Unicompartmental Osteoarthritis of the Knee: Diagnosis and Treatment of Malalignment

Osteoarthritis (OA) of the knee is a common medical condition that is often seen in general practice and causes considerable pain and immobility. In the United States, approximately 6% of the population aged 30 years and older and 12% of the population aged 65 years and older suffer from knee osteoarthritis.1 In addition to the consequences for the patient, osteoarthritis forms a considerable burden for society because of its chronic course and the high costs of interventions.2 In the Netherlands 1% of the total medical costs is spent on osteoarthritis.3 Osteoarthritis of the entire knee is distinguished from osteoarthritis of one compartment, which is generally caused by a mechanical problem.4 The mechanical axis of a straight leg is defined as a line passing from the centre of the hip, through the centre of the knee to the centre of the ankle.5 Patients with osteoarthritis of the medial compartment often have varus alignment, and the mechanical axis and load bearing pass through the medial compartment (=genu varum arthroticum). Patients with osteoarthritis of the lateral compartment often have a valgus alignment, and the mechanical axis and load bearing pass through the lateral compartment (genu valgum arthroticum). Axial malalignment (varus or valgus alignment) increases the risk for progression of knee osteoarthritis and predicts a decline in physical function.6 Besides the usual treatment for osteoarthritis, specific interventions for unicompartmental knee osteoarthritis include conservative interventions e.g. (knee braces and foot/ ankle orthoses) as well as surgical treatments (e.g. a correction osteotomy to reduce load of the osteoarthritic compartment of the knee).7-15 The anterior-posterior whole leg radiograph (WLR) is considered the gold standard for determining axial alignment and serves as the basis for planning a knee osteotomy in patients with osteoarthritis. In many studies the WLR has been made in standing position, whereas others have preferred the supine position.13,14,16,1

Femoral revision surgery with impaction bone grafting

The purpose of this prospective study was to evaluate the long-term clinical and radiological outcomes of revision of the femoral component of a total hip replacement using impaction bone grafting. Femoral revision with an impacted allograft was performed on 29 patients (31 hips). In all, 21 hips (68%) had grade III or IV femoral defects according to the Endo-Klinik classification. A total of 11 patients (12 hips) died before the ten-year follow-up period. Of the remaining patients, 18 patients (19 hips) were followed for 10 to 15 years; three further patients died during this time. None of the 31 stems underwent further revision of their stem. However, four stems showed extensive subsidence (> 15 mm). One of these patients had a femoral fracture that required fixation. Three other patients had a femoral fracture, two of which required fixation and the other was treated conservatively. Patients with a femoral fracture and/or severe subsidence had significantly more grade IV defects (six of seven hips; p = 0.004). One patient needed a closed reduction for dislocation. Impaction allografting in revision hip surgery gives good long-term results for femora with grades I

Stimuleren van Groene Groei. Verkenning van initiatieven voor circulaire en emissiearme economie

Het Kabinet heeft in 2013 een groene groeistrategie geformuleerd. In opdracht van het ministerie van Economische Zaken (EZ) heeft het LEI een onderzoek uitgevoerd om de kansen en belemmeringen voor vergroening voor enkele voorbeelden uit te werken. De volgende drie casussen zijn uitgewerkt: energiebesparing en decentrale opwekking van hernieuwbare elektriciteit; verduurzaming van en hergebruik in de katoenketen; vergroening als voorwaarde voor groei in de zuivelsector

Future Environments for Europe: Some Implications of Alternative Development Paths

This study analyzes eleven European environmental policy "dilemmas" for four alternative socioeconomic development pathways to the year 2030. The dilemmas include problems associated with: water management, soil acidification, forestry wood supply, marginalized land, sea level rise, coastal problems, chemical "time bombs", non-point source toxic materials, transport growth, urbanization, and summer oxidant episodes

L'environnement futur en Europe de l'ést et de l'ouest: Consequences de divers scénarios de développement

This study analyzes eleven European environmental policy "dilemmas" for four alternative socioeconomic development pathways to the year 2030. The dilemmas include problems associated with: water management, soil acidification, forestry wood supply, marginalized land, sea level rise, coastal problems, chemical "time bombs", non-point source toxic materials, transport growth, urbanization, and summer oxidant episodes

Is a high tibial osteotomy (HTO) superior to non-surgical treatment in patients with varus malaligned medial knee osteoarthritis (OA)?

Objective: No randomized controlled trial (RCT) has compared the high tibial osteotomy (HTO) with non-surgical treatment in patients with medial knee osteoarthritis (OA) and varus malalignment. The aim was to compare the effectiveness of an unloader brace treatment or a usual care program to the HTO regarding pain severity and knee function. Design: Surgical treatment (HTO) to two non-surgical options was compared by combining the data of two RCTs. One RCT (n = 117) compared an unloader brace to usual care treatment; the other RCT (n = 92) compared closing to opening wedge HTO. One-to-many propensity score matching was used to equalize patient characteristics. We compared clinical outcome at 1 year follow-up (VAS pain (0-10) and knee function (HSS, 0-100)) with mixed model analysis. Results: Propensity score matching resulted in a comparison of 30 brace patient with 83 HTO patients, and of 28 usual care patients with 71 HTO patients. Pain at 1 year after HTO (VAS 3.8) was lower than after valgus bracing (VAS 5.0) with a mean difference of -1.1 (95% CI -2.2; -0.1). Function showed a nonsignificant mean difference of 2.1 [95% CI -3.1; 7.3]. Comparing HTO to usual care a difference was seen in pain (-1.7 [95% CI -2.8; -0.6]) and function (6.6 [95% CI 0.2; 13.1])

No difference in 1-year improvement of patient-reported physical functioning and pain between resurfaced and unresurfaced patellae: analysis of 17,224 primary total knee arthroplasties in the Dutch Arthroplasty Register

Background and purpose - Whether or not to resurface the patella during primary total knee arthroplasty (TKA) remains controversial. We aimed to investigate the asso-ciation between patellar resurfacing and patient-reported outcome measure (PROM) improvement 1 year postopera-tively in terms of physical functioning and pain following TKA. Patients and methods - We performed an observa-tional study using the Dutch Arthroplasty Register on pro-spectively collected PROM data (n = 17,224, years 2014- 2019). Preoperative and 1-year PROM pain scores (NRS at rest; during activity) and physical functioning scores (KOOS-PS, OKS) were examined. Stratification was per-formed for cruciate-retaining (CR) and posterior-stabilized (PS) and for the 4 most frequently used TKA implants in the Netherlands (Nexgen, Genesis II, PFC/Sigma, Vanguard) using multivariable linear regression adjusting for age, ASA classification, preoperative general health (EQ VAS), and preoperative PROMs. Results - 4,525 resurfaced and 12,699 unresurfaced patellae in TKA were analyzed. Overall, no significant differ-ence in 1-year PROM improvement was found between the 2 groups. In CR TKAs, resurfacing resulted in less improve-ment in KOOS-PS and OKS (adjusted difference between groups (B) -1.68, 95% confidence interval (CI) -2.86 to -0.50 and B -0.94, CI -1.57 to -0.31. Fewer improvements for patellar resurfacing in TKA were found for the Genesis TKA on NRS pain at rest (B -0.23, CI-0.40 to -0.06) and Oxford knee score (B -1.61, CI -2.24 to -0.98). Conclusion - No significant differences were found in 1-year improvement of physical functioning and pain between TKA with resurfaced and unresurfaced patellae.Orthopaedics, Trauma Surgery and Rehabilitatio