Introduction:.
Introduction.
Insufficiency of the lateral collateral ligamentous complex causes posterolateral rotatory instability (PLRI). During reconstruction surgery the joint capsule is repaired, but its biomechanical influence on elbow stability has not been described. We hypothesized that capsular repair reduces ROM and varus angle after reconstruction of the lateral collateral complex. Six fresh frozen cadaveric elbow specimens were used.
Introduction.
A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is reportedly lower when using components with a longer keel-cortex distance (KCDs). The aim of this study was to examine how slight varus placement of the tibial component might affect the KCDs, and the rate of tibial plateau fracture, in a clinical setting. This retrospective study included 255 patients who underwent 305 OUKAs with cementless tibial components. There were 52 males and 203 females. Their mean age was 73.1 years (47 to 91), and the mean follow-up was 1.9 years (1.0 to 2.0). In 217 knees in 187 patients in the conventional group, tibial cuts were made orthogonally to the tibial axis. The varus group included 88 knees in 68 patients, and tibial cuts were made slightly varus using a new osteotomy guide. Anterior and posterior KCDs and the origins of fracture lines were assessed using 3D CT scans one week postoperatively. The KCDs and rate of fracture were compared between the two groups.Aims
Methods
Introduction.
John Insall described medial release to balance the varus knee; the release he described included releasing the superficial MCL in severe varus cases. However, this release can create instability in the knee. Furthermore, this conventional wisdom does not correct the actual pathology which normally exists at the joint line, and instead it focuses on the distal end of the ligament where there is no pathology. We have established a new protocol consisting of 5 steps to balance the varus knee without releasing the superficial MCL and we tried this algorithm on a series of 115 patients with varus deformity and compared it to the outcome with a similar group that we have performed earlier using the traditional Insall technique. 115 TKR were performed by the same surgeon using Zimmer Persona implant in varus arthritic knees. The deformities ranged from 15 to 35 degrees. First, the bony resection was made using Persona instrumentation as recommended by the manufacturer. The sequential balancing was divided into 5 steps (we will show a short video demonstrating the surgical techniques for each step) as follows:
Step 1: Releasing of deep MCL Step 2: Excising of osteophyte Step 3: Excising of scarred tissue in the posteromedial corner soft phytes Step 4: Excision of the posteromedial capsule in case of flexion contracture Step 5: Releasing the semi-membranous (in gross deformity) We used soft tissue tensioner to balance the medial and lateral gaps. When the gaps are balanced at early step, there was no need to carry on the other steps. We used only primary implant and we did not have to use any constrained implant. We have compared this group with a similar group matched for deformity from previous 2 years where the conventional medial release as described by Insall.Introduction
Material and method
The concept of constitutional varus and controversy regarding placing the total knee arthroplasty (TKA) in a neutral versus physiologic alignment in varus osteoarthritic (OA) patients is an important current discussion. However, the physiologic mechanical alignment of a varus OA knee is unknown and the relative contribution of the femur and tibia to the mechanical axis is unknown. The goal of this study was to determine and analyse the physiologic mechanical axis of medial OA knees. Plain radiographs of the knee and full-leg standing radiographs of 1558 patients were reviewed for inclusion criteria; 313 patients with a non-arthritic knee and a contralateral varus end-stage OA knee were analysed in the coronal plane. The Hip-Knee-Ankle (HKA), Condylar-Hip (CH)(femoral), Condylar-Plateau (CP) (intra-articular) and Plateau-Ankle (PA)(tibial) angles were measured for both the arthritic and non-arthritic/physiologic knee. The relationship and contribution of all angles was analysed for every 2° degrees of progressive varus: from 4° valgus to 8° varus. The proportion of patients with constitutional varus was also determined for the sample population and correlated with increasing HKA. The mean CH (femoral) angle was valgus in all groups and decreased with progressive varus alignment (p< 0.0001), ranging from 3.8° ± 1.0° with HKA of 2–4° valgus, to 0.1° ± 1.5° with HKA of 6–8° varus. The mean PA (tibial) angle was varus in all groups and decreased from valgus to progressively varus alignment (p p<0.0001), ranging from 0.78° ± 1.4° with HKA 2–4° valgus, to 5.6° ± 1.9° with HKA 6–8° varus. The CP angle showed no difference between all groups (p=0.3). Forty five percent of males and 22% of females with arthritic HKA in varus alignment were found to have constitutional varus. Correlation of unilateral arthritic knees to the unaffected, physiologic aligned knee using full-leg radiographs indicates that it may be possible to understand the patient's physiologic, pre-arthritic coronal plane alignment. The mechanical axis of physiologic knees in a unilateral varus OA population demonstrates a variable contribution of the femur (CH) and tibia (PA) from overall valgus to varus alignment. In addition, a significant proportion of the sample population possessed constitutional varus. This may provide important information regarding the placement of physiologic TKA's and direct future research questions.
