Between 2003 and 2007, 99 knees in 77 patients
underwent opening wedge high tibial osteotomy. We evaluated the effect
of initial stable fixation combined with an artificial bone substitute
on the mid- to long-term outcome after medial
Although it is clear that
Aims. To determine the relationship between articular cartilage status and clinical outcomes after medial
We report the treatment in 17 patients of 27 angular deformities of the long bones by progressive
We compared the incidence and severity of complications during and after closing- and
Our aim was to compare the degree of patellar descent and alteration in angle of the inclination of the tibial plateau in lateral closing-wedge and medial
Valgus high tibial osteotomy for osteoarthritis of the medial compartment of the knee can be performed using medial opening- and lateral closing-wedge techniques. The latter have been thought to offer greater initial stability. We measured and compared the stability of opening- and closing-wedge osteotomies fixed by TomoFix plates using radiostereometry in a series of 42 patients in a prospective, randomised clinical trial. There were no differences between the opening- and closing-wedge groups in the time to regain knee function and full weight-bearing. Pain and knee function were significantly improved in both groups without any differences between them. All the osteotomies united within one year. Radiostereometry showed no clinically relevant movement of bone or differences between either group. Medial
A prospective, randomised, controlled trial compared two different techniques of high tibial osteotomy with a lateral closing wedge or a medial opening wedge, stabilised by a Puddu plate. The clinical outcome and radiological results were examined at one year. The primary outcome measure was the achievement of an overcorrection of valgus of 4°. Secondary outcome measures were the severity of pain (visual analogue scale), knee function (Hospital for Special Surgery score), and walking distance. Between January 2001 and April 2004, 92 patients were randomised to one or other of the techniques. At follow-up at one year the post-operative hip-knee-ankle angle was 3.4° (± 3.6° . sd. ) valgus after a closing wedge and 1.3° (± 4.7° . sd. ) of valgus after an opening wedge. The adjusted mean difference of 2.1° was significant (p = 0.02). The deviation from 4° of valgus alignment was 2.7° (± 2.4° . sd. ) in the closing wedge and 4.0° (± 3.6° . sd. ) in the
Anterior cruciate ligament (ACL) graft failure from rupture, attenuation, or malposition may cause recurrent subjective instability and objective laxity, and occurs in 3% to 22% of ACL reconstruction (ACLr) procedures. Revision ACLr is often indicated to restore knee stability, improve knee function, and facilitate return to cutting and pivoting activities. Prior to reconstruction, a thorough clinical and diagnostic evaluation is required to identify factors that may have predisposed an individual to recurrent ACL injury, appreciate concurrent intra-articular pathology, and select the optimal graft for revision reconstruction. Single-stage revision can be successful, although a staged approach may be used when optimal tunnel placement is not possible due to the position and/or widening of previous tunnels. Revision ACLr often involves concomitant procedures such as meniscal/chondral treatment, lateral extra-articular augmentation, and/or osteotomy. Although revision ACLr reliably restores knee stability and function, clinical outcomes and reoperation rates are worse than for primary ACLr. Cite this article:
We treated three patients with malunion after comminuted intercondylar fractures of the humerus by intra-articular derotational
1 . The indications, technique and results of supra-malleolar wedge osteotomy of the tibia in the management of valgus or varus deformity of the ankle in children with myelomeningocele are described. 2. This operation should not be performed until as much correction as possible has been obtained by soft-tissue release and muscle balance has been restored by tendon transfer. 3. In sixteen feet satisfactory correction was obtained and maintained in fourteen, one of which had required revision for over-correction. 4. A closing-wedge osteotomy is recommended ; the two failures occurred after
The Ilizarov apparatus was used to carry out
Primary osteoarthritis of the ankle with no history of trauma is rare. We report the use of a low tibial osteotomy on 18 ankles in 18 patients, two men and 16 women. The osteotomy is designed to correct the varus tilt and anterior opening of the distal tibial joint surface where it has been shown by weight-bearing radiographs and arthroscopy that there is healthy articular cartilage on the lateral side of the ankle. An
New developments in osteotomy techniques and methods of fixation have caused a revival of interest of osteotomies around the knee. The current consensus on the indications, patient selection and the factors influencing the outcome after high tibial osteotomy is presented. This paper highlights recent research aimed at joint pressure redistribution, fixation stability and bone healing that has led to improved surgical techniques and a decrease of post-operative time to full weight-bearing.
Cubitus varus is the most common late complication of a supracondylar
fracture of the humerus in children. Correction can be performed
using one of a number of techniques of osteotomy but each has disadvantages.
