Mixed Reality has the potential to improve accuracy and reduce required dissection for the performance of peri-acetabular osteotomy. The current work assesses initial proof of concept of MR guidance for PAO.

A PAO planning module, based on preoperative computed tomography (CT) imaging, allows for the planning of PAO cut planes and repositioning of the acetabular fragment. 3D files (holograms) of the cut planes and native and planned acetabulum positions are exported with the associated spatial information. The files are then displayed on mixed reality head mounted device (HoloLens2, Microsoft) following intraoperative registration using an FDA-cleared mixed reality application designed primary for hip arthroplasty (HipInsight). PAO was performed on both sides of a bone model (Pacific Research). The osteotomies and acetabular reposition were performed in accordance with the displayed holograms. Post-op CT imaging was performed for analysis. Cutting plane-accuracy was evaluated using a best-fit plane and 2D angles (°) between the planned and achieved supra (SA)- and retroacetabular (RA) osteotomy and retroacetabular and ischial osteotomies (IO) were measured.

To evaluate the accuracy of acetabular reorientation, we digitized the acetabular rim and calculated the acetabular opening plane. Absolute errors of planned and achieved operative inclination and anteversion (°) of the acetabular fragment, as well as 3D lateral-center-edge (LCE) angles were calculated.

The mean absolute difference between the planned and performed osteotomy angles was 3 ± 3°.

The mean absolute error between planned and achieved operative anteversion and inclination was 1 ± 0° and 0 ± 0° respectively. Mean absolute error between planned and achieved 3D LCE angle was 0.5 ± 0.7°.

Mixed-reality guidance for the performance of pelvic osteotomies and acetabular fragment reorientation was feasible and highly accurate. This solution may improve the current standard of care by enabling reliable and precise reproduction of the desired acetabular realignment.

Aims

Although there are various pelvic osteotomies for acetabular dysplasia of the hip, shelf operations offer effective and minimally invasive osteotomy. Our study aimed to assess outcomes following modified Spitzy shelf acetabuloplasty.

Salter-Harris II fractures of the distal tibia affect children frequently, and when they are displaced present a treatment dilemma. Treatment primarily aims to restore alignment and prevent premature physeal closure, as this can lead to angular deformity, limb length difference, or both. Current literature is of poor methodological quality and is contradictory as to whether conservative or surgical management is superior in avoiding complications and adverse outcomes. A state of clinical equipoise exists regarding whether displaced distal tibial Salter-Harris II fractures in children should be treated with surgery to achieve anatomical reduction, or whether cast treatment alone will lead to a satisfactory outcome. Systematic review and meta-analysis has concluded that high-quality prospective multicentre research is needed to answer this question. The Outcomes of Displaced Distal tibial fractures: Surgery Or Casts in KidS (ODD SOCKS) trial, funded by the National Institute for Health and Care Research, aims to provide this high-quality research in order to answer this question, which has been identified as a top-five research priority by the British Society for Children’s Orthopaedic Surgery.

Cite this article: Bone Joint J 2023;105-B(5):471–473.

Aims

The aim of this study was to determine the association between knee alignment and the vertical orientation of the femoral neck in relation to the floor. This could be clinically important because changes of femoral neck orientation might alter chondral joint contact zones and joint reaction forces, potentially inducing problems like pain in pre-existing chondral degeneration. Further, the femoral neck orientation influences the ischiofemoral space and a small ischiofemoral distance can lead to impingement. We hypothesized that a valgus knee alignment is associated with a more vertical orientation of the femoral neck in standing position, compared to a varus knee. We further hypothesized that realignment surgery around the knee alters the vertical orientation of the femoral neck.

Background

Intraoperative balancing of total knee arthroplasty (TKA) can be accomplished by either more prevalent but less predictable soft tissue releases, implant realignment through adjustments of bone resection or a combination of both. Robotic TKA allows for quantifiable precision performing bone resections for implant realignment within acceptable final component and limb alignments.

Introduction

In total knee arthroplasty (TKA), component realignment with bone-based surgical correction (BBSC) can provide soft tissue balance and avoid the unpredictability of soft tissue releases (STR) and potential for more post-operative pain. Robotic-assisted TKA enhances the ability to accurately control bone resection and implant position. The purpose of this study was to identify preoperative and intraoperative predictors for soft tissue release where maximum use of component realignment was desired.

An osteochondral defect greater than 3cm in diameter and 1cm in depth is best managed by an osteochondral allograft.

