1
|
Rucinski K, Garlapaty A, Hartwig J, Cook JL, Crist BD. Lower extremity osteotomies for limb preservation: Indications, outcomes, and risk factors. J Orthop 2025; 62:49-55. [PMID: 39502670 PMCID: PMC11533470 DOI: 10.1016/j.jor.2024.10.011] [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: 09/12/2024] [Accepted: 10/09/2024] [Indexed: 11/08/2024] Open
Abstract
Objectives To delineate the key factors associated with treatment success or failure for patients undergoing lower extremity osteotomies to address a spectrum of lower extremity joint and limb deformities at an Integrated Limb Preservation Center (ILPC). Methods Design: Retrospective cohort study. Setting: Level I Academic Trauma Center. Patient selection criteria: Patients of the ILPC with at least 1-year of follow-up data regarding previous surgery to correct trauma-or developmental-related deformities between January 1, 2005, and October 1, 2022. Outcome measures and comparisons: Patients were categorized first based on etiology (developmental vs. traumatic) and then based on the nature of deformity (joint, limb, nonunion). Treatment data, demographics including age, sex, body mass index (BMI), tobacco use history, insurance status, marital status, mental health history, and history of comorbidities, concurrent procedures, and post-operative infection, revision, reoperation, and bone healing status were extracted from the medical record and compared. Treatment failure was defined as conversion of the limb preservation surgery (ies) to amputation of any type. Results 139 patients were included for analysis; 47 patients in the developmental-related cohort, and 92 patients in the trauma-related cohort. The treatment success rate in terms of preserving the affected limb for patients undergoing lower extremity osteotomies was 94.7 % for the developmental-related cohort and 92.4 % for the traumatic-related cohort. 57.4 % of patients in the developmental-related cohort and 59.8 % of patients in the trauma-related underwent unplanned secondary procedures Concurrent osteomyelitis debridement (p = 0.01) and postoperative infection (p = 0.049) were the only factors measured significantly associated with conversion to amputation. Conclusions Patients undergoing osteotomies at an ILPC to address developmental-related or trauma-related joint and/or limb deformities experienced high short-term success (>90 %) with respect to preserving the affected limb. However, 56 % of patients required subsequent unplanned surgeries and improvements in PROMs were only statistically significant in patients with trauma-related deformities. Level of evidence III.
Collapse
Affiliation(s)
- Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | | | - Jacob Hartwig
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - James L. Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Brett D. Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| |
Collapse
|
2
|
Reif TJ, Khabyeh-Hasbani N, Shin TJ, Rozbruch SR, Fragomen AT. Correction of Tetratorsional Malalignment of the Lower Extremities Improves Patient-Reported Outcomes. HSS J 2024; 20:522-529. [PMID: 39483668 PMCID: PMC11523178 DOI: 10.1177/15563316231183443] [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: 01/31/2023] [Accepted: 03/29/2023] [Indexed: 11/03/2024]
Abstract
Background Axial malalignment of the bilateral femurs and tibias, previously known as "miserable" malalignment, now renamed tetratorsional malalignment (TTM), presents with hip and/or knee pain refractory to nonoperative treatment. Purpose We sought to investigate whether bilateral rotational osteotomy of the femur and tibia leads to improvement in a deformity-specific patient-reported outcome measure (PROM). Methods A retrospective review of patients who underwent staged rotational correction of the bilateral femur and tibias was performed. Computed tomography (CT) was used to measure the preoperative rotational profile and plan the surgical correction. Stabilization was predominantly with intramedullary nails. The primary outcome measure was the Limb Deformity-modified Scoliosis Research Society (LDSRS) score. Secondary outcomes included change in mechanical limb alignment and complications of the procedure. Results Sixteen patients (13 female and 3 male) with average age of 23.1 years (range: 15-36 years) underwent 4-segment rotational correction. The averages for femoral and tibial deformity correction were 23.5° (6.2° SD) and 20.9° (5.2° SD), respectively. The total LDSRS score improved from 3.67 (0.3 SD) to 4.39 (0.3 SD) (P = .001). The LDSRS sub-scores for function, pain, and self-image also significantly improved. In patients not undergoing concurrent coronal deformity correction, the limb mechanical axis was not significantly changed. No additional procedures were performed to obtain bone union. Three patients required peroneal nerve decompression following the index procedure, and all neurologic symptoms resolved. Conclusion This retrospective review suggests that correction of TTM of the lower extremities may lead to improvements in function, pain, and self-image. There were minimal complications and no iatrogenic deformity among 16 patients reviewed. The new diagnosis, TTM, is descriptive of this debilitating condition without communicating a negative patient image.
