We present a series of 30 uncemented total hip replacements performed between June 1985 and January 2002 with a mean follow-up of seven years (5 to 20) in 27 patients who had previously undergone a valgus intertrochanteric osteotomy. No further osteotomy was undertaken to enable hip replacement. We used a number of uncemented modular or monoblock femoral components, acetabular components and bearings. The patients were followed up clinically and radiologically. We report 100% survival of the femoral component. One acetabular component was revised at five years post-implantation for aseptic loosening. We noted cortical hypertrophy around the tip of the monoblock stems in six patients. We believe that modular femoral components should be used when undertaking total hip replacement in patients who have previously undergone valgus femoral osteotomy

Nonunion of intertrochanteric fractures is uncommon but its effects are disabling. We describe a modification of the medial displacement and valgus osteotomy of Dimon and Hughston (1967) which we used in seven fractures, six of which united within 16 weeks. Postoperatively, hip function was good. The method provides good initial stability, a source of cancellous bone graft, good postoperative hip abductor function and reliable healing of the nonunion without the need for intraoperative imaging

Our study describes the mid-term clinical results of the use of transtrochanteric valgus osteotomy (TVO) for the treatment of osteoarthritis of the hip secondary to acetabular dysplasia. The operation included valgus displacement at the level of the lesser trochanter, and lateral displacement of the greater trochanter by inserting a wedge of bone. We reviewed 70 hips. The mean age of the patients at operation was 44 years (14 to 59). Most (90%) had advanced osteoarthritis. The scores for pain and gait had improved significantly at a mean follow-up of 9.4 years. The rate of survival until an endpoint of a further operation during a follow-up of ten years was 82%. The survival rate was 95% in patients with unilateral involvement who were less than 50 years of age at operation. TVO is a useful form of treatment for advanced osteoarthritis of the hip, particularly in young patients with unilateral disease

Aims. Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal femoral neck fractures. However, in many countries this option is economically unviable. To improve outcomes in financially disadvantaged populations, we studied the technique of concomitant valgus hip osteotomy and operative fixation (VOOF). This prospective serial study compares two treatment groups: VOOF versus operative fixation alone with cannulated compression screws (CCSs). Methods. In the first series, 98 hip fixation procedures were performed using CCS. After fluoroscopic reduction of the fracture, three CCSs were placed. In the second series, 105 VOOF procedures were performed using a closing wedge intertrochanteric osteotomy with a compression lag screw and lateral femoral plate. The alignment goal was to create a modified Pauwel’s fracture angle of 30°. After fluoroscopic reduction of fracture, lag screw was placed to achieve the calculated correction angle, followed by inter-trochanteric osteotomy and placement of barrel plate. Patients were followed for a minimum of two years. Results. Mean follow-up was 4.6 years (4.1 to 5.0) in the CCS group and 5.5 years (5.25 to 5.75) in the VOOF group. The mean Harris Hip Score at two-year follow-up was 83.85 in the CCS group versus 88.00 in the VOOF group (p < 0.001). At the latest follow-up, all-cause failure rate was 29.1% in the CCS group and 11.7% in the VOOF group (p = 0.003). The total cost of the VOOF technique was 7.2% of a THA, and total cost of the CCS technique was 6.3% of a THA. Conclusion. The VOOF technique decreased all-cause failure rate compared to CCS. The total cost of VOOF was 13.5% greater than CCS, but 92.8% less than a THA. Increased cost of VOOF was considered acceptable to all patients in this series. VOOF technique provides a reasonable alternative to THA in patients who cannot afford a THA procedure. Cite this article: Bone Jt Open 2023;4(5):329–337

