Iranian Journal of Orthopedic Surgery

Abstract Introduction:
Genu varum is a type of knee deformity. In this deformity lower limb mechanical axis, moves inward to the knee centre. In genu varum mechanical axis usually lies through the medial of the knee joint. In this deformity, the patient's lower limbs become bow shape. One of the best techniques for genu varum correction is high tibial osteotomy that this procedure can change some index include posterior tibial slope (PTS), and insall-salvati index (ISI).
Method:
Our study was a cross-sectional study performed on patients with genu varum before and after a step cut of the high tibia osteotomy. The method of examining the posterior tibia slope was that before and after the high tibia osteotomy by Step Cut-MCL sparing method, a simple radiographic image in true lateral view (True lateral) was taken from the knee of patients. The significance level of P Value <0.05 was considered.
Result:
In this study 21 patients ( 11 male and 10 female ) were enrolled. Mean age was 36.19 ± 10.17 year-old. Mean PTS pre operation was 11.48 ± 1.94 degrees and post operation was 11.48 ± 2.15 degrees.
Conclusion:
In our study, PTS increased after HTO that this increase was not statistically significant difference between men and women. In addition, we showed that this increase did not have significant relationship with age and BMI. In the present study, Insall-Salvati index showed no significant difference before and after the treatment.

Abstract Background: Knee arthroplasty has been traditionally based on mechanical alignment restoration. In the newer, “Kinematically aligned knee replacement”, the eroded bone and joint surfaces in addition to saw-blade thickness are removed and replaced by the components. This study compared the results of two techniques of knee arthroplasty. Methods: In a clinical trial study, 90 patients who were candidates for knee arthroplasty were divided into 2 groups: 45 cases received knee arthroplasty by “mechanically aligned” and 45 by “Kinematically aligned” technique. The two groups were compared after 1 year by Lysholm score, hospitalization period, subjective satisfaction, and period of need for ambulatory aid. Results: 73 patients referred for follow up: 37 patients in the kinematic and 36 in the mechanical group. The mean hemoglobin drop was not significantly different between the two kinematic and mechanical groups; while the post operation mean hemoglobin drop difference was significant (p < /em>=.001). No significant difference in the patient satisfaction of the operation was observed between two groups. The difference of mean Lyshlom score was different between two groups (p < /em>=.000). Conclusions: kinematically aligned” knee replacement is associated with less pain, earlier return to daily activity, lesser intra operative bleeding and more patient satisfaction.

Abstract   Hihg tibia osteotomy has its own position even with successful total knee replacement. A high tibial osteotomy affects not only the joint function as a whole, but also the dyferent sections of the knee joint. The biomechanical changes affect the patella inedial collateral ligament, quadriceps alignment and Q-angle and tibial plateau slope. The goal of high tibia osteotomy is more normal load distribution in nonarthritic knee in young persons, and slowing degeneration in arthritic knee in adults. All the high tibia osteotomies cause patellofemoral biomechanical changes, through tubercle displacement, or patellar tendon fibrosis or calcification. Q angle also increase with lateral displacement of tibial tuberosity when osteotomy is done proximal to the tibial tuberosity. The medial collateral ligament needs to be released in open wedge high tibia osteotiomy. If intact medial ligament is necessary, osteotomy should be done distal to medial collateral attachment. The proximal tibia configuration is roughly similar to a rectangle. Lateral cortex is in right angle to the posterior one. The posteromedial corner opens three times the anterior one in open wedge osteotomy otherwise there would be tibial slope change.

Abstract Background: Knee replacement is one of the final remedies for severe, symptomatic knee destruction. The results of this surgery are usually excellent. The number of reports from Iran on this subject is very few. We would like to report our experience with knee replacement in Kerman.Methods: In a clinical trial and prospective study, 54 patients (11 males, 43 females) with knee disease who underwent joint replacement from 2001 to 2006 in a Teaching hospital in Kerman, were studied. Mean age was 65 years (41-80) and mean follow-up 34.4 months (3 months to 5 years). 46 cases had osteoarthritis and 8 rheumatoid arthritis. The pre and post operative findings were assessed using the ‘Knee Society’ evaluation system. The opposite knees were used to compare the patients’ satisfaction from the procedure.Results: In a study on 54 cases, the pain score of ‘Knee Society’ improved from 33 to 77 and the functional score improved from 41 to 72. Ninety six percent of the cases were satisfied with their surgeries. The complications included 1 deep and 1 superficial infection, 2 wound healing problem and one patellar dislocation. Three revisions become necessary: 2 due to infection, one for loosening and deformity in tibial component.Conclusions: Knee replacement in Kerman is associated with high satisfaction rate in short-term. Early failure is mostly related to infection or technical errors in surgery.