If there is an associated knee deformity, then an osteotomy is performed. In our series of osteochondral allografts for large post-traumatic knee defects realignment osteotomy is performed about 60% of the time in order to off-load the transplant. To correct varus we realign the proximal tibia with an opening wedge osteotomy. To correct valgus, we realign the distal femur with a closing wedge osteotomy.

Our results with osteochondral allografts for the large osteochondral defects of the knee both femur and tibia, have been excellent in 85% of patients at an average follow-up of 10 years. The Kaplan-Meier survivorship at 15 years is 72%. At an average follow-up of 22 years in 58 patients with distal femoral osteochondral allograft, 13 have been revised (22%). The 15-year survivorship was 84%.

Retrieval studies of 24 fresh osteochondral grafts obtained at graft revision or conversion total knee replacement at an average of 12 years (5 – 25) revealed the following. In the areas where the graft was still intact, the cartilage was of normal thickness and architecture. Matrix staining was normal except in the superficial and upper mid zones. Chondrocytes were mostly viable but there was chondrocyte clusters and loss of chondrocyte polarity. Host bone had extended to the calcified cartilage but variable remnants of dead bone surrounded by live bone persisted. With a stable osseous base the hyaline cartilage portion of the graft can survive for up to 25 years.

Background

Intraoperative balancing can be accomplished by either more prevalent but less predictable soft tissue releases, implant realignment through adjustments of bone resection or a combination of both. There is no published study directly comparing these methods.

Aims

The aim of this study was to report the outcome of femoral condylar fresh osteochondral allografts (FOCA) with concomitant realignment osteotomy with a focus on graft survivorship, complications, reoperation, and function.

An osteochondral defect greater than 3cm in diameter and 1cm in depth is best managed by an osteochondral allograft.

If there is an associated knee deformity, then an osteotomy was performed. In our series of osteochondral allografts for large post-traumatic knee defects, realignment osteotomy is performed about 60% of the time in order to off load the transplant. To correct varus we realign the proximal tibia with an opening wedge osteotomy. To correct valgus, we realign the distal femur with a closing wedge osteotomy.

Our results with osteochondral allografts for the large osteochondral defects of the knee both femur and tibia, have been excellent in 85% of patients at an average follow-up of 10 years. The Kaplan-Meier survivorship at 15 years is 72%. At an average follow-up of 22 years in 58 patients with distal femoral osteochondral allograft, 13 have been revised (22%). The 15-year survivorship was 84%.

Retrieval studies of 24 fresh osteochondral grafts obtained at graft revision or conversion to total knee replacement at an average of 12 years (5 – 25) revealed the following. In the areas where the graft was still intact, the cartilage was of normal thickness and architecture. Matrix staining was normal except in the superficial and upper mid-zones. Chondrocytes were mostly viable but there was chondrocyte clusters and loss of chondrocyte polarity. Host bone had extended to the calcified cartilage but variable remnants of dead bone surrounded by live bone persisted. With a stable osseous base the hyaline cartilage portion of the graft can survive for up to 25 years.

Purpose

We share our experience in management of failed in-situ pinning in severe unstable Slipped Capital Femoral Epiphysis (SCFE) by surgical dislocation approach.

The lateral compartment is predominantly affected in approximately 10% of patients with osteoarthritis of the knee. The anatomy, kinematics and loading during movement differ considerably between medial and lateral compartments of the knee. This in the main explains the relative protection of the lateral compartment compared with the medial compartment in the development of osteoarthritis. The aetiology of lateral compartment osteoarthritis can be idiopathic, usually affecting the femur, or secondary to trauma commonly affecting the tibia. Surgical management of lateral compartment osteoarthritis can include osteotomy, unicompartmental knee replacement and total knee replacement. This review discusses the biomechanics, pathogenesis and development of lateral compartment osteoarthritis and its management.

Cite this article: Bone Joint J 2013;95-B:436–44.

Introduction

Patients who are symptomatic with concurrent acetabular dysplasia and proximal femoral deformity may have Perthes disease. Osteotomies to correct both the acetabular and proximal femur deformities may optimise biomechanics and improve pain and function. In this study, we assessed the long-term results for such a combined procedure.

Hyaline articular cartilage has been known to be a troublesome tissue to repair once damaged. Since the introduction of autologous chondrocyte implantation (ACI) in 1994, a renewed interest in the field of cartilage repair with new repair techniques and the hope for products that are regenerative have blossomed. This article reviews the basic science structure and function of articular cartilage, and techniques that are presently available to effect repair and their expected outcomes.

