Purpose: This prospective study was conducted to evaluate correction of post-traumatic deformity of the thoracolumbar and lumbar spine at consolidation after posterior instrumentation associated with transpedicular graft.

Material and method: The analysis began in 1998 and included 11 patients (mean age 37 years, age range 19–62 years) with lumbar (two L2) or thoracolumbar (four T12 and five L1) fractures. The Magerl classification was A1=2, A2=3, mixed=3. Inclusion criteria were: age < 65 years, regional kyphosis > 10°), intact pedicles, relative gain on local and/or regional kyphosis peroperatively > 70% after correction for reduction-distraction. Posterior instrumentation used the V-V assembly in two cases and 2VV-1VC assembly in nine. Evaluation criteria were, postoperatively and at consolidation: local kyphosis, corrected regional kyphosis, Cobb angle in the frontal plane. Autologous graft tissue harvested from the iliac crest was introduced via the right and left pedicle into the damaged vertebra using an adapted funnel after raising the vertebral plate with a spatula.

Results: Mean follow-up was 11 months (range 8–18). Associated procedures were laminectomy in three cases and posterior graft in two. Preoperatively local kyphosis was 19° (12° to 37°) and regional kyphosis was 17° (10° to 35°). Postoperatively, local and regional kyphosis were 4.5° (0–11°) and −2° (−10 to 5°) giving a mean relative gain of 80% (SD = 0.1). Mean relative gain at consolidation was 75% (SD = 0.2 for local kyphosis and 86% for regional kyphosis. The correction was statistically significant. There was no significant difference between the correction postoperatively and at consolidation.

Discussion: Transpedicular grafting associated with posterior instrumentation can avoid anterior access in a certain number of cases. Indications are fractures in patients under 65 years of age with a regional kyphosis > 10° and an important anterior defect after reduction (> 40% reduction in height). All patients achieved bone healing without significant loss of correction. The limitations of this technique include the requirement for intact pedicles, a posterior wall displacement of less than 60% and a peroperative relative gain greater than 70% for the local and/or regional kyphosis. An anterior approach must be associated in other cases.

Conclusion: Transpedicular grafting is a simple technique allowing true reconstruction of the vertebral body. It can avoid a certain number of supplementary anterior approaches.

Purpose: We report our experience with 10 cases of osteotomy performed at the same time as total hip arthroplasty.

Material and methods: This series included ten knees in ten patients, mean age 63 years. The knees were divided into two groups: five with tibial deviations in one or two planes (three callus deformities, one congenital varus, and one coxalgia sequela) and six mono- or biplanar femoral deviations (three callus deformities, two congenital valgus, and one coxalgia sequela). The principal extra-articular deviation was greater than 10° in all cases. A total knee arthroplasty preserved the posterior cruciate ligament in nine cases with a non-cemented femoral stem implant and cemented tibial implant with or with out a stem. The tibial osteotomies were all in the proximal metaphysis. The femoral osteotomy was in the distal metaphysis in four cases, subtro-chanteric with derotation in one and in the diaphysis with derotation in one. The correction osteotomy was performed before the prosthesis bone cut. Complementary osteosynthesis was used in all cases.

Results: Minimal follow-up was 12 months with a mean of 19.6 months. Bone healing was achieved in all cases. Complete weight bearing was achieved at a mean 2.5 months. The mean postoperative HSS score was 76. Results were excellent in four knees, good in four, fair in one and poor in one. Mean joint amplitude was 105°. Radiographically, complete tibial correction was obtained for three knees (two biplanar corrections); for two knees the biplanar correction was incomplete in one plane. Among the four biplanar femoral deviations, complete correction was achieved in three and incomplete frontal correction in one, with two varus overcorrections in the frontal plane on the single plane deviations.

Discussion: We used this method to avoid intra-articular correction of extra-articular deviations, a source of complications.

Conclusion: Combining osteotomy with total knee arthroplasty during the same operation for patients with major axial deviation and degenerative joint disease provides satisfactory results in 80% of the cases.