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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2015

01-07-2015 | Knee

Valgus bracing in symptomatic varus malalignment for testing the expectable “unloading effect” following valgus high tibial osteotomy

Authors: Philipp Minzlaff, Tim Saier, Peter U. Brucker, Bernhard Haller, Andreas B. Imhoff, Stefan Hinterwimmer

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2015

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Abstract

Purpose

The purpose of this study was to evaluate whether the expectable postoperative pain relief following valgus high tibial osteotomy (HTO) is reliably predictable with the temporary use of an unloading knee brace preoperatively.

Methods

Fifty-seven patients with symptomatic varus malalignment were treated with a valgus producing unloading knee brace for 6–8 weeks. The pain intensity in the respective knee compartment was monitored using the visual analogue scale (VAS) before and following this treatment. A “positive” Brace-Test was defined as a pain relief medially without initiated symptoms laterally. In these cases, a valgus HTO was suggested as a promising surgical option. Patients who were subsequently operated were clinically re-evaluated 1 year postoperatively to compare the postoperative outcome with the result of the Brace-Test.

Results

The mean VAS score decreased from 6.7 [standard deviation (SD) 1.6] to 2.5 points (SD 1.7) (p < 0.001) following the Brace-Test. Overall, 48 patients had a positive test. A valgus HTO was performed in 29 of them. The mean postoperative VAS score was 1.9 (SD 1.7) points with no difference to the result of the test (n.s.). Nineteen patients with a positive test initially decided for a conservative treatment. In three of nine patients with a negative test, a total knee replacement was performed.

Conclusion

This study shows that the temporary use of an unloading valgus producing knee brace may well predict future outcome of HTO surgery in terms of expectable postoperative pain relief. The Brace-Test gives both the patient and the orthopaedic surgeon more detailed preoperative information, especially in critical or borderline indications. Thus, it is a useful tool to test the unloading effect before indicating an HTO.

