1 / 75

Operation of Arthritic Knee - HTO vs UKA -

Operation of Arthritic Knee - HTO vs UKA -. Beom Koo Lee, M.D. Dept. of Orthopaedic Surgery Gil Medical Center, Gachon University. Surgical Options for Mono-compartmental OA. Arthroscopic Debridedment Cartilage Transplantation Osteotomy UKA TKA.

maude
Download Presentation

Operation of Arthritic Knee - HTO vs UKA -

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Operation of Arthritic Knee- HTO vs UKA - Beom Koo Lee, M.D. Dept. of Orthopaedic Surgery Gil Medical Center, Gachon University

  2. Surgical Options for Mono-compartmental OA • Arthroscopic Debridedment • Cartilage Transplantation • Osteotomy • UKA • TKA

  3. Discussion Point to compare HTO vs UKA • Trend • Survival • Function • Kinematics • Indication & contraindication • Biologic aspect • Perioperative morbidity • Weight bearing, Rehabilitation, General Complication • Problem • Complication • Cosmetics • Technical Problem associated with TKA after Procedure

  4. Trend

  5. Trend of UKA • The early reported series of unicompartmental knee replacement done by experienced surgeons did not have encouraging results, with 70% survivorship reported at 5 to 7 years, and 65% and 53% survivorships reported at 11 and 12 years, respectively. Callahan, CORR, 2005

  6. Trend of UKA, Recently • However, more recently the reports of unicompartmental knee replacement have been more encouraging with 94% survivorship at 10 years and 90% survivorship at 18 years. Callahan, CORR, 2005

  7. Kinematics of UKA • The UKA preserve Normal Kinematics Patil, JBJS(Am), 2005

  8. Kinematics of UKA Patil, JBJS(Am), 2005

  9. Kinematics of UKA Patil, JBJS(Am), 2005

  10. Kinematic of UKA • Variable Femoral Roll Back Dennis, JBJS(Am), 2001

  11. Indications & Contraindications

  12. Ideal Indications of HTO • Young • Active • Male • Varus Deformity Mont, AAOS ICL, 2004

  13. Ideal Indications of UKA • Low Demand • Female • Elderly • No instability & Contracture • Correctable Deformity Mont, AAOS ICL, 2004

  14. Contraindications

  15. Range of Correction • UKA • Varus 10 - 20° • Valgus < 15° • Preferably 10° Pagnano, AAOS ICL, 2005 • osteotomy • Even Severe Deformity over 20 can be corrected by Dual Osteotomy. • Hanssen Insall 3rd edit

  16. T-F angle : Varus 14° Mechanical Axis : Varus 20°

  17. Lateral Instability • moderate to severe Lateral instability, and subluxation is contraindicated in HTO (Insall 3rd edit) • TKA is advisable in Great subluxation than UKA ( Insall 3rd edit) UKA is contraindicated for instability (ICL 2005) • Management in Mild Lateral Laxity in HTO • Slight Overcorrection • Reefing of LCL 배대경 • Spontaneous shortening 조세현

  18. ACL Instability in UKA • ACL insufficiency ; relative contraindication in UKA ICL 2005 • HTO can be done in ACL Deficiency Noyes, Am J Sports Med, 2000

  19. UKA in Elderly O’Rourke, CORR, 2005

  20. Summary of Indications • UKA는 HTO에비해 비교적 Deformity 정도가 적어야하고, Ligament가 Stable 해야한다. • UKA에서 80세 이상의 노인이나, 40대의 여성에서 유리하다. • HTO는 활동이 많은 젊은 나이에 유리하다.

  21. Survival

  22. Survival of UKA O’Rourke, CORR, 2005

  23. Survival of UKA Stukenborg, The Knee, 2001

  24. Survival of MIS-UKA • Despite an accelerated recovery and decreased hospital stay in our MIS-UKA, the rate of Revision due to aseptic loosening and the overall Reoperation rate compare to unfavorably with those performed with an open technique. Engh, J Arthroplasty, 2006

  25. Survival of HTO Insall & Scott, Surger of the Knee, 4th ed.

  26. Survival of HTO & UKA 배대경, 대한슬관절학회지, 2001 HTO UKA 배대경, 대한정형외과학회지, 2002

  27. Summary of Survival • 과교정된 HTO나 UKA는 결과가 비슷하다. • 젊은 나이에서는 UKA는 비교적 초기에 실패한다.

  28. Quality of Life

  29. Results of HTO vs UKA Broughton, JBJS(Br), 1986 UKA Results were signinficantly Better than HTO

  30. Function of HTO vs UKA Stukenborg, The Knee, 2001 Better Function in HTO

  31. Pain of HTO vs UKA Broughton, JBJS(Br), 1986

  32. Activity Level of HTO vs UKA Gillquist, CORR, 1991

  33. Activity after HTO • Manual Labor: 17/34 • Jumping Sport: 45-60% Nagel, JBJS(Am), 1996 Odenbring, Acta Ortho Scan, 1989

  34. ROM • HTO is better than UKA Koshino, APKS, 2006

  35. Kneeling • HTO is better than UKA Koshino, APKS, 2006

  36. Summary of Quality of Life • UKA에서 동통이 적으나, • 노동은 HTO에서 가능하다. • HTO에서 ROM이 더 좋고, Kneeling도 가능 하다.

  37. Biologic Aspect

  38. Cartilage Healing after HTO • Joint Space • Preop.: 1.8mm • 3 Yr F-up: 2.9mm 송은규, 대한슬관절학회지, 2002 • Joint Space (2Y F/U) • Koshino -Joint space ;pre-op 1.1mm post-op 2.3mm -Pattern No reg;13/146 pink and yellow fibrillation 2/143 Partial coverage 50/143 Full coverrage 16/143 13,86,47/146

  39. Pre-op Medial joint space narrowing Post-op 14 M Restored medial joint space

  40. Cartilage defect in tibia Cartilage defect in femur Pre-op Regenerated cartilage Healed cartilage Post-op

  41. Healed cartilage defect site POD 17 Months initial microfracture post-op 2 Yr POD 17 M

  42. Complications

  43. early perioperative complication after HTO vs UKA Broughton, JBJS(Br), 1986

  44. Early Cx after HTO • Infection • Patella baja • Intraarticular fracture • Peroneal nerve dysfunction • Compartment syndrome • Vascular injury

  45. DVT Case after HTO • Incidence : 41% Tuner, JBJS(Br), 1993

  46. Retained Cement after UKA • Engh, J Arthroplasty, 2006

  47. Rehabilitation • Easy in UKA • Faster Recovery Gillquist, CORR, 1991

  48. Summary of early perioperative course • UKA가 HTO에비해 Rehabilitation이 쉽고,, Peri- operative Complication 면에서 월등하다.

  49. Cosmesis

  50. Alignment • HTO : Overcorrection • UKA : Undercorrection

More Related