Background. Femoral neck nonunion is a challenging problem. If it is not treated properly, it will be ended with a catastrophe because the victims are younger and active patients and missing hip joint will result in a handicapped like person. If the head is viable, the best treatment is valgus osteotomy. In the original technique, site of nonunion was not explored but in our technique, there is exploration and cleaning of nonunion site and after reduction of fragments, fixation and subtrochanteric osteotomy were done. Materials and methods. Patients with established nonunion of femoral neck fracture entered in study. Inclusion criteria's were age under 60 years old, spherical head of femur without changing the density of it and femoral neck nonunion at least 6 months after fracture. Nonunion site was freshed and any hard ware was removed and head was reduced as possible and subtrochanteric valgus osteotomy to 150 degree was done and fixed with angle blade plate. Bone graft was not used. Patients were studied one year monthly for signs of union of fracture site and signs of avascular necrosis of femoral head. Results. 29 patients were entered in study. 21 male and 8 female with the mean age of 33 years(18 to 55). 19 had Garden type 4 and 7 garden type 3 and the rest 3 had garden type2 at first. Fracture of fixation device were seen in 15 patients. After average 4 months (3 to 5.5) 27 of them showed union of fracture site but in 7 cases, because of some collapse in fracture site, tip of hard ware entered the joint and in 2 cases avascular necrosis of head appeared. Discussion. Exploration of nonunion has some advantages. At first, in some cases removing of broken implants would be necessary for proper insertion of new device. Second, better reduction of fracture site may improve fixation and biomechanics. Third, it seems that in these cases there were through union but in the original method, there were metaplasia of fibrous tissue in the fracture site nonunion

Müller Weiss disease (MWD) is characterized by lateral navicular necrosis which is associated with a varus alignment of the subtalar joint, varying degrees of arthritis of the talonavicular-cuneiform joints and a paradoxical flatfoot deformity in advanced cases. Although arthrodesis of the hindfoot is commonly used, we present the results of a previously unreported method of treatment using a calcaneus osteotomy incorporating a wedge and lateral translation.

Fourteen patients with MWD who were treated with a calcaneus osteotomy were retrospectively reviewed. There were seven females and seven males with an average age of 56 years (range 33–79), and included one grade 5, five grade 4, four grade 3 and four grade 2 patients. Patients had been symptomatic for an average of eleven years (range 1–14), and all underwent initial conservative treatment with an orthotic support that posted the heel into valgus. The primary indication for surgery was a limited but positive response to the use of the orthotic support, and a desire to avoid an arthrodesis of the hindfoot.

Abstract. INTRODUCTION. Fracture neck of femur is aptly called as “the fracture of necessity” owing to the various factors responsible for its non-union. Pauwel's inter-trochantric valgus osteotomy is a useful approach to deal with such fractures. AIM. The aim of this study is to evaluate the functional outcome of valgus osteotomy in treatment of neglected and non-union fracture neck of femur using Harris Hip Scoring system (HHS). MATERIAL AND METHODS. This observational study included 25 patients of the age between 25 years and 50 years with more than 3 weeks since injury and the patients with failed primary fixation. Valgus osteotomy using120° double angled blade plate was done. The patients were followed up till one year. The patients' functional outcome was evaluated with pre-operative and post-operative Harris Hip Score (HHS) at 6 months and one year. RESULTS. Outcome was excellent in 14 patients (HHS>90), good in 8 patients (HHS between 80–90) and fair in one patient (HHS=75.6). Two patients ended up in non-union with blade cut out. The mean HHS at the end of one year was 89.18 + 7.822. The mean change in HHS values pre-operatively and one year post-operatively came out to be 69.58 + 20.032. CONCLUSION. We conclude that for the patients under 50 years of age with neglected fracture of the femoral neck, the Pauwel's osteotomy produces many good results