Collapse
Affiliation(s)
- Taylor J. Reif
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Nathan Khabyeh-Hasbani
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Tom Jonggu Shin
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - S. Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Austin T. Fragomen
- Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
3
|
Zodey K, Mankar S, Agrawal PP. The Management of Complex Knee Deformity Using Ortho-SUV: A Case Study. Cureus 2024; 16:e68065. [PMID: 39347215 PMCID: PMC11436753 DOI: 10.7759/cureus.68065] [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: 08/28/2024] [Indexed: 10/01/2024] Open
Abstract
Lower limb deformities are debilitating and affect the function of the lower limb and the social life of the patient. The deformities around the knee joint might be a combination of multiple deformities in various planes including coronal, sagittal, or rotational and may be present in both the femur and the tibia. We present a case of a 19-year-old female with complex deformity around the left knee joint involving both the femur and the tibia with shortening. The deformity was thoroughly planned and managed with both the Ortho-SUV and the Ilizarov technique. Complications such as neurological injury and nonunion were faced, but the neurology was improved spontaneously, and the autologous bone graft was done. The end result was excellent with no residual neurodeficit and no limb length discrepancy. Deformities such as these have to be addressed with meticulous planning and strategic surgical management. Complications such as nonunion, infection, neurological injury, and noncompliance might be faced in the course of the treatment. Though the Ilizarov apparatus is the most commonly used to address deformities and limb lengthening, the newer six-axis devices such as the Ortho-SUV can greatly aid in deformity correction.
Collapse
Affiliation(s)
- Kaustubh Zodey
- Orthopedics, N.K.P. Salve Institute of Medical Sciences (NKPSIMS) and Lata Mangeshkar Hospital, Nagpur, IND
| | - Sushil Mankar
- Orthopedics and Traumatology, N.K.P. Salve Institute of Medical Sciences and Research Centre (NKPSIMS and RC), Nagpur, IND
| | - Pallav P Agrawal
- Orthopedics and Traumatology, N.K.P. Salve Institute of Medical Sciences and Research Centre (NKPSIMS and RC), Nagpur, IND
| |
Collapse
|
4
|
Vogt B, Biermann C, Gosheger G, Laufer A, Rachbauer A, Antfang C, Lueckingsmeier M, Toporowski G, Tretow H, Roedl R, Frommer A. Simultaneous correction of leg length discrepancy and angular deformity of the distal femur with retrograde Precice nails: a retrospective analysis of 45 patients. Acta Orthop 2024; 95:364-372. [PMID: 39007719 PMCID: PMC11248716 DOI: 10.2340/17453674.2024.40947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/17/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND AND PURPOSE Magnetically controlled motorized intramedullary lengthening nails (ILNs) can be employed for simultaneous correction of angular deformities of the distal femur and leg length discrepancy. This spares typical complications of external fixators but requires precise preoperative planning and exact intraoperative execution. To date, its results are insufficiently reported. We aimed to elucidate the following questions: (i) Is acute angular deformity correction and gradual femoral lengthening via a retrograde ILN a reliable and precise treatment option? (ii) What are the most common complications of treatment? METHODS Acute angular deformity correction and subsequent gradual lengthening of the distal femur with retrograde ILN was retrospectively analyzed in 45 patients (median patient age: 15 years, interquartile range [IQR] 13-19 and median follow-up: 40 months, IQR 31-50). Outcome parameters were accuracy, precision, reliability, bone healing, and complications of treatment. RESULTS The median distraction was 46 mm (IQR 29-49), median distraction and consolidation index 0.9 mm/day (IQR 0.7-1.0) and 29 days/cm (IQR 24-43), respectively. The median preoperative mechanical axis deviation (MAD) was 30 mm (IQR 23-39) in the varus cohort and -25 mm (IQR -29 to -15) in the valgus cohort and reduced to a mean of 8 mm (standard deviation [SD] 8) and -3 (SD 10), respectively. Accuracy, precision, and reliability of lengthening were 94%, 95% and 96%, respectively. Accuracy and precision of deformity correction were 92% and 89%, respectively. In total, 40/45 of patients achieved distraction with a difference of less than 1 cm from the initial plan and a postoperative MAD ranging from -10 mm to +15 mm. In 13/45 patients unplanned additional surgeries were conducted to achieve treatment goal with nonunion being the most frequent (4/45) and knee subluxation (3/45) the most severe complication. CONCLUSION Acute deformity correction and subsequent lengthening of the distal femur with retrograde ILN is a reliable and accurate treatment achieving treatment goal in 89% but unplanned additional surgeries in 29% of patients should be anticipated.
Collapse
Affiliation(s)
- Bjoern Vogt
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany.
