Abrasion Arthroplasty with High Tibial Osteotomy

Abrasion Arthroplasty with High Tibial Osteotomy for
treatment of sever osteoarthritis – a follow up subjective
study.
Since 1980 we have started treatment of advanced osteoarthritis knee
by abrasion under arthroscopic guidance. But since 1985 we have started the
combination of Arthroscopic Abrasion Arthroplasty (AAA) and High Tibial
Osteotomy (HTO).
Aim of the study
To present the follow up results of AAA and HTO performed to patients
with advanced varus osteoarthritis knee; who are candidates for Total Knee
Replacement (TKR) or Unicompartmental Knee Replacement (UKR)
Materials and methods
All patients in this study were those suffering from advanced (severe)
knee joint varus osteoarthritis. The patients were of any age, any gender, and
the most important point is that the patient must accept the 6-8 weeks nonweight
bearing rehabilitation program. The patient also my be obese (mild) but
not morbid obesity. All our patient were candidate for artificial prosthesis (they
mentioned they had already date for TKR & UTKR), they search about an alternative
to prosthesis.
Since 1985 till 2006 more than 1.500 patients with advanced osteoarthritis
of medial knee compartment; underwent AAA with HTO at the clinic of Dr
Witwity, and Oxford score was sent to 946 patients till 2003 as we are concerning
with patients more than three years follow up-also some patient come for
metal removal and second look also was included. The Oxford 12 points questionnaire
is reliable and used by many surgeons to evaluate the patients with
TKR &UKR.509 patients sent their answers, 246 females and 263 males, 260
Lt knee, 249 Rt knee and 19 were bilateral. Average age 60 years (29 – 84
year).

Technique of the operation
Arthroscopic Abrasion Arthroplasty with High Tibial Osteotomy done
for all patients with grade IV chodromalacia and sclerotic lesion medial compartmental
knee osteoarthritis (bare bone).
AAA is multiple tissue debridement procedure and it is consisted of
Abrasion, which must be strictly intra-cortical, preserving the tide mark as a
vital bearing zone for the expected newly formed fibrocartlige. Only 1-3 mm is
abraded till the appearance of the superficial blood vessels which take the salt
and pepper appearance (minute dark red tinny vessels against pale white background
of abraded bone). In few number patients Micro-fracture technique is
done using special sharp knife to reach the deep cortical layers without disturbing
the tide-mark line