The Bernese periacetabular osteotomy (PAO) is not indicated for growing hips as it crosses the triradiate cartilage in its posterior branch, and experimental work has shown this can induce substantial deformations, similar to posttraumatic dysplasia, which is observed after pelvis crash injuries in childhood. Upon examination, all injuries in the 19 cases of posttraumatic dysplasia described in literature plus 16 hips of our personal collection took place before the age of 6, which is striking as pelvic injuries in children increase with age. Based on this observation, we started to extend the PAO indication to severe dysplasias in children with open growth plate, initially aged 9 years and older. Following the positive results, it was extended further, our youngest patient being 5 years old. We retrospectively examined radiographic outcomes of 23 hips (20 patients), aged 10.6±1.8 years [range 5.0 – 13.2], operated by us in four centers. Pre- and 3-months postoperative, and the latest FUP radiograph at growth plate closure were measured. We evaluated the acetabular index (AI), lateral center-edge (LCE), ACM-value and compared them with reference values adjusted for age. The age at triradiate cartilage closure was compared with the non-operated side. The follow-up time was 5.4±3.7 years [0.8 - 12.7]. In 5 hips, growth plate closure was delayed by a few months. All angles significantly normalized after PAO (LCE: 14±8° → 38±11°, AI: 20±8° → 7±4°, ACM: 53±5° → 48±4°), with >80% of them severe pathological pre-PAO, none afterwards. Acetabular molding was normal. Only few complications occurred; one had signs of coxarthosis, one sciatic nerve pain, one interfering osteosynthesis material that was removed, one had an additional valgus osteotomy, and all resolved. Based on 20 cases with follow-up until complete triradiate cartilage closure, we believe to have sufficient information to extend the PAO indication to growing hips of 9 years and older

Purpose: The current literature lacks a truly comprehensive examination of the use of a valgus osteotomy to treat osteonecrosis of the femoral head and Perthes disease in the pediatric and adolescent population. Owing to the severity of the pathology, a retrospective examination of the success of valgus osteotomies in treating avascular necrosis and Perthes disease in children and adolescents is warranted. Method: Twenty-four patients with diagnosis of osteo-necrosis of the femoral head or Perthes disease treated between 1995 and 2007 with a proximal femoral valgus osteotomy were identified. The causes of avascular necrosis were Perthes (N=14, 60.9%), slipped capital femoral epiphyses, (N=4, 17.4%), femoral neck fracture (N=2, 8.7%), hip septic arthritis (N=2, 8.7%) and developmental delays and idiopathic osteonecrosis (N=1, 4.3%). The average age of receiving a femoral valgus osteotomy was 10± 3.6 years. The average age at follow-up was 12.2± 4 years, mean time of follow-up from the initial valgus osteotomy to last assessment was 23± 15.3 months. Results: Postoperative pain improved significantly compared to preoperative pain (p=.002). Seventy five percent of patients (n=9) who had limitations in their daily activities preoperatively reported that they no longer experienced them after the treatment. External rotation (p=.005) and abduction (p=.003) improved significantly at follow up. Postoperative Ficat & Arlet classification was significantly better when compared to the classification before valgus osteotomy (p=0.007). Univariate analysis showed that sixty percent of patients (n=6) who had Perthes had improved in their Ficat & Arlet stage whereas one (14.3%) patient with a different diagnosis improved (p=.082). Complications from the surgery were reported in 5 of the 23 (21.7%) cases. Conclusion: The results of this study suggest that proximal femoral valgus osteotomy is a safe and effective treatment method for osteonecrosis of the femoral head in the pediatric population. Perthes patients improved their femoral head shape more than all other etiologies; there was a trend toward statistical significance in this change. Proximal femoral valgus osteotomy may improve pain and activity limitations in children with osteonecrosis of the femoral head. It is also effective at improving range of motion and femoral head x-ray appearance of the femoral head for these children

The aims of this study were to report functional outcomes of salvage procedures for patients with cerebral palsy (CP) who have chronic dislocation of the hip using validated scoring systems, and to compare the results of three surgical techniques. We reviewed 37 patients retrospectively. The mean age at the time of surgery was 12.2 years (8 to 22) and the mean follow-up was 56 months (24 to 114). Patients were divided into three groups: 14 who underwent proximal femoral resection arthroplasty (PFRA group 1), ten who underwent subtrochanteric valgus osteotomy (SVO group 2), and 13 who underwent subtrochanteric valgus osteotomy with resection of the femoral head (SVO with FHR group 3). All patients were evaluated using the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) and the Pediatric Quality of Life Inventory (PedsQL). Significant improvements occurred in most CPCHILD and PedsQL subsection scores following surgery in all patients, without significant differences between the groups. There were 12 post-operative complications. Less severe complications were seen in group 1 than in groups 2 and 3. Salvage surgery appears to provide pain relief in patients with CP who have painful chronic dislocation of the hip. The three salvage procedures produced similar results, however, we recommend the use of PFRA as the complications are less severe. Take home message: Salvage surgery can be of benefit to patients with CP with chronic painful hip dislocation, but should be limited to selected patients considering complications. Cite this article: Bone Joint J 2016;98-B:137–43

