee Replacement (total knee replacement) or Unicompartmental Knee Replacement (UKR) Materials and methods
All patients in this study were those suffering from advanced (severe) knee joint varus osteoarthritis. The patients were of any age, any gender, and the most important point is that the patient must accept the 6-8 weeks non weight bearing rehabilitation program. The patient also my be obese (mild) but not morbid obesity. All our patients were candidate for artificial prosthesis (they mentioned they had already date for total knee replacement & total knee replacement), they search for an alternative to prosthesis.
Since 1985 till 2006 more than 1.500 patients with advanced osteoarthritis of the medial knee compartment; underwent AAA with HTO at the clinic of Dr Witwity, and Oxford score was sent to 946 patients till 2003 as we are concerning with patients more than three years following up-also some patients come for metal removal and second look also was included. The Oxford 12 points questionnaire is reliable and used by many surgeons to evaluate the patients with total knee replacement & UKR.509 patients sent their answers, 246 females and 263 males, 260 Lt knee, 249 Rt knee and 19 were bilateral. Average age 60 years (29 – 84 year).
Technique of the operation Arthroscopic Abrasion Arthroplasty with High Tibial Osteotomy done for all patients with grade IV chondromalacia and sclerotic lesion medial compartmental knee osteoarthritis (bare bone).
AAA is multiple tissue debridement procedure and it is consisted of Abrasion, which must be strictly intra-cortical, preserving the tide mark as a vital bearing zone for the expected newly formed fibrocartilage. Only 1-3 mm is abraded until the appearance of the superficial blood vessels which take the salt and pepper appearance (minute dark red tiny vessels against pale white background of abraded bone).
In few number patients Microfracture technique is done using special sharp knife to reach the deep cortical layers without disturbing the tide-mark line
Case presentation
Here are some patients arthroscopic photos taken during 2nd look arthroscopy during metal removal and the corresponding x-ray.
