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Coppa V, Marinelli M, Procaccini R, Falcioni D, Farinelli L, Gigante A. Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment. World J Orthop 2022; 13:427-443. [PMID: 35633744 PMCID: PMC9124997 DOI: 10.5312/wjo.v13.i5.427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/02/2021] [Accepted: 04/09/2022] [Indexed: 11/09/2022] Open
Abstract
Coronal plane deformity around the knee, also known as genu varum or genu valgum, is a common finding in clinical practice for pediatricians and orthopedists. These deformities can be physiological or pathological. If untreated, pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis. The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.
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Affiliation(s)
- Valentino Coppa
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Mario Marinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Roberto Procaccini
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Danya Falcioni
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
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Choudhary R, Kunal K, Sud A, Kumar R, Munde K, Roy S. Clinical outcome and correction following V osteotomy for genu valgum in adolescents and young adults: A systematic review. J Clin Orthop Trauma 2022; 26:101803. [PMID: 35211377 PMCID: PMC8850320 DOI: 10.1016/j.jcot.2022.101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Genu Valgum usually originates from distal femur and many open and closed wedge osteotomies of distal femur have been reported but none has proved to be the best. Distal femur V osteotomy is a wedgeless osteotomy and is a rarely reported osteotomy with only a few case series and 167 cases of isolated distal femur V osteotomy for genus valgum in young patients (<25 years) in literature but with a tendency to have an excellent outcomes. PURPOSE To determine correction and clinical outcome following V osteotomy for genu valgum in adolescents and young adults (10-25 years). PATIENT AND METHODS A systematic research was conducted of PubMed, MEDLINE and Google Scholar to identify studies reporting the correction and clinical outcome following V osteotomy in adolescents and young adults (10-25 years) for genu valgum by 2 different authors according to PRISMA guidelines. RESULTS 5 studies with 167 patients and 263 knees were identified meeting the inclusion criteria for review. The follow-up period ranged from 3 months to 36 months. Overall complication rate was 12.3%, the most common being plaster sore, 4.2% (11/263) followed by superficial infection, 2.7% (7/263). The mean correction was 19.1° and a mean post-operative valgus was 5.7°. In those compared with Bostman score (157/167), 94.3% had excellent (148/157) and remaining 5.7% (9/157) had good scores (20-27/30) with none showing poor score (<20/30). CONCLUSION V osteotomy is a reliable method of distal femoral osteotomy to attain a good correction with an excellent clinical outcome even with variations of fixation however longer follow-up period are required for better evaluation of recurrence.
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Hernandez-Vaquero D, Noriega-Fernandez A, Roncero-Gonzalez S, Ruete-Gil GL, Fernandez-Carreira JM. Can the need for soft tissue release in total knee replacement be predicted pre-operatively? A study based on surgical navigation. Int Orthop 2021; 46:815-821. [PMID: 34817630 PMCID: PMC8930874 DOI: 10.1007/s00264-021-05263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
Introduction In complex and deformed knees, soft tissue release (STR) is required to obtain symmetry in the femorotibial gap. The objective of this study was to attempt to predict the need for soft tissue release using surgical navigation in total knee replacement (TKR). Methods Prospective and non-randomized study. One hundred thirty knees. At the start of navigation, an attempt was made to correct the femorotibial mechanical axis by applying force to the medial or lateral side of the knee (varus-valgus stress angle test). A gap balanced technique with computer-assisted surgery (CAS) was performed in all cases. The ligaments were tensioned, and using CAS visualization and control, progressive STR was performed in the medial or lateral side until a symmetry of the femorotibial gap was achieved. Results Eighty-two patients had a varus axis ≥ 3° and 38 had a valgus axis (P < 0.001). STR was performed under navigation control in 38.5% of cases, lateral release (LR) in 12 cases, and medial release (MR) in 38 cases. After performing the varus-valgus stress angle test (VVSAT), the axis of 0° could be restored at some point during the manoeuvre in 28 cases. STR was required in 44.6% of varus cases and 27% of valgus cases (P = 0.05). A significant relationship was found between the previous deformity and the need for MR (P < 0.001) or LR (P = 0.001). STR was more common in male patients (P = 0.002) and as obesity increased. Conclusion This study shows that pre-operative factors favouring the need to perform STR in a TKR implant can be defined.
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Affiliation(s)
- Daniel Hernandez-Vaquero
- Department of Orthopedic Surgery, School of Medicine, University of Oviedo, Julian Claveria, s/n, 33006, Oviedo, Spain.
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Baghdadi S, Saberi S, Baghdadi T. Guided growth in the correction of knee deformity in patients with congenital insensitivity to pain. J Orthop Surg Res 2021; 16:184. [PMID: 33706758 PMCID: PMC7948364 DOI: 10.1186/s13018-021-02304-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Orthopedic manifestations of congenital insensitivity to pain (CIP) can be devastating if left untreated. Knee deformities are common in patients with CIP and might lead to joint destruction and loss of walking ability. The purpose of the present study was to report the results and complications of guided growth procedures around the knee in patients with CIP. Methods In a retrospective review, all patients with CIP who underwent guided growth procedures around the knee from 2009 to 2017 at a tertiary referral hospital were evaluated. Patients with secondary insensitivity to pain (e.g., syringomyelia), as well as patients with incomplete records, were excluded. Demographic data, clinical findings, correction rate, and complications were recorded. Results Ten knees in six patients fulfilled the inclusion criteria. The median age was 10 (range, 5–12), with a mean follow-up of 31 months (range, 16–56). Distal femoral tension-band hemiepiphysiodesis was the most common procedure, followed by proximal tibial hemiepiphysiodesis. The mean correction rate was 0.28°/month for femoral deformity. Staples were removed prematurely in one patient due to extrusion. No cases of infection or skin dehiscence were observed. None of the patients needed a reconstructive knee procedure during the study period. Conclusions The findings of this study suggest that guided growth procedures might have a role in the correction of knee deformities in patients with CIP. However, the correction rate is lower than that of typically developing children, patients should be closely followed to prevent complications, and stringent patient selection criteria should be followed to ensure success.