Introduction. Osteogenesis imperfect (OI) is a geno- and phenotypically heterogeneous group of congenital collagen disorders characterized by fragility and microfractures resulting in long bone deformities. OI can lead to progressive femoral coxa vara from bone and muscular imbalance and continuous microfracture about the proximal femur. If left untreated, patients develop Trendelenburg gait, leg length discrepancy, further stress fracture and acute fracture at the apex of the deformity, impingement and hip joint degeneration. In the OI patient, femoral coxa vara cannot be treated in isolation and consideration must be given to protecting the whole bone with the primary goal of verticalization and improved biomechanical stability to allow early loading, safe standing, re-orientation of the physis and avoidance of untreated sequelae. Implant constructs should therefore be designed to accommodate and protect the whole bone. The normal paediatric femoral neck shaft angle (FNSA) ranges from 135 to 145 degrees. In OI the progressive pathomechanical changes result in FNSA of significantly less than 120 degrees and decreased Hilgenreiner epiphyseal angles (HEA). Proximal femoral valgus osteotomy is considered the standard surgical treatment for coxa vara and multiple surgical techniques have been described, each with their associated complications. In this paper we present the novel technique of controlling femoral version and coronal alignment using a tubular plate and long bone protection with the use of teleoscoping rods. Methodology. After the decision to operate had been made, a CT scan of the femur was performed. A 1:1 scale 3D printed model (AXIAL3D, Belfast, UK) was made from the CT scan to allow for accurate implant templating and osteotomy planning. In all cases a subtrochanteric osteotomy was performed and fixed using a pre-bent 3.5 mm 1/3 tubular plate. The plate was bent to allow one end to be inserted into the proximal femur to act as a blade. A channel into the femoral neck was opened using a flat osteotome. The plate was then tapped into the femoral neck to the predetermined position. The final position needed to allow one of the plate holes to accommodate the growing rod. This had to be determined pre operatively using the 3D printed model and the implants. The femoral canal was reamed, and the growing rod was placed in the femur, passing through the hole in the plate to create a construct that could effectively protect both the femoral neck and the full length of the shaft. The distal part of the plate was then fixed to the shaft using eccentric screws around the nail to complete the construct. Results. Three children ages 5,8 and 13 underwent the procedure. Five coxa vara femurs have undergone this technique with follow-up out to 62 months (41–85 months) from surgery. Improvements in the femoral neck shaft angle (FNSA) were av. 18. o. (10–38. o. ) with pre-op coxa vara FNSA av. 99. o. (range 87–114. o. ) and final FNSA 117. o. (105–125. o. ). Hilgenreiner's epiphyseal angle was improved by av. 29. o. (2–58. o. ). However only one hip was restored to <25. o. In the initial technique employed for 3 hips, the plates were left short in the neck to avoid damaging the physis. This resulted in 2 of 3 hips fracturing through the femoral neck above the plate at approximately 1 year. There were revisions of the 3 hips to longer plates to prevent intra-capsular stress riser. All osteotomies united and both intracapsular fractures healed. No further fractures have occurred within the protected femurs and no other repeat operations have been required. Conclusions. Surgical correction of the OI coxa vara hip is complex. Bone mineral density, multiplanar deformity, a desire to maintain physeal growth and protection of the whole bone all play a role in the surgeon's decision making process. Following modifications, this technique demonstrates a novel method in planning and control of multiplanar proximal femoral deformity, resulting in restoration of the FNSA to a more appropriate anatomical alignment, preventing long bone fracture and improved femoral verticalization in the medium term follow-up