Introduction. Young, high-demand patients with large post-traumatic tibial osteochondral defects are difficult to treat. Fresh osteochondral allografting is a joint-preserving treatment option that is well-established for such defects. Our objectives were to investigate the long-term graft survivorships, functional outcomes and associated complications for this technique. Methods. We prospectively recruited patients who had received fresh osteochondral allografts for post-traumatic tibial plateau defects over 3cm in diameter and 1cm in depth with a minimum of 5 years follow-up. The grafts were retrieved within 24 hours, stored in cefalozolin/bacitracin solution at 4°C, non-irradiated and used within 72 hours. Tissue matching was not performed but joints were matched for size and morphology. Realignment osteotomies were performed for malaligned limbs. The Modified Hospital for Knee Surgery Scoring System (MHKSS) was used for functional outcome measure. Kaplan-Meier survivorship analysis was performed with conversion to TKR as end point for graft failure. Results. Of 132 patients identified, 14 were lost to follow-up and 37 had less than 5 years follow-up, leaving 81 patients. There were 29 conversions to TKR at a mean of 12 (3-23) years post-operatively. The remaining 52 patients had a mean MHKSS score of 83 (49-100) with a mean follow-up of 11.7 (5-34) years. The Kaplan-Meier graft survivorships were 94% at 5 years (SE 2.7), 83% at 10 years (SE 4.6), 62% at 15 years (SE 7.4) and 45% at 20 years (SE 8.5). Associated complications included infection (1.2%) treated by 2-stage TKR, graft collapse (8.6%) treated by TKR, osteotomy and conservatively and knee pain relieved by hardware removal (7.4%). Conclusion. Fresh osteochondral allograft is a successful treatment option for large post-traumatic tibial osteochondral defects in young patients, with satisfactory long term survivorships and functional outcomes with acceptable complication rates

In developed nations Charcot arthropathy is most commonly caused by diabetes mellitus. Worldwide, leprosy remains the primary cause. All evidence points to a relationship between neurologic loss, continued loading activities and the development of unrecognized bone fragmentation. In type 2 diabetes, dysregulation of leptin biology causes bone loss and may be an important factor in precipitating Charcot events. Bone density studies show massive loss of bone in patients with ankle and hindfoot Charcot problems, but not midfoot problems. This suggests a different mechanism for collapse. Stable collapse with ulcer development in the midfoot can be treated with exostectomy. Realignment and fusion remain the mainstays of treatment for diabetic Charcot neuropathy, especially in the ankle and hindfoot. Bone mineralization deficiencies require special consideration of fixation techniques. Thin wire external fixation – either as primary fixation or to reinforce/neutralize other methods can be very helpful. Large bridging screws and carefully selected bridging plates are frequently also valuable to consider. Excessive immobilization periods (often double the normal amount of time) are generally required. The goal may be limited to a braceable, plantigrade foot

Background: No studies exist about the long-term correlation of patellofemoral osteoarthrosis to poor outcome after traditional realignment surgery for chronic patellofemoral instability. The objective of this study was to evaluate the recurrent instability and symptomatic osteoarthrosis over a long follow-up period.

Methods: Fifty-two patients underwent distal realignment surgery for chronic patellar instability, 28 with Roux-Goldthwait procedure and 24 with Krogius procedure. A follow-up evaluation was performed at a mean 12 years (range, 8 to 22 years) after surgery, in which 39 of 52 patients participated. Recurrent instability and osteoarthrotic characteristics were evaluated by plain radiographs and magnetic resonance images obtained at follow-up. The original hospital data were reviewed to assess patients’ background. Subjective symptoms were assessed with patellofemoral scores.

Results: Of the 39 controlled patients, 10 had chronic patellar instability, including 4 patients who underwent reoperation during follow-up. The mean patient age at follow-up was 33 years (range, 26 to 43). Patellofemoral full-thickness cartilage lesions were found on MRI in 29 (75%) of patients and all of the patients had mild lesions. A joint space narrowing was present in 6 cases in plain radiographs indicating severe patellofemoral osteoarthrosis. Only 48% of the patients reported satisfaction with the patellar stability and anterior knee symptoms and the unsatisfactory result was associated with patellofemoral osteoarthrosis (P=0.05). The mean Kujala score was 83 (range 52–100) points. The surgical technique employed did not affect the overall outcome.

Conclusion: The long-term outcome of traditional realignment surgery for chronic patellofemoral instability seemed to be strongly associated with patellofemoral osteoarthrosis. Despite the relatively rare occurrence of recurrent instability, less than half of patients achieved a satisfactory result. Patellofemoral osteoarthrosis seems to be the long-term consequence in patients treated with traditional surgical procedures for patellar instability. In future studies focusing on patellar stability, preventive methods against the development of patellofemoral osteoarthrosis should be emphasized.

