Introduction: The results of high tibial osteotomy tend to deteriorate over time. Consequently, a certain percentage of these patients will ultimately undergo TKR for the symptomatic treatment of the osteoarthritis of their knees. High tibial osteotomy, on the other hand, produces anatomic alterations around ipsilateral knee joint, that might bring about technical difficulties during the performance of TKR procedure. One of these difficulties has to do with the alteration of relationship between tibial anatomic axis and ipsilateral plateau.

Aim: The radiographic evaluation of the alteration of the relative position of the tibial medullary canal with respect to the ipsilateral plateau, after high tibial, closed-wedge osteotomy, with stable fixation.

Material – Method: For this aim, we studied 49 knees (in 45 patients), that had undergone high tibial valgus osteotomy, between 1990 and 1997, in our Department. The relative change of tibial anatomic axis was determined by calculating the index of “tibial condylar offset” in the AP view of each knee during three follow up examinations done at the direct post operative period, three months post operatively and at least one year post operatively.

Results: There was a definite tendency of medialization of the tibial anatomic axis post operatively (and, consequently, of the tibial medullary canal) with respect to the centre of the ipsilateral plateau. This was in direct proportion to the degree of valgus correction. The mean percentage of post operative alteration of “tibial condylar offset”, in comparison to its preoperative value, was 19%.

Conclusions: The insertion of a stemmed tibial implant, in a knee that has previously undergone high tibial osteotomy, through the centre of the tibial plateau runs a certain risk of abutment on the lateral cortex, due to the medialization of the tibial medullary canal with respect to the centre of tibial plateau. The above observations show the importance of a thorough pre-op plan of every TKR procedure that has been preceded by high tibial osteotomy

Purpose: The aim of this study is the evaluation of the use of plate and screws without restoration of the opposite cortex and without the use of bone graft in the treatment of multifragmentary fractures of femur.

Material and Methods: For this purpose, we retrospectively studied 26 multifragmentary femoral fractures that were treated in our department in accordance with the above principles, between 1992 and 2001. All fractures were reduced indirectly with traction on the fracture table without any direct manipulation at the comminution zone. Emphasis was given to the restoration of the proper length, axial and rotational alignment of each fracture. The fixation was done with a long bridge plate, without the use of interfragmentary screws.

Twenty five of the fractures (96.5%) united, without any serious complication, within 3–5 months. In one fracture the fixation failed and had to be revised.

Conclusions: The use of plate and screws in the treatment of multifragmentary fractures of femur, once it is done with complete respect to the fracture biology leads to speedy fracture union, high union rate and a very low complication rate.

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.