We describe a new technique for correcting post-traumatic cubitus
varus using a lateral closing wedge isosceles triangular osteotomy. A lateral closing wedge isosceles triangular osteotomy was performed
in 25 patients (15 male and ten female with a mean age of 9.5 years
(6 to 12)) between May 2010 and April 2013. All patients had cubitus
varus secondary to malunion of a supracondylar fracture, with good
function of the elbow and a full range of movement. The osteotomy
lines were marked on the bone with an isosceles triangular template
made before surgery, after which the osteotomy was performed leaving
the medial cortex intact. Fixation was performed using two lateral
2 mm Kirschner (K)-wires and patients were immobilised in an above-elbow
plaster. By six to eight weeks callus was present and the wires
and cast were removed. Patients were reviewed at four and six weeks,
three, six and 12 months and then every two years until skeletal
maturity. Clinical and radiographic outcomes were categorised as excellent,
good or poor.Aims
Patients and Methods
We report the outcome of 32 patients (37 knees) who underwent hemicallostasis with a dynamic external fixator for osteoarthritis of the medial compartment of the knee. There were 16 men (19 knees) and 16 women (18 knees) with a mean age at operation of 54.6 years (27 to 72). The aim was to achieve a valgus overcorrection of 2° to 8° or mechanical axis at 62.5% (± 12.5%). At a mean follow-up of 62.8 months (51 to 81) there was no change in the mean range of movement, and no statistically significant difference in the Insall-Salvati index or tibial slope (p = 0.11 and p = 0.15, respectively). The mean hip-knee-ankle angle changed from 190.6 (183° to 197°) to 176.0° (171° to 181°), with a mean final position of the mechanical axis of 58.5% (35.1% to 71.2%). The desired alignment was attained in 31 of 37 (84%) knees. There were 21 excellent, 13 good, two fair and one poor result according to the Oxford knee score with no correlation between age and final score. This score was at its best at one year with a statistically significant deterioration at two years (p = 0.001) followed by a small but not statistically significant deterioration until the final follow-up (p = 0.17). All the knees with Ahlback grade 1 osteoarthritis had excellent or good results. Complications included pin tract infections involving 16.4% of all pins used, delayed union in two, knee stiffness in four, fracture of the lateral cortex in one and ring sequestrum in one. In conclusion, hemicallostasis provides precision in attaining the desired alignment without interfering with tibial slope or patellar height, and is relatively free of serious complications.
Radiographs of 110 patients who had undergone 120 high tibial osteotomies (60 closed-wedge, 60 open-wedge) were assessed for posterior tibial slope before and after operation, and before removal of the hardware. In the closed-wedge group the mean slope was 5.7° ( Posterior tibial slope decreases after closed-wedge high tibial osteotomy and increases after an open-wedge procedure because of the geometry of the proximal tibia. The changes in the slope are stable over time, emphasising the influence of the operative procedure rather than of the implant.
We are currently facing an epidemic of periprosthetic
fractures around the hip. They may occur either during surgery or
post-operatively. Although the acetabulum may be involved, the femur
is most commonly affected. We are being presented with new, difficult
fracture patterns around cemented and cementless implants, and we
face the challenge of an elderly population who may have grossly
deficient bone and may struggle to rehabilitate after such injuries.
The correct surgical management of these fractures is challenging.
This article will review the current choices of implants and techniques
available to deal with periprosthetic fractures of the femur. Cite this article:
We report the long-term outcome of 33 patients
(37 knees) who underwent proximal tibial open-wedge osteotomy with
hemicallotasis (HCO) for medial osteoarthritis of the knee between
1995 and 2000. Among these, 29 patients with unilateral HCO were
enrolled and 19 were available for review at a mean of 14.2 years
(10 to 15.7) post-operatively. For these 19 patients, the mean Hospital
for Special Surgery knee score was 60 (57 to 62) pre-operatively
and 85 (82 to 87) at final follow-up (p <
0.001; paired Cite this article:
The aim of this study was to examine the functional
outcome at ten years following lateral closing wedge high tibial osteotomy
for medial compartment osteoarthritis of the knee and to define
pre-operative predictors of survival and determinants of functional
outcome. 164 consecutive patients underwent high tibial osteotomy between
2000 and 2002. A total of 100 patients (100 knees) met the inclusion
criteria and 95 were available for review at ten years. Data were
collected prospectively and included patient demographics, surgical
details, long leg alignment radiographs, Western Ontario and McMaster Universities
osteoarthritis index (WOMAC) and Knee Society scores (KSS) pre-operatively
and at five and ten years follow-up. At ten years, 21 patients had been revised at a mean of five
years. Overall Kaplan–Meier survival was 87% (95% confidence interval
(CI) 81 to 94) and 79% (95% CI 71 to 87) at five and ten years,
respectively. When compared with unrevised patients, those who had
been revised had significantly lower mean pre-operative WOMAC Scores
(47 (21 to 85) This study has shown that improved survival is associated with
age <
55 years, pre-operative WOMAC scores >
45 and, a BMI <
30. In patients over 55 years of age with adequate pre-operative
functional scores, survival can be good and functional outcomes
can be significantly better than their younger counterparts. We
recommend the routine use of pre-operative functional outcome scores
to guide decision-making when considering suitability for high tibial osteotomy. Cite this article: