Osteotomy of proximal Tibia:
An osteotomy of proximal tibia for OA knee involves cutting the bone precisely and then correcting the alignment. The goal is to shift the patient’s body weight off the damaged area to the other side of the knee, where the cartilage is still healthy. Osteotomy of tibia is surgical treatment option for early antero-medial OA of knee with mal-alignment to prevent the progression of arthritis. In advanced antero-medial OA of knee in younger age group who are candidate for UKA as an alternative treatment option. In advanced antero-medial OA of knee at any age group with fixed mal-alignment of knee as an alternative treatment option to TKA for patient who are unwilling for it. In the first indication osteotomy can prevent disease progression and in second scenario this procedure will provide symptomatic relief and may delay the need for joint sacrificing procedure; TKA, for a significant time period. Sometimes an osteotomy may need some adjunct arthroscopic procedure like cartilage regeneration procedure; micro-fracture / abretio chondroplasty or repair and resection of meniscus.
Unlike Joint sacrificing procedure; TKA/UKA, osteotomy needs longer rehabilitation time and prolong abstain from normal daily activity. Usually one permitted to walk with walking aid and partial weight bearing till osteotomy unites. Philosophically osteotomy is a preferred mode of surgical treatment for the indicated group of OA knee patient as its preserves the natural joint. But the final decision depends on patients understanding lifestyle demand and socio-economic circumstances.
Steam cell therapy for AVN:
Stem-cell therapy is the use of stem cells to treat or prevent a disease or condition.
Bone Marrow Replacement is the most widely used stem-cell therapy, but some therapies derived from umbilical cord blood are also in use.
Avascular necrosis (AVN), also called osteo-necrosis, bone infarction aseptic necrosis, and ischemic bone necrosis is cellular death (necrosis) of bone components due to interruption of the blood supply Without blood, the bone tissue dies and the bone collapses If avascular necrosis involves the bones of a joint it often leads to destruction of the joint articular surfaces.
Avascular necrosis is especially common in the hip joint. A variety of methods are now used to treat avascular necrosis,the most common being the Total hip Replacement or THR.
Other treatments include core decompression, where internal bone pressure is relieved by drilling a hole into the bone, and a living bone chip and an electrical device to stimulate new vascular growth are implanted; and the free vascular fibular graft (FVFG), in which a portion of the fibula, along with its blood supply, is removed and transplanted into the femoral head
Progression of the disease could possibly be halted by transplanting nucleated cells from bone marrow into avascular necrosis lesions after core decompression, although much further research is needed to establish this technique. This is particularly useful in intial stages of the disease when the femoral head is maintain its shape and architecture.
The treatment option ultimately depends upon the patient profile.