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The Journal of Bone and Joint Surgery, Vol 72, Issue 6 905-909, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
The influence of walking mechanics and time on the results of proximal tibial osteotomy
JW Wang, KN Kuo, TP Andriacchi and JO Galante
Department of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
The current study describes the influence of the passage of time on the
original findings. The mechanisms used by some patients to reduce loading
at the knee (adduction moment) also were analyzed. We evaluated the gait of
twenty-seven patients (thirty-two knees) who had had a proximal tibial
osteotomy for a varus gonarthrosis. Twenty-four patients (twenty-eight
knees) returned for follow-up at three to 8.9 years after the osteotomy.
This is a follow-up to our original study (Prodromos et al.), which
described a relationship between the magnitude of the adduction moment at
the knee during walking and the outcome of proximal tibial osteotomy. The
patients were divided into low and high adduction-moment groups on the
basis of the magnitude of the adduction moment at the knee as measured
preoperatively during walking. All fourteen patients in the low
adduction-moment group and nine of the fourteen patients in the high
adduction-moment group had a good or excellent result. The varus deformity
recurred in ten patients in the high adduction-moment group and in three
patients in the low adduction-moment group. All of the results degenerated
over time. The adaptive mechanism that was used to lower the adduction
moment during gait included shortening the stride and toeing-out. The
significant correlation between the magnitudes of the inversion moment at
the ankle and the adduction moment at the knee suggested that the toe-out
gait reduced the adduction moment at the knee.(ABSTRACT TRUNCATED AT 250
WORDS)
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