| | - Caja Biermann
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital
| | - Georg Gosheger
- General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Andrea Laufer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Anna Rachbauer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Carina Antfang
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Milena Lueckingsmeier
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Gregor Toporowski
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Henning Tretow
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| | - Robert Roedl
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital
| | - Adrien Frommer
- Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital; General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Germany
| |
Collapse
|
5
|
Geffner AD, Ellsworth BK, Greenstein M, Fragomen AT, Rozbruch SR. Outcomes of percutaneous femoral derotational osteotomy in pediatric patients. J Child Orthop 2023; 17:276-283. [PMID: 37288041 PMCID: PMC10242370 DOI: 10.1177/18632521231159426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/29/2023] [Indexed: 06/09/2023] Open
Abstract
Background Percutaneous femoral derotational osteotomies are performed in both adult and pediatric patients. There is little published on the outcomes after femoral derotational osteotomy in pediatric patients. Methods A retrospective cohort study of pediatric patients treated with percutaneous femoral derotational osteotomy by one of two surgeons between 2016 and 2022 was performed. Data collected included patient demographics; surgical indications; femoral version; tibial torsion; magnitude of rotational correction; complications; time to hardware removal; pre-operative and post-operative patient-reported outcome scores, including Limb Deformity-Scoliosis Research Society and Patient-Reported Outcomes Measurement Information System; and time to consolidation. Descriptive statistics were used to summarize the data and t tests used to compare means. Results Thirty-one femoral derotational osteotomies in 19 patients were included with an average age of 14.7 (9-17) years. The average rotational correction was 21.5° ± 6.4° (10°-40°). The average length of follow-up was 17.9 ± 6.7 months. There were no instances of nonunion, joint stiffness, or nerve injury. No patients returned to the operating room for additional surgeries other than routine hardware removal. There were no cases of avascular necrosis of the femoral head. Of the 19 patients, 8 completed both a pre-operative and post-operative survey set. There were significant improvements in the Limb Deformity-Scoliosis Research Society Self-Image/Appearance sub-category and the Patient-Reported Outcomes Measurement Information System Physical Function sub-category. Conclusion Femoral derotational osteotomy using a percutaneous drill hole technique with antegrade trochanteric entry femoral nail is safe in the pediatric population and improves self-image in patients with symptomatic femoral version abnormalities.
Collapse
Affiliation(s)
- Adam D Geffner
- Division of Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - Bridget K Ellsworth
- Division of Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
- Department of Pediatric Orthopedics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael Greenstein
- Division of Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - Austin T Fragomen
- Division of Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - S Robert Rozbruch
- Division of Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
6
|
LIMB-Q Kids—German Translation and Cultural Adaptation. CHILDREN 2022; 9:children9091405. [PMID: 36138714 PMCID: PMC9498267 DOI: 10.3390/children9091405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022]
Abstract
(1) Purpose: Lower limb deformities can have a severe impact on health-related quality of life (HRQL). LIMB-Q Kids is a new patient-reported outcome measure (PROM) aiming to elucidate the experience of 8–18-year-old patients before, during and after treatment, and to measure the different aspects of HRQL. The aim of this study was to translate and culturally adapt LIMB-Q Kids to German. (2) Methods: The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines were followed. Three forward translations, a backward translation, an expert panel meeting with eight participants, and twenty cognitive debriefing interviews led to the final German version of LIMB-Q Kids. (3) Results: In the forward translations, 4/159 items were difficult to translate, and 2/159 items in the backward translation differed from the original English version. Cognitive debriefing interviews with 20 patients identified 7/159 items that were difficult to comprehend/answer, and 2 of these items were changed. (4) Conclusions: Lower limb deformities can have a great impact on children, and it is important to measure and consider the impact on HRQL. In order to be able to use PROMs in different countries, conceptually equivalent translations and cultural adaptations should be performed in order to ensure comprehensibility. The final German version of LIMB-Q Kids is ready for use in an international field test.
Collapse
|
7
|
German Translation and Cross-Cultural Adaptation of the Limb Deformity-Scoliosis Research Society (LD-SRS) Questionnaire. Healthcare (Basel) 2022; 10:healthcare10071299. [PMID: 35885825 PMCID: PMC9322954 DOI: 10.3390/healthcare10071299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Patient-reported outcome measures are gaining increasing importance in clinical research and quality control. Clinical impairment through limb deformities can appear in various forms. This study aimed at translating and culturally adaptating the Limb Deformity-Scoliosis Research Society (LD-SRS) patient-reported outcome measure (PROM) into German by following the scientific rigor of the cross-cultural adaptation process as well as ensuring the reliability of the translated version. The LD-SRS is applicable in children and adults. Methods: The translation was performed in accordance with the creators of the LD-SRS following the Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines for translation and cultural adaptation. Two forward translations were performed, and after a consensus meeting, a professional translator translated the PROM back to English. The creators reviewed the back translation of the preliminary German version. Thirty patients with upper and lower limb deformities participated in cognitive debriefing interviews. The version was proofread and, finally, the test-retest reliability was estimated. Results: The mean age was 19 years (range 6–61). Twenty-six patients (87%) completed the retest after 6 days (range 3–26). The internal consistency was estimated with a Cronbach’s alpha of 0.96 (range 0.94–0.97), and the intraclass correlation was 0.92 (range 0.89–0.94), indicating an excellent reliability. The scores were normally distributed. Thereafter, the German version was proofread and finalized. Conclusions: The German translation and cross-cultural adaptation of the LD-SRS score resulted in a high reliability and internal consistency. The German LD-SRS score is readily usable and may be applied in future studies of German-speaking limb deformity patients.
Collapse
|
8
|
Chhina H, Klassen A, Bade D, Kopec J, Cooper A. Establishing content validity of LIMB-Q Kids: a new patient-reported outcome measure for lower limb deformities. Qual Life Res 2022; 31:2805-2818. [DOI: 10.1007/s11136-022-03140-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/27/2023]
|