Background:.
Introduction. By all developments of new technologies on the improvement of the Total Knee implantation, the discussion about the optimum Alignment is in full way. Besides, is to be considered, that Alignment contains not only static, but also dynamic factors and beside the frontal plan also the sagittal plan as well as in particular the rotation in femur and tibia have a great importance for the outcome after TKR. However, beside the bone alignment, the kapsulo-igamentous structures also play an important role for the results after TKR. If a Varus-Malalignment was valid, in the past the „older” literature described it as a big risk factor for pain, less function and durability. However, in the present literature, we discuss more and more about the optimum Alignment during TKR. In particular, newer publications show no interference of the durability with coronar Alignment also outside from 3 °, also the score results and patient's satisfaction seem to deliver no worse results with slight untercorrection of the varus alignment. Some publications described even better score results and Patient satisfaction with slight untercorrection. Condition for it is probably an exact balancing of the extension and flexion gap. Material and method. With a new developed instruments it was examined with a tibia and extensions-Gap-First-Technique, to what extent a correction of the AMA opposed after digital planning within from 3 ° in distal femur a balancierung of the extension gap could be reached under avoidance of 3° releases with a varusarthritis oft the knee. 103 directly knee arthroplasties following on each other were selected with Varus-OA without exclusion criteria. Surgical technology. Midvastus-Approach, mostly in LIS technology. Besides, tibial 1–2 ° release and the following resection of the exophytes medial, lateral and intercondylar. External adjustment of the proxima tibia cut, place adjustable (Varus/Valgus, Slope) cutting block, control of the varus-(valgus position and slope after Fixation and if necessary postcorrection of these parameters. Resection of the proximal tibia. Next intramedullar adjustment of teh ditals femur cut according digital planning and fixation the adjustable/
Introduction.
