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Knee: R. W. Brouwer, S. M. A. Bierma-Zeinstra, T. M. van Raaij, and J. A. N. Verhaar Osteotomy for medial compartment arthritis of the knee using a closing wedge or an opening wedge controlled by a Puddu plate: A ONE-YEAR RANDOMISED, CONTROLLED STUDY J Bone Joint Surg Br 2006; 88-B: 1454-1459 [Abstract] [Full text] [PDF]

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Osteotomy for medial compartment arthritis of the knee

Alam M, David M Ricketts   (6 December 2006)

Osteotomy for medial compartment arthritis of the knee 6 December 2006
Alam M, SpR Orthopaedics & Trauma Princess Royal Hospital, Haywards Heath, UK, David M Ricketts Send letter to journal: Re: Osteotomy for medial compartment arthritis of the knee mahbubalam{at}doctors.org.uk Alam M, et al.	Sir, We read this paper with interest and we would like to make the following points: 1. Patient randomisation was described as being in ‘blocks of 16’. The exact randomisation method is not described. Did the authors mean that 16 closing-wedge osteotomies were performed followed by 16 opening-wedge operations? 2. The study involved four surgeons. Did the results of the individual surgeons differ in any way? 3. It is clinically difficult to predict which patients will have a poor result from the osteotomies described.1 In their study did the authors find any predictive factors for individual good or bad results? 4. Moderate overcorrection is desirable,1 with overcorrection of between 2 to 8 valgus to the mechanical axis being described as ideal.1-3 What was the evidence base for using the 4° valgus overcorrection, as opposed to a range, as the primary outcome of this study? 5. The overall complication rates were high. In the opening-wedge group the complication rate was 44/45 (98%). For the closing-wedge group it was 16/47 (34%). On this basis we would not perform these operations. M. Alam, Specialist Registrar Orthopaedic Surgery, D.M. Ricketts, Consultant Orthopaedic Surgeon, Princess Royal Hospital, Haywards Heath, UK. 1. Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE. High Tibial Osteotomy. J Am Acad Orthop Surg 2005;13:279-289. 2. Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy: a critical long-term study of eighty-seven cases. J Bone Joint Surg [Am] 1993;75:196-201. 3. Valenti JR, Calvo R, Lopez R, Canadell J. Long term evaluation of high tibial valgus osteotomy. Int Orthop 1990;14:347-9.