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Petersen W, Al Mustafa H, Häner M, Braun K. [Modified pendulum osteotomy to correct severe tibial varus deformity]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024:10.1007/s00064-024-00854-w. [PMID: 39150497 DOI: 10.1007/s00064-024-00854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE Correction of a severe tibial varus deformity near the knee joint with only a slight influence on leg length and patella height. INDICATIONS Medial osteoarthritis and/or cartilage damage with a severe varus deformity > 10° with a medial proximal tibial angle (MPTA) < 80°. CONTRAINDICATIONS Femoral varus deformity with lateral distal femoral angle > 91°, severe lateral cartilage damage, lateral osteoarthritis, lateral meniscus loss. SURGICAL TECHNIQUE Skin incision of approx. 8-10 cm between the tibial tuberosity and the head of the fibula. Exploration of the peroneal nerve. Detachment of the extensors. Insertion of an obliquely ascending guidewire ending approximately 10 mm below the medial articular surface. Insertion of a second guidewire. This aims at the middle of the first wire (hemi wedge). Check the wire position under fluoroscopy. Osteotomy with an oscillating saw under cooling. Removal of the wedge and closure of the osteotomy. Percutaneous needling of the medial collateral ligament with a cannula to carefully lengthen the ligament. Check the correction result with a metal rod. Osteosynthesis with lateral angle-stable plate. POSTOPERATIVE MANAGEMENT Partial weight-bearing with 10 kg for 6 weeks postoperatively, free range of motion. RESULTS Reports from the literature show that good clinical results can be achieved with this procedure for severe tibial varus deformities. Postoperative leg length discrepancies are less common with this procedure than with laterally closing osteotomy.
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Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland.
| | - Hasan Al Mustafa
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
| | - Martin Häner
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
| | - Karl Braun
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
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Lott A, James MG, Kaarre J, Höger S, Kayaalp ME, Ollivier M, Getgood A, Hughes JD, Musahl V. Around-the-knee osteotomies part II: Surgical indications, techniques and outcomes - State of the art. J ISAKOS 2024; 9:658-671. [PMID: 38604568 DOI: 10.1016/j.jisako.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/24/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
Recent advances in surgical techniques and planning for knee-based osteotomies have led to improvements in addressing lower extremity malalignment. Part 1 of this review presented the biomechanical and clinical rationale of osteotomies, emphasizing the importance of osteotomies for restoring normal knee kinematics. In Part 2 of this review, indications, surgical technique and outcomes of osteotomies to correct coronal, sagittal and axial plane deformities will be examined. Traditional high tibial and distal femoral osteotomies will be discussed in addition to more recent advanced techniques including biplanar corrections and double-level osteotomies, as well as slope-correcting osteotomies. Patient-specific instrumentation and its use in more complex corrections will also be addressed.
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Affiliation(s)
- Ariana Lott
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael G James
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Svenja Höger
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Enes Kayaalp
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedics and Traumatology, Istanbul Kartal Training and Research Hospital, Istanbul, Turkey
| | | | - Al Getgood
- Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA.
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Takagawa S, Kobayashi N, Yukizawa Y, Hirotomi K, Higashihira S, Inaba Y. Hybrid Closed Wedge High Tibial Osteotomy Maintains the Leg Length After Surgery Compared With Open Wedge High Tibial Osteotomy. Cureus 2024; 16:e57953. [PMID: 38738055 PMCID: PMC11082916 DOI: 10.7759/cureus.57953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND This study aimed to assess the changes in leg length following open wedge high tibial osteotomy (OWHTO) and hybrid closed wedge high tibial osteotomy (h-CWHTO) and whether the change in leg length was associated with preoperative radiographic factors and the change in planned opening or closing width. METHODS We retrospectively evaluated the data of patients who underwent OWHTO (n=57) and h-CWHTO (n=31) between 2016 and 2019. Standing full-length anteroposterior radiographs were obtained preoperatively and one year postoperatively. Changes in the lower leg and tibial length were measured using radiography, and the planned opening or closing width was decided via operative planning. Flexion contracture was examined preoperatively and one year postoperatively using a goniometer, and the correlation factors and changes in leg length were analyzed using Spearman's rank correlation. RESULTS In the OWHTO group, the lower leg was significantly longer by a mean of 6.0±8.7 mm compared to that preoperatively (p<0.01); however, no significant difference was observed in the h-CWHTO group (mean, -0.56±11.6 mm) (p=0.788). In the OWHTO group, flexion contracture did not improve after surgery, however, in the h-CWHTO group, flexion contracture significantly improved from -7.1±7.0 degrees to -4.7±6.2 degrees postoperatively (p<0.01). No radiographic factors or bone opening or closing width were associated with changes in leg length in both groups. CONCLUSION OWHTO led to a significant elongation of the lower leg while leg length was maintained post-h-CWHTO. However, the changes in leg length following both OWHTO and h-CWHTO were not predictable from preoperative radiographic factors or changes in bone width.