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Affiliation(s)
- Soroush Baghdadi
- Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Sadegh Saberi
- Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Taghi Baghdadi
- Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran.
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Thadi M, Mane PP, Sharma A. Challenges in successful management of haemophilic knee arthropathy: Our experience in a tertiary centre. J Orthop 2020; 19:194-8. [PMID: 32055146 DOI: 10.1016/j.jor.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background Haemophilia is characterized by a partial or complete deficiency of clotting factor VIII or IX. The repeated bleeding episodes into the joints contributes to subsequent chronic arthropathy which debilitates the patient and affects the quality of life. There are lot of hurdles in successful management of such patients. We present our experience in dealing such patients. Materials and Methods 24 patients (27 knees) with haemophilic knee arthropathy were included. The preoperative VAS (Visual Analogue Scale) and KSS (Knee Society Score) were assessed. All underwent total knee arthroplasty with stemmed constrained prosthesis. Postoperatively VAS and KSS were analysed at the end of 12 months. Results The mean preoperative VAS was 8.2 (Range: 7-10), mean KSS clinical score was 39.9 (Range: 12-61) and mean KSS functional score was 51.4(Range: 20-70). The mean postoperative VAS was 2.7(Range: 2-4), mean KSS clinical score was 70.5 (Range: 61-80) and mean KSS functional score was 74.2(Range: 60-80). There was statistical significant difference between preoperative and post-operative scores. At the end of 12 months, 17 patients (63%) had good outcome, seven patients (26%) had fair and three patients (11%) had excellent outcome as per the KSS scores. Conclusions Total knee arthroplasty has good outcome with respect to clinical as well as functional outcome in haemophilic arthropathy. Although the results and outcome of total knee arthroplasty in haemophilic knee arthropathy may still be inferior to the results seen in a normal individual, a multidisciplinary approach yields a better functional and quality of living in such haemophilic patients.
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Vaish A, Rabari Y, Vaish R, Vaishya R. Correction of a Severe Flexion Knee Deformity Using 3D Printing. Indian J Orthop 2020; 54:228-229. [PMID: 32257042 PMCID: PMC7096339 DOI: 10.1007/s43465-019-00035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Abhishek Vaish
- grid.414612.40000 0004 1804 700XDepartment of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, SaritaVihar, Mathura Road, New Delhi, 110076 India
| | - Yash Rabari
- grid.414612.40000 0004 1804 700XDepartment of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, SaritaVihar, Mathura Road, New Delhi, 110076 India
| | - Riya Vaish
- grid.414612.40000 0004 1804 700XDepartment of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, SaritaVihar, Mathura Road, New Delhi, 110076 India
| | - Raju Vaishya
- grid.414612.40000 0004 1804 700XDepartment of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, SaritaVihar, Mathura Road, New Delhi, 110076 India
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Mazzotti A, Perna F, Golinelli D, Quattrini I, Stea S, Bordini B, Faldini C. Preoperative valgus deformity has twice the risk of failure as compared to varus deformity after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:3041-3047. [PMID: 30539306 DOI: 10.1007/s00167-018-5331-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/07/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to assess whether preoperative valgus or varus deformity affected survivorship after total knee arthroplasty (TKA) and to quantify the risk factors for implant failure in a registry-based population. METHODS The Emilia-Romagna Registry of Prosthetic Orthopedic Implants was examined regarding TKAs performed on patients with a preoperative diagnosis of valgus or varus deformity. Demographics, implant characteristic and survivorships were investigated and compared. A total of 2327 TKA procedures performed from 2000 to 2016 were included in the study. Six hundred and forty primary TKAs with a diagnosis of valgus deformity were evaluated with a median follow-up of 3.3 years; 1687 primary TKAs with a diagnosis of varus deformity were evaluated with a median follow-up of 2.5 years. RESULTS Bi-compartmental, cemented posterior stabilised fixed-bearing implants were preferred. For both diagnoses, the implant survivorship rate was greater than 98% in the first year. However, the survival curve of the TKAs implanted for valgus deformity showed a greater slope in the first 3 years as compared to the survival curve of those implanted for varus deformity. Valgus deformity had a 2.1-fold higher risk for revision as compared with varus deformity. Infection was a major cause of implant failure in TKAs for varus deformity, 9/24 (37.5%), while its incidence was lower for valgus deformity, 1/21 (4.8%). CONCLUSIONS Preoperative valgus alignment showed a twofold risk of failure as compared to varus alignment after TKA. This should be considered in daily practice, and surgeons are called on to pay more attention when performing TKAs on such patients. Prospective randomised controlled trials are, therefore, necessary to better understand the role of preoperative coronal knee deformity in implant failure. LEVEL OF EVIDENCE Prognostic study, level III.
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Affiliation(s)
- Antonio Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabrizio Perna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy.
| | - Irene Quattrini
- IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy
| | - Susanna Stea
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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