It is very difficult to perform total knee arthroplasty (TKA) for severe varus bowing deformity of femur. We performed simultaneous combined femoral supra-condyle valgus osteotomy and TKA for the case had bilateral varus knees with bowing deformity of femurs. Case presentation. A 62-year-old woman consulted our clinic with bilateral knee pain and walking distability. She was diagnosed rickets and had bilateral severe varus bowing deformity of femurs from an infant. Her height was 133 cm and body weight was 51 kg. Bilateral femur demonstrated severe bowing and her knee joint demonstrated varus deformity with medial joint line tenderness, no local heat, and no joint effusion. Bilateral knee ROM was 90 degrees with motion crepitus. Bilateral lower leg demonstrated mild internal rotation deformity. Bilateral JOA knee score was 40 Roentgenogram demonstrated knee osteoarthritis with incomplete development of femoral condyle. Mechanical FTA angles were 206 degree on the right and 201 on the left. She was received right simultaneous femoral supra-condyle valgus osteotomy with TKA was performed at age 63. Key points of surgical techniques were to use the intramedullary guide for valgus osteotomy as temporary reduction and fixation then performed mono-cortical locking plate fixation. Several mono cortical screws were exchanged to bi-cortical screws after implantation of the femoral component with long stem. Cast fixation performed during two weeks and full weight bearing permitted at 7 weeks after surgery. Her JOA score was slightly improved 50 due to other knee problems at 9 months after surgery, her right mechanical FTA was decreased to 173, and she received left simultaneous femoral supra-condyle valgus osteotomy with TKA as the same technique at April of this year. She has been receiving rehabilitation at now. Conclusions. Most causes of varus knee deformity are defect or deformity of medial tibial condyle and TKA for theses cases are not difficult to use tibial augment devices. However the cases like our presentation need supra-femoral condyle osteotomy before TKA. It was easy and useful to use intramedullary guide for valgus osteotomy as temporary reduction and fixation then performed mono-cortical locking plate fixation before TKA

Aims: To review the results of reconstruction of pseudoarthrosis and/or significant varus with retroversion of proximal femur in congenital longitudinal lower limb deficiencies. Methods: 23 of 95 patients had proximal femoral reconstruction. 7 had pseudoarthrosis of the neck of femur and the remaining had significant coxa vara with retroversion of femur. 3 patients with pseudoarthroses were treated with valgus derotation osteotomy and cancellous bone grafting, 2 with fibular strut grafts, 1 King’s procedure and 1 with excision of fibrous tissue and valgus derotation osteotomy. Remaining patients underwent valgus derotation osteotomies. A variety of internal fixation devices and external fixators were used. Results: All patients with pseudoarthroses underwent multiple procedures to achieve union. 3 with cancellous bone grafting underwent repeat osteotomies to correct residual varus and 2 had grafting repeated twice. 2 patients achieved union after fibular strut grafting. One patient, who underwent excision of pseudoarthrosis, achieved union but had to undergo further valgus osteotomy. The remaining 17 patients with coxa vara and retroversion of femur also had valgus osteotomies repeated more than once (average 2.3) for recurrence of varus deformity. There were significant numbers of implant failures. Average initial neck-shaft angle of 72 degrees improved to 115 degrees after reconstruction. Conclusion: Achieving union of pseudoarthrosis and early axis correction using valgus derotation osteotomy with a view to later lengthening is important in limb reconstruction. Recurrence may require repeated osteotomies and pseudoarthrosis may need more aggressive surgery to achieve union. Muscle slides and soft tissue releases decrease the stress on implant and maintain correction

