The Historical Background of Transosseous Osteosynthesis. Authors; Possibilités données par le fixateur externe d’Hoffmann Das Verhalten der.
By continuing to browse this site you agree to us using cookies as described in About Cookies. Patients with unicompartmental osteoarthritis of the knee can be treated with an osteotomy. The goal of an osteotomy is to unload the diseased compartment of the knee. This is the second update of the original review published in The Cochrane LibraryIssue 1, To assess the benefits and harms of an osteotomy for treating patients with knee osteoarthritis, including the following main outcomes scores: Randomised and controlled clinical trials comparing an osteotomy with other treatments for Thrombophlebitis an der Ilizarov Fixateur with unicompartmental osteoarthritis of the knee.
Two review authors independently selected trials, extracted data and assessed risk of bias using the domains recommended in the 'Risk of bias' tool of The Cochrane Collaboration. Eight new studies were included in this update, for a total of 21 included studies involving people.
In four studies, the randomised sequence was adequately generated Thrombophlebitis an der Ilizarov Fixateur clearly described. In eight studies, allocation concealment was adequately generated and described. In four studies, the blinding procedures were sufficient. In six studies, incomplete outcome data were not adequately addressed. Furthermore, in 11 studies, the selective outcome reporting item was unclear because no study protocol was provided.
Follow-up of studies comparing different osteotomy techniques was too short to measure treatment failure, which implicates revision to a knee arthroplasty. No data on health-related quality of life and mortality were presented. Serious adverse events were reported in only four studies and were not significantly different low-quality evidence between groups.
The reoperation rate were scored as early hardware removal because of pain and pin track infection due to the external fixator. Risk of reoperation was 2. The quality of evidence for most outcomes comparing different osteotomy techniques was downgraded to low because of the numbers of available studies, the numbers of participants and limitations in design.
Two studies compared high tibial osteotomy versus unicompartmental knee replacement. Treatment failure and pain and function scores were not different between groups after a mean follow-up of 7. The osteotomy group reported more adverse events when compared with the unicompartmental knee replacement group, but the difference was not statistically significant. Ten included studies compared differences in perioperative or postoperative conditions after high tibial osteotomy.
In most of these studies, no statistically significant differences in outcomes were noted between groups. The conclusion of this update did not change: Valgus high tibial osteotomy reduces pain and improves knee function in patients with medial compartmental osteoarthritis of the knee. However, this conclusion is based on within-group comparisons, not on non-operative controls. No evidence suggests differences between different osteotomy techniques.
No evidence shows whether an osteotomy is more effective than alternative surgical treatment such as unicompartmental knee replacement or non-operative treatment. So far, the results of this updated review do not justify a conclusion on benefit of specific high tibial osteotomy technique for knee osteoarthritis. Researchers from The Cochrane Collaboration conducted a review of the effects of an osteotomy in people with osteoarthritis of the knee, Thrombophlebitis an der Ilizarov Fixateur.
Upon searching for all relevant studies until Novemberthey found 21 studies that included up to people. Their findings are summarised below. What is osteoarthritis of the knee, and what is an osteotomy? Osteoarthritis OA is a disease of the joints, such as the knee or the hip. When the joint loses cartilage, the bone grows to try to repair the damage.
Instead of making things better, however, the bone grows abnormally and makes things worse. For example, the bone can become misshapen, and this can make the joint painful and unstable. This can affect physical function or ability to use the knee. Two main types of surgery are used to treat patients with osteoarthritis of the knee: Osteotomy is surgery in which the bones are cut and realigned.
Osteotomy around the knee changes the alignment of the knee. Weight bearing will be shifted from the diseased part to a healthy part of the knee. By 'unloading' the damaged cartilage of the knee, osteotomy may decrease pain, improve function, slow knee deterioration and possibly delay the need for partial or total knee replacement surgery.