Level of evidence

III.
Literature
1.
Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A (2003) High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg 16(1):21–26PubMed
2.
Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H (2008) The long-term outcome of high tibial osteotomy: a 10- to 20-year follow-up. J Bone Joint Surg Br 90(5):592–596PubMedCrossRef
3.
Baker K, Goggins J, Xie H, Szumowski K, LaValley M, Hunter DJ, Felson DT (2007) A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis Rheum 56(4):1198–1203PubMedCrossRef
4.
Braun S, Minzlaff P, Hollweck R, Wörtler K, Imhoff AB (2008) The 5.5-year results of MegaOATS–autologous transfer of the posterior femoral condyle: a case-series study. Arthritis Res Ther 10(3):R68PubMedCentralPubMedCrossRef
5.
Brinkman J-M, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg Br 90(12):1548–1557PubMedCrossRef
6.
Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RM, Reijman M, Pols HA, Bierma-Zeinstra SM (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56(4):1204–1211. doi:10.​1002/​art.​22515 PubMedCrossRef
7.
Brouwer RW, van Raaij TM, Verhaar JA, Coene LN, Bierma-Zeinstra SM (2006) Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. Osteoarthr Cartil 14(8):777–783PubMedCrossRef
8.
Cooke TD, Harrison L, Khan B, Scudamore A, Chaudhary MA (2002) Analysis of limb alignment in the pathogenesis of osteoarthritis: a comparison of Saudi Arabian and Canadian cases. Rheumatol Int 22(4):160–164PubMedCrossRef
9.
Dennis DA, Komistek RD, Nadaud MC, Mahfouz M (2006) Evaluation of off-loading braces for treatment of unicompartmental knee arthrosis. J Arthroplasty 21(4 Suppl 1):2–8PubMedCrossRef
10.
Fantini Pagani CH, Potthast W, Brüggemann G-P (2010) The effect of valgus bracing on the knee adduction moment during gait and running in male subjects with varus alignment. Clin Biomech 25:70–76 (Bristol, Avon)CrossRef
11.
Felson DT, Zhang Y (1998) An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum 41(8):1343–1355PubMedCrossRef
12.
Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P (2013) Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 21(1):170–180PubMedCrossRef
13.
Guillemin F, Rat AC, Mazieres B, Pouchot J, Fautrel B, Euller-Ziegler L, Fardellone P, Morvan J, Roux CH, Verrouil E, Saraux A, Coste J (2011) Prevalence of symptomatic hip and knee osteoarthritis: a two-phase population-based survey. Osteoarthr Cartil 19(11):1314–1322PubMedCrossRef
14.
Haladik JA, Vasileff WK, Peltz CD, Lock TR, Bey MJ (2013) Bracing improves clinical outcomes but does not affect the medial knee joint space in osteoarthritic patients during gait. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-013-2596-7 PubMed
15.
Hayes MHS, Patterson DG (1921) Experimental development of the graphic rating method. Psychol Bull 18:98–99
16.
Hinterwimmer S, Beitzel K, Paul J, Kirchhoff C, Sauerschnig M, von Eisenhart-Rothe R, Imhoff AB (2011) Control of posterior tibial slope and patellar height in open-wedge valgus high tibial osteotomy. Am J Sports Med 39(4):851–856PubMedCrossRef
17.
Horlick SG, Loomer RL (1993) Valgus knee bracing for medial gonarthrosis. Clin J Sport Med 3:251–255CrossRef
18.
Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, Chana R, Pinczewski LA (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39(1):64–70PubMedCrossRef
19.
20.
Kirkley A, Webster-Bogaert S, Litchfield R, Amendola A, MacDonald S, McCalden R, Fowler P (1999) The effect of bracing on varus gonarthrosis. J Bone Joint Surg Am 81(4):539–548PubMed
21.
Komistek RD, Dennis DA, Northcut EJ, Wood A, Parker AW, Traina SM (1999) An in vivo analysis of the effectiveness of the osteoarthritic knee brace during heel-strike of gait. J Arthroplasty 14(6):738–742PubMedCrossRef
22.
Krohn K (2005) Footwear alterations and bracing as treatments for knee osteoarthritis. Curr Opin Rheumatol 17(5):653–656PubMedCrossRef
23.
LaPrade RF, Spiridonov SI, Nystrom LM, Jansson KS (2012) Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthroscopy 28(3):354–364PubMedCrossRef
24.
Maillefert JF, Hudry C, Baron G, Kieffert P, Bourgeois P, Lechevalier D, Coutaux A, Dougados M (2001) Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study. Osteoarthr Cartil 9(8):738–745PubMedCrossRef
25.
Minzlaff P, Feucht MJ, Saier T, Schuster T, Braun S, Imhoff AB, Hinterwimmer S (2013) Osteochondral autologous transfer combined with valgus high tibial osteotomy: long-term results and survivorship analysis. Am J Sports Med 41(10):2325–2332PubMedCrossRef
26.
Müller M, Strecker W (2007) Arthroscopy prior to osteotomy around the knee? Arch Orthop Trauma Surg 128(11):1217–1221PubMedCrossRef
27.
Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757PubMed
28.
Pham T, Maillefert JF, Hudry C, Kieffert P, Bourgeois P, Lechevalier D, Dougados M (2004) Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis. A 2-year prospective randomized controlled study. Osteoarthr Cartil 12(1):46–55PubMedCrossRef
29.
Pollo FE (1998) Bracing and heel wedging for unicompartmental osteoarthritis of the knee. Am J Knee Surg 11(1):47–50PubMed
30.
Pollo FE, Jackson RW (2006) Knee bracing for unicompartmental osteoarthritis. J Am Acad Orthop Surg 14(1):5–11PubMed
31.
Pollo FE, Otis JC, Backus SI, Warren RF, Wickiewicz TL (2002) Reduction of medial compartment loads with valgus bracing of the osteoarthritic knee. Am J Sports Med 30(3):414–421PubMed
32.
Self BP, Greenwald RM, Pflaster DS (2000) A biomechanical analysis of a medial unloading brace for osteoarthritis in the knee. Arthritis Care Res 13(4):191–197PubMedCrossRef
33.
Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286(2):188–195PubMedCrossRef
34.
Waller C, Hayes D, Block JE, London NJ (2011) Unload it: the key to the treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19(11):1823–1829PubMedCrossRef
Metadata
Title
Valgus bracing in symptomatic varus malalignment for testing the expectable “unloading effect” following valgus high tibial osteotomy
Authors
Philipp Minzlaff
Tim Saier
Peter U. Brucker
Bernhard Haller
Andreas B. Imhoff
Stefan Hinterwimmer
Publication date
01-07-2015
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2832-1

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