Total knee arthroplasty (TKA) after proximal tibial valgus osteotomy is thought to be technical demanded and its outcome is not as sufficient as primary TKA. Purpose of this study is to identify particular surgical procedures and outcome of TKA after proximal tibial valgus osteotomy in the different type of osteotomies. Fourteen TKA after proximal tibial valgus osteotomies were underwent for 13 patients with osteoarthritis. Average age at surgery was 72 years old. The mean duration from proximal tibial valgus ostetomy to TKA was 9 years and 10 months and the mean follow up period after TKA was three years and nine months. Four closed wedged osteotomies, five modified Levy’s reversed V shaped osteotomies and five domed osteotomies were underwent before TKA. The V-Y lengthening of quadriceps tendon or osteotomy of the tibial tubercle was necessary for each one knee. Both knee had patella infera due to previous osteotomies of tibial tubercle for patello- femoral osteoarthritis. 11 lateral releases including release of lateral collateral ligament and two lengthening of iliotbial tract were needed to achieve sufficient ligament balance. The stems of tibial components could be placed almost centrally especially in knees, which had reversed V shaped oseteotomies and laterally in knees, which had domed or closed wedged osteotomies. Clinical results evaluated by Japan Orthopedic Association score had improved from 53 points before TKA to 84 points after TKA. This study suggests that 1) approach is difficult in the knee, which had previous osteotomy of tibial tubercle, 2) lateral release including lateral collateral ligament and iliotibial tract is necessary to achieve sufficient ligament balance, 3) the stem of tibial component might be placed laterally in knees, which had previous domed oseteotomy or closed wedged osteotomy, 4) outcome of TKA after proximal valgus osteotomy is as good as primary TKA

To review the results of reconstruction of pseudoar-throsis and/or significant varus with retroversion of proximal femur in congenital longitudinal lower limb deficiencies, twenty-three of ninety-five patients with lower limb deficiencies underwent proximal femoral reconstruction at the Sheffield Children’s Hospital. All twenty-three underwent valgus derotation osteotomies to correct coxa vara and retroversion of femur. Seven patients also had pseudoarthrosis of the neck of femur. Three of these were treated with valgus derotation osteotomy and cancellous bone grafting, two with fibular strut grafts, one King’s procedure and one with excision of fibrous tissue and valgus derotation osteotomy. A variety of internal fixation devices and external fixator were used. Seventeen of the twenty-three patients had valgus osteotomies repeated more than once (average 2.3) for recurrence of varus deformity. Average initial neck-shaft angle was 72 degrees, which improved to an average of 115 degrees after reconstruction. All seven patients with pseudoarthroses underwent multiple procedures (average 3.3) to achieve union. Cancellous bone grafting was repeated twice in two patients to achieve union but all three with cancellous bone grafting underwent repeat osteotomies to correct residual varus. Two patients achieved union after fibu-lar strut grafting. One patient, who underwent excision of pseudoarthrosis, achieved union but had to undergo further valgus osteotomy. No particular advantage of any one-fixation device over the others was noted in achieving correction. Early axis correction using valgus derotation oste-otomy is important in limb reconstruction when there is significant coxa vara and retroversion, although recurrence may require repeated osteotomies. Pseudoarthro-ses needed more aggressive surgery to achieve union

Aim:. Audit of the outcome of subcapital osteotomy for a series of cases of severe unstable slipped capital femoral epiphysis. Method:. 57 cases of unstable severe slipped capital femoral epiphysis were operated on by a single surgeon between 2000 and 2011. The procedure was performed through the anterior abductor sparing approach. Patients have been followed up prospectively and the results are presented at average follow up is 6.4 years with a minimum of 18 month follow to include all risks of avn. Results:. There were 35 males (average age 13.85 years) and 22 females (average age 12.4 years). Three syndromic cases, 2 Trisomy 21 (with no avn) and one pituitary/corpus callosum agenesis (developed avn) were included. 5 patients (8.7%) developed avn, one syndromic, another with noted avn on pre-operative MRI and the third with partially healed growth plate. Excluding these patients the avn rate was 2/54 (3.7%). Re-operations were performed on the avn group including two head neck debridements and valgus osteotomy, one head neck debridement alone and one arthrodesis. One patient is awaiting debridement and valgus osteotomy. One patient developed chondrolysis and has had no intervention 6 years. 2 patients developed asymptomatic heterotopic bone ossification and the incidence of lateral cutaneous nerve symptoms was 35% none requiring intervention. Leg length difference was less than 1 cm in those patients who did not develop avn. Conclusion:. This single surgeon audit shows lower risk of avn than and strengthens the argument for referral to specific centres for such conditions. Level of evidence: IV