Knee varus malalignment increases medial knee compartment loading and is associated with knee osteoarthritis (OA) progression and severity1. Altered biomechanical loading and dysregulation of joint tissue biology drive OA progression, but mechanistic links between these factors are lacking. Subchondral bone structural changes are biomechanically driven, involve bone resorption, immune cell influx, angiogenesis, and sensory nerve invasion, and contribute to joint destruction and pain2. We have investigated mechanisms underlying this involving RANKL and alkaline phosphatase (ALP), which reflect bone resorption and mineralisation respectively3 and the axonal guidance factor Sema3A. Sema3A is osteotropic, expressed by mechanically sensitive osteocytes, and an inhibitor of sensory nerve, blood vessel and immune cell invasion4. Sema3A is also differentially expressed in human OA bone5.HYPOTHESIS: Medial knee compartment overloading in varus knee malalignment patients causes dysregulation of bone derived Sema3A signalling directly linking joint biomechanics to pathology and pain. Synovial fluid obtained from 30 subjects with medial knee OA (KL grade II-IV) undergoing high tibial osteotomy surgery (HTO) was analysed by mesoscale discovery and ELISA analysis for inflammatory, neural and bone turnover markers. 11 of these patients had been previously analysed in a published patient-specific musculoskeletal model6 of gait estimating joint contact location, pressure, forces, and medial-lateral condyle load distribution in a published data set included in analyses. Data analysis was performed using Pearson's correlation matrices and principal component analyses. Principal Components (PCs) with eigenvalues greater than 1 were analysed.Abstract
OBJECTIVE
METHODS
Iatrogenic hallux varus is a rare complication after hallux valgus surgery. Operative treatment comprises a wide variety of techniques, of which the reversed transfer of the abductor hallucis tendon is the most recent described technique. This paper will present the long-term clinical results of the reversed transfer of the abductor hallucis longus. Therefore, we performed a prospective clinical observational study on 16 female patients. Our hypothesis is that the tendon transfer will persist in a good alignment and patient satisfaction on long term. There is a 100% follow-up rate with a range from 10 to 101 months. Patients were subjected to a clinical examination, three questionnaires and their general satisfaction.Background
Methods
Historically, cemented THA femoral stems inserted in varus have yielded poor clinical results. Very few studies to date have addressed the question of the effects of varus alignment on uncemented stems. We have conducted a retrospective review of one hundred and twenty-five uncemented THA femoral stems implanted by a single surgeon from 1994 to 1999. Within this single surgeon group we were able to identify sixteen stems implanted in varus and thus proceeded to analyze the effect of varus alignment on functional outcome. To assess functional and radiographic outcome of uncemented primary THA femoral stems implanted in varus. After four-years of follow-up, there have been no radiographic or clinical problems associated with implanting uncemented femoral stems in varus. Although it is not recommended to implant stems in varus, radiographic and clinical problems associated with implanting uncemented femoral stems in varus appear to be non-consequential. Of the study sample, one hundred and sixteen hips were in neutral alignment as compared to sixteen varus hips. We could not show any significant difference in Harris Hip scores between the varus and non-varus hips (p>
0.5). No cases showed evidence of radiographic loosening, or subsidence (p=0.3) at four-year follow-up. Retrospective radiographic review of one hundred and twenty-five uncemented primary THA femoral stems implanted by a single surgeon (now retired) from 1994 to 1999, using the Watson-Jones approach, identified sixteen femoral stems implanted in varus. These sixteen stems were matched 1:1 for demographics and preoperative diagnosis to a cohort of sixteen non-varus uncemented stems implanted by the same surgeon over the same study period. Functional outcome included Harris Hip score and range of motion at four-years postoperative. Radiographic signs of loosening and subsidence, defined as >
2mm, were measured.
Femoral components used in total hip arthroplasty (THA) rely on good initial fixation determined by implant design, femoral morphology, and surgical technique. A higher rate of varus alignment may be of specific concern with short stem implants.
