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Koiwa S, Tsunoda T, Madachi A, Murashima R. Single-Stage Total Knee Arthroplasty and Open-Wedge Distal Femoral Osteotomy for Osteoarthritis with Femoral Shortening and Extra-Articular Varus Deformity: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00067. [PMID: 36947647 DOI: 10.2106/jbjs.cc.22.00601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
CASE A 76-year-old female patient with a history of pyogenic arthritis of the right knee in childhood presented with severe osteoarthritis of the right knee with 24-mm femoral shortening and severe extra-articular femoral varus deformity. She received single-stage total knee arthroplasty (TKA) combined with a medial open-wedge distal femoral osteotomy and achieved good postoperative clinical and radiological results. CONCLUSION This case illustrated that extra-articular open-wedge distal femoral osteotomy and TKA performed simultaneously may be efficacious for severe extra-articular deformities with femoral shortening.
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Affiliation(s)
- Sora Koiwa
- Department of Orthopedics, Asama General Hospital, Saku City, Nagano, Japan
- Department of Orthopedics and Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Toshiharu Tsunoda
- Department of Orthopedics, Asama General Hospital, Saku City, Nagano, Japan
| | - Atsushi Madachi
- Department of Orthopedics, Asama General Hospital, Saku City, Nagano, Japan
| | - Ryutaro Murashima
- Department of Orthopedics, Asama General Hospital, Saku City, Nagano, Japan
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Sponer P, Korbel M, Kucera T. Total Knee Arthroplasty in Spondyloepiphyseal Dysplasia with Irreducible Congenital Dislocation of the Patella: Case Report and Literature Review. Ther Clin Risk Manag 2021; 17:275-283. [PMID: 33833516 PMCID: PMC8020459 DOI: 10.2147/tcrm.s294876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Spondyloepiphyseal dysplasia is the clinical term applied to a group of rare genetic disorders with primary involvement of the vertebrae and epiphyses, predisposing the afflicted individuals toward the premature development of osteoarthritis. There are few reports concerning joint replacement therapy in these patients, particularly describing the role of total hip arthroplasty. In this report, we describe the anatomical and technical aspects of spondyloepiphyseal dysplasia that must be considered during surgical planning and performance of total knee arthroplasty. Case Presentation A 49-year old woman with a history of spondyloepiphyseal dysplasia suffered from severe osteoarthritis of the knee and irreducible congenital dislocation of the patella. After careful preoperative evaluations and planning, the knee joint deformity was solved by knee joint replacement with realignment of the extensor mechanism using quadricepsplasty. After 2 years of surgery, the patient showed no pain and was able to walk with the help of elbow crutches. The Hospital for Special Surgery knee score increased from preoperative 51 points to 85 points during the final follow-up. The postoperative range of motion increased to final flexion of 0–115°. Conclusion The advances made so far in the medical care for patients with skeletal dysplasia have improved their overall survival during adulthood. The case report described herein demonstrates the numerous challenges and technical aspects of a successful total knee arthroplasty in cases of spondyloepiphyseal dysplasia, highlighting the need to consider skeletal and soft tissue abnormalities of skeletal dysplasia during the planning and performance of joint replacement surgery.
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Affiliation(s)
- Pavel Sponer
- Department of Orthopedic Surgery, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Martin Korbel
- Department of Orthopedic Surgery, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Tomas Kucera
- Department of Orthopedic Surgery, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
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Sun JY, Zhang GQ, Shen JM, Du YQ, Li TJ, Geng ZJ, Zhou YG, Wang Y. Single-stage total knee arthroplasty and femoral osteotomy for osteoarthritis with severe supracondylar deformity. J Orthop Surg Res 2021; 16:149. [PMID: 33610184 PMCID: PMC7896386 DOI: 10.1186/s13018-021-02293-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background Knee osteoarthritis associated with extra-articular deformity (EAD) can confront the arthroplasty surgeons with challenges of bone resection and soft tissue balancing. The aim of this study was to describe a single-stage procedure associating corrective osteotomy with total knee arthroplasty (TKA), and to determine the outcome at mid- to long-term follow-up. Methods A total of seven patients (seven knees) with knee osteoarthritis and supracondylar deformity were included in this study. Six patients were female, and one was male, with the median age of 62 years (range, 37-76 years). All patients were treated with single-stage TKA and femoral osteotomy. Osteotomy was fixed with long cemented stem. Hospital of Special Surgery (HSS) scores, collateral ligament laxity, and range of motion (ROM) were clinically evaluated preoperatively and at each follow-up. Radiographic parameters including the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), mechanical proximal tibial angle (mMPTA), and joint line congruence angle (JLCA) were also measured. The occurrence of perioperative complications was recorded. Results The median follow-up time was 91 months (range, 38-104 months). At the last follow-up, all components were stable and no patients required revision. Nonunion of the osteotomy occurred in one patient. In all patients, the lower limb mechanical alignment improved greatly. The mean angle of MAD was restored from 10.49±6.05 cm preoperatively to 1.11±4.97 cm postoperatively. The 90° mLDFA was almost acquired in all cases, with the postoperative value of 90.79±2.40°. After operation, the mMPTA improved from 84.18±6.13° to 91.33±3.13°. The JLCA changed from 2.94±1.61° to −0.71±3.50°. The median HSS score improved from 45 (range, 34-56) preoperatively to 90 (range, 82-97) postoperatively, with the outcome of all patients rated good to excellent. The median ROM improved from 70° (range 0–110°) preoperatively to 105° (range 90–125°) postoperatively. No instability of knee joint was observed. Complications included an intraoperative split fracture of distal femur and one case of wound exudation resulting from fat liquefaction. Conclusions For knee osteoarthritis with femoral supracondylar deformity, single-stage TKA and corrective osteotomy was feasible but technically demanding. The use of long cemented stem for osteotomy fixation can provide reliable rotational control of the bone segments.
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Affiliation(s)
- Jing-Yang Sun
- Medical School of Chinese PLA, Beijing, 100853, China.,Department of Orthopedics, The First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Guo-Qiang Zhang
- Medical School of Chinese PLA, Beijing, 100853, China.,Department of Orthopedics, The First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jun-Min Shen
- Department of Orthopedics, The First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yin-Qiao Du
- Department of Orthopedics, The First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Tie-Jian Li
- Medical School of Chinese PLA, Beijing, 100853, China.,Department of Orthopedics, The First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zong-Jie Geng
- Medical School of Chinese PLA, Beijing, 100853, China.,Department of Orthopedics, The First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yong-Gang Zhou
- Medical School of Chinese PLA, Beijing, 100853, China. .,Department of Orthopedics, The First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Yan Wang
- Medical School of Chinese PLA, Beijing, 100853, China. .,Department of Orthopedics, The First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China.
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