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Affiliation(s)
- Shu Takagawa
- Orthopaedics Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Naomi Kobayashi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Yohei Yukizawa
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Kunihito Hirotomi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shota Higashihira
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Yutaka Inaba
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
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Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H, Inaba Y. Potential anatomic risk factors resulting oversized postoperative medial proximal tibial angle after double level osteotomy. BMC Musculoskelet Disord 2022; 23:1121. [PMID: 36550449 PMCID: PMC9784003 DOI: 10.1186/s12891-022-06101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Double level osteotomy (DLO) has been introduced to prevent increased postoperative joint line obliquity. However, although DLO is planned, knees with postoperative medial proximal tibial angle (MPTA) > 95° in preoperative surgical planning are present. This retrospective study aimed to evaluate risk factors for an MPTA > 95° in preoperative surgical planning for DLO in patients with varus knee osteoarthritis (OA). METHODS A total of 168 knees that underwent osteotomies around the knee for varus knee OA were enrolled. The hip-knee-ankle angle (HKA), weight-bearing line (WBL) ratio, mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and mechanical medial proximal tibial angle (mMPTA) were measured on preoperative radiographs. The postoperative WBL ratio was planned to be 62.5%. When the postoperative mMPTA was more than 95° in isolated high tibial osteotomy (HTO), (DLO) was planned so that the postoperative mLDFA was 85°, and residual deformity was corrected by HTO. Knees with postoperative mMPTA ≤ 95° and > 95° were classified into the correctable group and uncorrectable group, respectively. RESULTS DLO was required in 101 knees (60.1%). Among them, 41 knees (40.6%) were classified into the uncorrectable group. Binomial logistic regression analysis showed that preoperative JLCA and mMPTA were independent predictors in the uncorrectable group. CONCLUSIONS Even with DLO, postoperative mMPTA was more than 95° in approximately 40% of cases. Preoperative increased JLCA and decreased mMPTA were risk factors for a postoperative mMPTA of > 95° after DLO.
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Affiliation(s)
- Shuntaro Nejima
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Ken Kumagai
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Shunsuke Yamada
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Masaichi Sotozawa
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Dan Kumagai
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Hironori Yamane
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Yutaka Inaba
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
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Association of the joint line orientation angle of the contralateral limb with the alignment change of the unilateral and bilateral opening-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2022; 31:1593-1602. [PMID: 35994078 DOI: 10.1007/s00167-022-07123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE This study aimed to evaluate and compare unilateral and bilateral open-wedge high tibial osteotomy (OWHTO) using mid-term serial assessment of clinical and radiological outcomes, especially focussing on coronal lower extremity alignment. METHODS Serial radiological assessments were performed in 40 patients (80 knees) with bilateral OWHTO and 49 patients (49 knees) with unilateral OWHTO. Both groups were further divided into four subgroups to compare each limb (unilateral involved and non-involved limbs and bilateral primarily and secondarily treated limbs). Radiological and clinical outcomes were evaluated and compared among the four groups. For the alignment change assessment, the pelvic tilt angle (PTA), weight-bearing line ratio (WBLR), joint line orientation angle (JLOA), medial proximal tibia angle (MPTA), joint line convergence angle (JLCA), distal tibia articular angle (DTAA), and talar inclination (TI) were measured pre- and postoperatively at 3, 6, and 12 months and annually thereafter. Student's t-test, one-way repeated-measures analysis of variance, and correlation analysis were used to compare the groups. RESULTS Patients in the unilateral and bilateral OWHTO groups had similar postoperative radiological and clinical outcomes. Each unilaterally involved limb and primarily treated bilaterally involved limb were negatively affected by the contralateral limb with respect to increased JLOA during the postoperative period (unilateral OWHTO group: r = -0.350, p = 0.023; bilateral OWHTO group: r = -0.520, p = 0.005). The correction change of the ankle parameters in the secondarily treated limb showed greater varus alignment than the primarily treated limb after bilateral OWHTO (DTAA (0.1 ± 3.0 vs. -0.5 ± 3.8°, p = 0.014) and TI (0.9 ± 3.2° vs. -0.3 ± 2.9, p = 0.001)). CONCLUSION Unilateral and bilateral OWHTOs shared similar postoperative radiological and clinical outcomes. Alignment changes of the unilateral OWHTO and the primarily treated limb of the bilateral OWHTO were associated with the JLOA of the contralateral limb. LEVEL OF EVIDENCE Cohort study; Level III.