Introduction: High tibial osteotomy is an established procedure for the mid-term treatment of unicompartmental osteoarthritis of the knee. Nevertheless, it produces anatomic alterations of the proximal part of tibia, which might affect the later performance of TKR. These anatomic changes are basically patella infera and medialization of the tibial medullary canal with respect to the tibial plateau (tibial condilar offset). Material and Method: The purpose of the present retrospective study is the evaluation of the above mentioned anatomic changes, caused by high tibial valgus osteotomy (Mittelmeier’s technique). For this purpose we studied the X-rays of 44 kness (pre-op, p-op and 1 year p-op) that had under gone the above procedure. Results: We didn’t find any statistically significant difference of the postoperative position of the patella with respect to the preoperative one, whereas there was definite medialization of the tibial anatomic axis with respect to the preoperative situation. The latter change was directly correlated with the degree of valgus correction. The mean change of the tibial anatomic axis (as estimated by the value of the tibial condylar offset ratio) was 15%. Conclusions: Although Mittelmeier’s high tibial valgus osteotomy does not cause any significant alteration of the position of the patella, it does alter the relationship of the tibial medullary canal with respect to the tibial plateau in direct correlation with the degree of valgus correction. Thus, the performance of TKR after proximal tibial osteotomy necessitates a thorough preoperative plan and the selection of the appropriate implant

The optimal correction of the weight bearing line during High Tibial Osteotomy has not been determined. We used finite element modelling to simulate the effect that increasing opening wedge HTO has on the distribution of stress and pressure through the knee joint during normal gait. Subject-specific models were developed by combining geometry from 7T MRI scans and applied joint loads from ground reaction forces measured during level walking. Baseline stresses and pressures on the articulating proximal tibial cartilage and menisci were calculated. Progressive osteotomies were then simulated to shift the weight-bearing line from the native alignment towards/into the lateral compartment (between 40 – 80% of medial-lateral tibial width). Changes in calculated stresses and pressures were recorded. Both stress and pressure decreased in the medial compartment and increased in the lateral compartment as increasingly valgus osteotomies were simulated. The models demonstrated a consistent “safe zone” for weight bearing line position at 50%-65% medial-lateral tibial width, outside of which compartment stresses and pressures substantial increased. This study suggests a safe correction zone within which a medial opening wedge HTO can be performed correcting the WBL to 55% medio-lateral width of the tibia

If and how closed valgus osteotomy of tibia is possible to influence intra and post operative results of total knee arthroplasty. Since 1985 to 2002 196 high tibial osteotomies were performed. 57 of them were treated by T.K.A. In 21 of 196 cases diagnostic arthoscopy performed for evaluation of the lesion. All osteotomies were closed wedge. Stabilization of the knee was done with plaster clast and in 50% of cases staples used. The time interval from osteotomy to T.K.A was 2–17 years mean 8 years. Follow-up of T.K.A. was 3–20 years. Scars, patella Baja, shortens of patellar tendon increased operative time and degree of difficulty. Postoperative results of T.K.A, were evaluated according the WOMAC (pain, stiffness, function) KSS (function) KSRIS (x-ray findings) were the same with those of primary T.K.A. Postoperative complications:. 11 cases decrease in range of knee movment. 3 fractures of external tibial condyle. 2 mechanical loosening of T.K.A. skin necrosis. rupture of extension complex. Intaoperative difficulties in high valgus tibial osteotomy and afterrwords in T.K.A. were increased although postoperative results were the same. This is the reason that surgical experience is the target point of the result