Purpose: Our purpose was to study the 10-year results of a proximal soft-tissue procedure combined with a Lateral Patellar Facetectomy technique for an isolated osteoarthritis of patellofemoral joint.

Methods: The study group included 39 knees (30 patients). There were 19 female and 11 male patients. Mean age 52 years old (range 40–65). All patients were evaluated at a mean follow-up of 10 years. The indications for surgery were instability of patellofemoral joint with isolated arthritis. Patient outcome scores, patient demographics, and data from a physical examination, x-Ray and TC were collected before and after surgery. A release of the lateral patellofemoral ligament and a retinacular release were performed, leaving the synovial tissue intact to isolate the joint. The lower fibers of the vastus lateralis were released as well, and the release was carried down to the level of the tubercle. Medially, an imbrication of the medial retinacular tissue from the medial aspect of the quadriceps tendon to the proximal aspect of the tibial tubercle, as Insall described, was performed.

Results: At final follow-up, the results were excellent or good in 89% of the knees, fair in 7%, and poor in 3%. Subjective improvement was reported by 90% of patients. Follow-up radiographs showed slow progression of osteoarthritis in the patellofemoral and tibiofemoral compartments, but radiographic appearance did not always correlate with clinical symptoms. The success of this procedure depends largely on relief of pain.

Conclusions: proximal soft-tissue realignment combined with a Lateral Patellar Facetectomy for a severe isolated osteoarthritis of patellofemoral joint is a powerful way to correct malalignment and offload the lateral and distal parts of the patella. This technique relief pain and improved the activity level. Is an effective surgical treatment for middle-aged to elderly active patients with isolated lateral patellofemoral osteoarthritis who want to maintain activity level.

We present a retrospective review of 167 patients aged 18 years and under who were treated for chronic haematogenous osteomyelitis at our elective orthopaedic hospital in Malawi over a period of four years. The median age at presentation was eight years (1 to 18). There were 239 hospital admissions for treatment during the period of the study. In 117 patients one admission was necessary, in 35 two, and in 15 more than two.

A surgical strategy of infection control followed by reconstruction and stabilisation was employed, based on the Beit CURE radiological classification of chronic haematogenous osteomyelitis as a guide to treatment. At a minimum follow-up of one year after the end of the study none of the patients had returned to our hospital with recurrent infection.

A total of 350 operations were performed on the 167 patients. This represented 6.7% of all children’s operations performed in our hospital during this period. One operation only was required in 110 patients and none required more than three. Below-knee amputation was performed in two patients with chronic calcaneal osteomyelitis as the best surgical option for function. The most common organism cultured from operative specimens was Staphylococcus aureus, and the tibia was the bone most commonly affected. Polyostotic osteomyelitis occurred in four patients. We believe this is the largest reported series of patients treated for chronic haematogenous osteomyelitis.

Aim: To evaluate results of fully congruent Mobile bearing knee arthroplasty for valgus arthritic knees using lateral capsular approach and realignment of vastus lateralis.

Material and Method: We reviewed results of 50 mobile bearing total knee arthroplasties performed consecutively between 2001 and 2006 for Valgus arthritic knees, using lateral capsular approach and realignment of vastus lateralis. Patients were evaluated using oxford and International knee society Score. Radiographs were examined for alignment of the component, evidence of loosening and scanograms assessed to evaluate the restoration of mechanical axis.

Results: The study group consisted of 47 patients, 20 men and 27 women who received fifty knees. The mean age at the primary operation was 71.57 years (range 47–82 years; SD, 9.5). The mean follow up was 4.2 years (range 1–6 years; SD, 1.35). The mean Valgus deformity was 15.92° (rang from 15–20 SD 1.89). Fixed flexion deformity was seen in 15 knees.

The mean Oxford Knee Society ratings was 52 (range 47–55; SD, 3.18) preoperatively, and 19 (range 14–24; SD, 3.72) at final follow up. The pre op mean range motion was 84.28° (range 45°–120°; SD 21.73). At final follow up the average range of motion was 107.5° (range 95°–120°; SD 8.93). According to the system of the Knee Society, the average knee score was 94 points and the average functional score was 89 points at final follow up.

There were no clinical failures or cases of postoperative instability and no cases of radiographic loosening or wear.

Radiological evaluation: None of these knees had radiographic evidence of loosening or osteolysis. Mechanical axis was restored in all the patients.

Conclusion: This study demonstrates satisfactory results of Mobile bearing knee arthroplasty using lateral parapatellar with proximal realignment of vastus lateralis for Valgus arthritic knees.