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Kondo E, Yabuuchi K, Joutoku Z, Matsubara S, Iwasaki K, Matsuoka M, Onodera T, Momma D, Inoue M, Yagi T, Iwasaki N, Yasuda K. Effect of the Inverted V-Shaped Osteotomy on Patellofemoral Joint and Tibial Morphometry as Compared With the Medial Opening Wedge High Tibial Osteotomy. Am J Sports Med 2022; 50:2439-2452. [PMID: 35762976 DOI: 10.1177/03635465221104708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies have reported that medial opening wedge (OW) high tibial osteotomy (HTO) induces patella baja, resulting in degenerative changes in the patellofemoral joint. We have developed an inverted V-shaped (iV) HTO, which is classified as a neutral wedge osteotomy. HYPOTHESES The study hypotheses were as follows: (1) patellar height, posterior tibial slope, and tibial length will not change between pre- and postoperative evaluations after iV-HTO; (2) the lateral shift ratio of the patella and the distance between the tibial tubercle and the trochlear groove may be significantly decreased after iV-HTO. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 191 patients (220 knees) who underwent HTO for medial osteoarthritis were enrolled retrospectively in this study: 107 knees underwent OW-HTO and 113 knees underwent iV-HTO. Clinical and radiological evaluations were performed before and at least 3 years after surgery. RESULTS Postoperatively, the mean Caton-Deschamps ratio was significantly decreased (P < .0001) from 0.95 to 0.79 in the OW group, while there were no significant changes in the iV group. The mean posterior tibial slope was significantly increased (P < .0001) from 8.5° to 10.5° in the OW group, while there were no significant differences in the iV group. Although the entire leg length was significantly increased (P < .0003) in both groups after HTO, there were no significant differences in tibial length between the pre- and postoperative periods in the iV group. Regarding the congruity of the patellofemoral joint, the mean lateral shift ratio did not significantly change in the OW group, whereas it was significantly decreased (P = .0012) from 11.5% to 8.8% in the iV group. The mean tibial tubercle-trochlear groove distance was significantly decreased (P < .0001) from 12.8 to 9.7 mm in the iV group, while it was significantly increased in the OW group (P < .0001). Concerning the clinical outcome, the Japanese Orthopaedic Association (JOA) and Lysholm knee scores at final follow-up (OW vs iV: JOA, 91.2 vs 90.1; Lysholm, 92.5 vs 89.0) were significantly increased (P < .0001) as compared with the preoperative values (OW vs iV: JOA, 68.3 vs 66.8; Lysholm, 67.9 vs 61.0). CONCLUSION Patellar height, posterior tibial slope, and tibial length did not change after the iV-HTO, while they were significantly changed after the OW-HTO. Although the preoperative degrees of varus knee and patellofemoral osteoarthritis were more severe in the iV group than the OW group, the iV-HTO led to altered patellofemoral joint congruity.
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Affiliation(s)
- Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Koji Yabuuchi
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Zenta Joutoku
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinji Matsubara
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Koji Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Momma
- Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Masayuki Inoue
- Department of Orthopaedic Surgery, NTT East Japan Sapporo Hospital, Sapporo, Japan
| | - Tomonori Yagi
- Department of Orthopaedic Surgery, Yagi Orthopaedic Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazunori Yasuda
- Sports Medicine and Arthroscopy Center, Yagi Orthopaedic Hospital, Sapporo, Japan
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Yamamuro Y, Kabata T, Goshima K, Kajino Y, Inoue D, Ohmori T, Ueno T, Takagi T, Yoshitani J, Ueoka K, Taninaka A, Tsuchiya H. Change in leg length after open-wedge high tibial osteotomy can be predicted from the opening width: A three-dimensional analysis. Knee 2021; 30:185-194. [PMID: 33940306 DOI: 10.1016/j.knee.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/09/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate true change in leg length after open-wedge high tibial osteotomy (OWHTO) using three-dimensional (3D) assessments, examine the factors that influence leg lengthening and verify their validity in clinical practice. METHODS Study 1: a retrospective case series simulation study, included 46 patients (55 knees) that underwent knee arthroplasty or HTO. OWHTO was simulated from preoperative computed tomography using 3D preoperative planning software. Uni- and multivariate regression analyses were conducted to identify predictors related to change in leg length. Study 2: a retrospective case series study, included 53 patients (55 knees) that underwent OWHTO in another institution. Change in leg length was measured preoperatively and 1 year postoperatively and was compared with the predicted change in leg length calculated using the formula obtained from Study 1. RESULTS Study 1: the true change in leg length significantly increased and showed a strong correlation with the opening width. The change in leg length was predicted using the formula "change in leg length = opening width × 0.75-1.5." Study 2: the predicted change in leg length showed no significant difference from the change in leg length 1 year postoperatively and a strong correlation with the measured change. CONCLUSIONS The true change in leg length after OWHTO was predicted using the formula obtained from the 3D model. Predicting the change in leg length preoperatively can be a basis to consider other HTOs.