What happens to people after an osteotomy for knee osteoarthritis? Follow-up of all studies was too short to allow scoring of treatment failure; this refers to a revision to a knee replacement. In all studies, people reported less pain and improved knee function and quality of life after any type of high tibial osteotomy. However this comparison is based on differences before and after an osteotomy, not on comparison with non-operative treatment, Thrombophlebitis an der Ilizarov Fixateur.
Probably no differences in pain and function scores are noted between different osteotomy Thrombophlebitis an der Ilizarov Fixateur. The most important reasons for reoperation include hardware removal resulting from pain and pin track infection due to the external fixator.
This reoperation rate may be higher in patients undergoing another high tibial osteotomy technique compared with those treated with the closing wedge technique. Two studies compared high tibial osteotomy versus partial knee replacement.
Benefits did not differ between these types of surgery. L'arthrose est une maladie des articulations comme le genou ou la hanche. Summary of findings 2 Closing wedge high tibial osteotomy CW-HTO compared with unicompartmental knee arthroplasty for people with knee osteoarthritis.
Osteoarthritis has a major impact on functioning and independence and ranks among the top 10 causes of disability worldwide Badley ; Murray Osteoarthritis of the knee is defined as a multi-factorial disease that may result from both biological and mechanical events.
Osteoarthritis of the entire knee is distinguished from osteoarthritis of one compartment Grelsamerwhich generally is caused by a mechanical problem Tetsworth The mechanical axis of a straight leg is a line passing from the centre of the hip, through the centre of the knee, to the centre of the ankle Phillips Patients with osteoarthritis of the medial compartment often have varus alignment, and the mechanical axis and load bearing pass through the medial compartment.
Patients with osteoarthritis of the lateral compartment often have a valgus alignment, Thrombophlebitis an der Ilizarov Fixateur, and the mechanical axis and load bearing pass through the lateral compartment. The medial compartment is almost 10 times more frequently involved than the lateral compartment. Moreover, varus but not valgus alignment increases the risk of incident tibiofemoral osteoarthritis Brouwer ; Sharma Both varus malalignment and valgus malalignment increase the progression of knee osteoarthritis and predict declines in Thrombophlebitis an der Ilizarov Fixateur function Sharma Patients with unicompartmental osteoarthritis of the knee not reacting to non-active interventions such as standard care including physiotherapy Anandacoomarasamy ; Fransen ; Knoop ; Wangor to active non-operative control interventions such as corrective insoles and braces Brouwer 2intra-articular injection of hyaluronic acid Berenbaum ; Strand or autologous platelet-rich plasma Cerzaor both, Thrombophlebitis an der Ilizarov Fixateur, can be treated with a correction osteotomy Aglietti ; Coventry ; Edgerton ; Naudie Alternative surgical treatment for patients with unicompartmental knee osteoarthritis in the standard orthopaedic clinic depends on the degree of osteoarthritis, Thrombophlebitis an der Ilizarov Fixateur.
In cases of early-stage osteoarthritis, arthroscopic debridement of the knee is frequently performed Thrombophlebitis an der Ilizarov Fixateur ; Steadman In cases of moderate or severe osteoarthritis, Thrombophlebitis an der Ilizarov Fixateur, unicompartmental or total knee replacement is the preferred treatment option. Cartilage repair surgery such as autologous cartilage implementation, microfracture and an osteochondral autograft transfer system nowadays is possible only when a focal cartilage defect is present in one of the knee compartments, especially on the femoral site Vasiliadis ; Vavken An osteotomy is a surgical procedure, which implies that the bone is cut, Thrombophlebitis an der Ilizarov Fixateur.
A correction osteotomy at the knee is used to realign the leg and to transfer the weight-bearing axis from the pathological compartment to the healthy compartment. Patients with osteoarthritis of the medial compartment and varus alignment can be treated with a valgus osteotomy, and those with osteoarthritis of the lateral compartment and valgus alignment with varus osteotomy. Several correction osteotomy techniques are available for unicompartmental knee osteoarthritis such as the closing wedge technique with removal of a wedge of bone, the opening wedge technique with creation of a wedge, a combined opening and closing wedge technique and techniques that are performed without creating a wedge in the bone, including dome osteotomy and hemicallotasis osteotomy with an external fixator Brouwer ; Gaasbeek ; Magyar a ; Nakamura ; Papp The correction osteotomy for knee osteoarthritis is performed at the proximal tibia or the distal femur.