Angular deformities of the distal femur can be corrected by opening, closing and neutral wedge techniques. Opening wedge (OW) and closing wedge (CW) are popular and well described in the literature. CW and OW techniques lead to leg length difference whereas the advantage of neutral wedge (NW) technique has several unique advantages. NW technique maintains limb length, wedge taken from the closing side is utilised on the opening side and since the angular correction is only half of the measured wedge on either side, translation of distal fragment is minimum. Leg lengths are not altered with this technique hence a useful technique in large deformities. We found no reports of clinical outcomes using NW technique. We present a technique of performing external fixator assisted NW correction of large valgus and varus deformities of distal femur and dual plating and discuss the results. We have treated 20 (22 limbs – 2 patients requiring staged bilateral corrections) patients for distal femoral varus and valgus deformities with CWDFO between 2019 and 2022. Out of these 4 patients (5 limbs) requiring large corrections of distal femoral angular deformities were treated with Neutral Wedge (NW) technique. 3 patients (four limbs) had distal femoral valgus deformity and one distal femoral varus deformity. Indication for NW technique is an angular deformity (varus or valgus of distal femur) requiring > 12 mm opening/closing wedge correction. We approached the closing side first and marked out the half of the calculated wedge with K – wires in a uniplanar fashion. Then an external fixator with two Schanz screws is applied on the opposite side, inserting the distal screw parallel to the articular surface and the proximal screw 6–7 cm proximal to the first pin and at right angles to the femoral shaft mechanical axis. Then the measured wedge is removed and carefully saved. External fixator is now used to close the wedge and over correct, creating an appropriate opening wedge on the opposite side. A Tomofix (Depuoy Synthes) plate is applied on the closing side with two screws proximal to osteotomy and two distally (to be completed later). Next the osteotomy on the opposite side is exposed, the graft is inserted. mLDFA is measured under image intensifier to confirm satisfactory correction. Closing wedge side fixation is then completed followed by fixation of opposite side with a Tomofix or a locking plate.Introduction
Materials & Methods
Cubitus varus following paediatric supra-condylar humeral fracture represents a complex three-dimensional malunion. This affects cosmesis, function and subsequent distal humeral fracture risk. Operative correction is however difficult with high complication rates. We present the 40-year Yorkhill experience of managing this deformity. From a total of 3220 supracondylar humeral fractures, 40 cases of post-traumatic cubitus varus were identified. There were ten undisplaced fractures, treated in cast, and thirty displaced fractures. Five were treated in cast, thirteen manipulated (MUA), four MUA+k-wires, seven ORIF (six k-wire, one steinman pin) and one in skeletal-traction. Sixteen malunions were treated operatively. The mean pre-operative varus was 19°. All had cosmetic concerns, three mild pain, one paraesthesia/weakness and three reduced movement (ROM). The operative indication was cosmetic in fifteen and functional in one (concern about instability). Twelve patients had lateral closing-wedge osteotomies; three complex/3D osteotomies (dome, unspecified rotational, antero-lateral wedge) and two had attempted 8-plate guided-growth correction. Complications occurred in eight patients (50 %): Fixation was lost in three (two staples, one k-wiring), incomplete correction in six (both 8-plates, both staples, two standard plates) and one early wound infection requiring metalwork removal resulting in deformity recurrence. One patient underwent revision lateral wedge osteotomy with full deformity correction but marked ROM restriction (20–100°) secondary to loose bodies. Those without complications were satisfied (50 %). All patients with residual deformity were unsatisfied. 1 patient with keloid scarring was unsatisfied despite deformity correction.
To analyze the short-term outcome after medial open-wedge high tibial osteotomy with a 3D-printing technology in early medial keen osteoarthritis and varus malalignment. 32 knees(28 cases) of mOWHTO (fixation with an angular-stable TomoFix implant(Synthes)) with a 3D-printing technology combined with arhtroscopy were prospectively surveyed with regard to functional outcome(Hospital for special knee score [HSS] score). Pre- and postoperative tibial bone varus angle (TBVA), mechanical medial proximal tibial angle (MPTA), and alignment were analyzed with regard to the result.Objective
Design and Method
Studies have shown that dissatisfaction following TKA may stem from poor component placement and iatrogenic factors related to variability in surgical execution. A CT-based robotic assisted system (RA) allows surgeons to dynamically balance the joint prior to bone resection. This study aimed to determine if this system could improve TKA planning, reduce soft tissue releases, minimize bone resection, and accurately predict component size in varus knee. Four hundred and seventy four cases with varus deformity undergoing primary RATKA were enrolled in this prospective, single center and surgeon study. Patient demographics and intraoperative surgical details were collected. Initial and final 3-dimensional alignment, component position, bone resection depths, use of soft tissue releases, knee balancing gaps, and component size were collected intraoperatively. WOMAC and KOOS Jr. scores were collected 6 months, and 1 year postoperatively. Descriptive statistics were applied to determine the changes in these parameters between initial and final values.Introduction
Method