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Affiliation(s)
- Yuki Yamamuro
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan.
| | - Kenichi Goshima
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan; Department of Orthopaedics and Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Takaaki Ohmori
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Takuro Ueno
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Tomoharu Takagi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Junya Yoshitani
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Ken Ueoka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Atsushi Taninaka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
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Gómez-Palomo JM, Meschian-Coretti S, Esteban-Castillo JL, García-Vera JJ, Montañez-Heredia E. Double Level Osteotomy Assisted by 3D Printing Technology in a Patient with Blount Disease: A Case Report. JBJS Case Connect 2021; 10:e0477. [PMID: 32649128 DOI: 10.2106/jbjs.cc.19.00477] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe the case of a 26-year-old patient diagnosed with Blount disease. She underwent a medial oblique supracondylar biplanar closing-wedge osteotomy of the distal femur followed by a medial oblique biplanar opening-wedge osteotomy of the proximal tibia. 3D printed cutting guides were used for the procedures. At 18 months after surgery, the patient is pain-free and walks without aids. CONCLUSIONS Using 3D printed guides allowed for accurate correction of the deformity and reduced the risk of damaging critical structures. These guides could be an appropriate alternative for the surgical treatment of patients with Blount disease.
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Affiliation(s)
- Juan M Gómez-Palomo
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Stephan Meschian-Coretti
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José L Esteban-Castillo
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan J García-Vera
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Elvira Montañez-Heredia
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Ogawa H, Matsumoto K, Sengoku M, Yoshioka H, Yamamoto K, Shimokawa T, Ohnishi K, Akiyama H. Clinical course and outcomes of simultaneous-versus staged-bilateral medial opening wedge high tibial osteotomy. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 23:13-17. [PMID: 33344173 PMCID: PMC7725662 DOI: 10.1016/j.asmart.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/12/2020] [Accepted: 11/26/2020] [Indexed: 11/08/2022]
Abstract
Background Difference in the clinical course and outcomes between simultaneous- and staged-bilateral medial opening wedge high tibial osteotomies (OWHTOs) over time was unknown. The study hypothesis was that patients who underwent simultaneous-bilateral OWHTO (SMBO) have a more rapid improvement in knee function than those who underwent staged-bilateral OWHTO (STBO) due to difference in the change of lower limb alignment between SMBO and STBO. Methods The records of 56 knees in 28 patients who underwent either SMBO (n = 28) or STBO (n = 28) were retrospectively analysed. The time course data of weight-bearing line percentage (%WBL), joint line convergence angle (JLCA), and Knee Society Score were compared between the two procedures. Results Hospitalisation for SMBO was longer than that for STBO by 1 week. No significant difference was observed in %WBL between the two procedures. The JLCA was significantly lower with SMBO than with the first-stage surgery of STBO (P < 0.05), but it became equivalent in both groups at the last follow-up. The knee scores in both SMBO and the first-stage surgery of STBO significantly improved in approximately 1 year. The function scores in the first-stage surgery of STBO did not significantly improve until the completion of the second-stage surgery whereas those in SMBO significantly improved 1 year after surgery and become stable. The function score 1 year after surgery was significantly higher in SMBO than in the first-stage surgery of STBO (p < 0.001). Conclusions Although both SMBO and STBO achieved the desired therapeutic results, SMBO led to earlier functional improvement and decreased JLCA compared with STBO.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan.,Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu, 501-1194, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu, 501-1194, Japan
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
| | - Hiroki Yoshioka
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu, 501-1194, Japan
| | - Kyosuke Yamamoto
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
| | - Tetsuya Shimokawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
| | - Kazuichiro Ohnishi
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital. Hayashi-machi 6-85-1, Ogaki, 503-0015, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine. Yanagido 1-1, Gifu, 501-1194, Japan
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Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
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