The choice of osteotomy technique and the level of the osteotomy depend on the degree and location of malalignment and the experience of the surgeon in performing one or more of these techniques. A correction osteotomy will change the alignment of the affected leg with unloading of the osteoarthritic compartment of the knee. Unloading will result in slowing down of the osteoarthritis process. In retrospective studies, this procedure resulted in pain relief, improved function and postponement of knee arthroplasty for seven to 20 years, Thrombophlebitis an der Ilizarov Fixateur, depending on participant selection, Thrombophlebitis an der Ilizarov Fixateur, stage of osteoarthritis and achievement and maintenance of adequate operative correction Berman ; Brouwer 2 ; Cameron ; Finkelstein ; Hernigou ; Mathews ; Naudie ; Raaij ; Rudan Literature suggests Thrombophlebitis an der Ilizarov Fixateur a correction osteotomy for unicompartmental knee osteoarthritis leads to good results, but many surgical techniques are available.
Moreover, a few important surgical alternatives such as intra-articular cartilage repair Thrombophlebitis an der Ilizarov Fixateur for early-stage osteoarthritis and unicompartmental knee arthroplasty for end-stage osteoarthritis may be selected Bouwmeester ; Broughton ; Stukenborg It is unclear which of these treatment options is superior.
Randomised controlled trials RCTs and controlled clinical trials CCTs investigating all types of osteotomy for treatment of osteoarthritis of the knee compared with other surgical and non-operative treatment modalities. All types of osteotomy around the knee for patients with unicompartmental osteoarthritis of the knee were compared with inactive control interventions i.
Thrombophlebitis an der Ilizarov Fixateur comparing one technique of osteotomy versus different perioperative conditions or versus different types of postoperative treatment were also included. Serious adverse events, neurovascular complications e. Adverse effects resulting from anatomical changes after high tibial osteotomy, including patellar descent and tibial plateau slope change, which may influence results of future total knee arthroplasty, and adverse effects resulting from use of an external fixator, including local pin track infection.
Other minor outcomes, including visual analogue scale VAS score satisfaction, Patient Global Assessment, Thrombophlebitis an der Ilizarov Fixateur imaging, walking distance, range of motion ROMThrombophlebitis an der Ilizarov Fixateur, collateral laxity and walking distance. The search strategy search date, 5 November yielded a total Ursache für Krampfadern Bein records from the following databases: After duplicates were removed, records remained.
We applied no language restrictions. Two review authors selected the trials, initially on the basis of title and abstract. Title, keywords and abstract were assessed to establish whether the study met the inclusion criteria regarding diagnosis, design and intervention.
For each selected study, the full article was retrieved for final assessment. Next, two review authors independently performed a final selection of trials for inclusion in the review, using a pretested standardised form. Disagreements on inclusion were resolved by discussion, Thrombophlebitis an der Ilizarov Fixateur, and the final decision of a third review author was not necessary.
Three review authors independently extracted data on the intervention, types of outcome measures, follow-up, loss to follow-up and outcomes, using a pretested standardised form. Various outcome measures are presented separately. The Cochrane Collaboration recommends a specific tool for assessing risk of bias in each included study.
This comprises a judgement and a support for each judgement in a 'Risk of bias' table, in which each entry addresses a specific feature of the study.
Thrombophlebitis an der Ilizarov Fixateur Thrombophlebitis an der Ilizarov Fixateur
To make matters Beschreibung von Krampfadern, protracted delays in healing compromise the function of the limb, thereby disabling the patient permanently.
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The Historical Background of Transosseous Osteosynthesis. Authors; Possibilités données par le fixateur externe d’Hoffmann Das Verhalten der.
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