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Results for “Bone Malalignment”

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At least 217 records · Page 12Linked to original sources
PubMed2004

[Clinical results after Sauve-Kapandji procedure in relation to diagnosis].

We present the results of a retrospective study on 56 patients who underwent the Sauve-Kapandji procedure for chronic disorders of the distal radioulnar joint (DRUJ). Outcome was assessed with special regard to the diagnosis. The average follow-up was 5.9 years (1-12 years). Patients were assessed for pain, range of motion of wrist and forearm, and radiological features. The DASH score and Mayo wrist score were used. The diagnosis had an influence on the outcome. Patients with primary arthrosis of the DRUJ demonstrated better results than patients with traumatic disorders. Patients with growth deficiency-related complaint of the DRUJ showed slightly inferior results after the Sauve-Kapandji procedure compared to all patients. Patients were free of pain or had pain only during heavy labor in 81% of cases; 95% of the patients rated the outcome as excellent or improved, but only 50% were free of symptoms on the operated side during heavy manual labor. Symptoms of ulnar impingement were found in 11%. Improvement in range of motion of wrist and forearm was significant. The postoperative DASH score was 24.2+/-22.5 and the Mayo wrist score was 76.1+/-17.6. Our results confirm the Sauve-Kapandji procedure to be a reliable salvage procedure resulting in high patient satisfaction and reliable improvement in range of motion. However, decreased grip strength on the affected side must be accepted to some extent. The diagnosis of a DRUJ disorder influences the outcome.

Adult↗
PubMed1999

[Multidimensional corrective osteotomy of the distal femur using a retrograde femoral nail].

We report the case of a 62-year-old woman with marked valgus and limitation of extension of the right knee joint as the result of a supracondylar fracture of the femur, originally treated by internal fixation with a dynamic condylar screw. Two years later, revision osteotomy with retrograde femoral nailing was carried out to achieve variation and improve extension. Within a week of operation the patient's right leg was fully weight bearing with normal axial positioning. A retrograde locking nail provides satisfactory and stable internal fixation in cases of revision.

Bone Malalignment↗
PubMed2003

[Kinematic analysis before and after bicondylar resurfacing knee arthroplasty].

Knee joint motion appears as a hinge movement around the flexion-extension axis. Corresponding to the rolling-sliding mechanism and alternative models of knee joint kinematics, an instant center pathway must be expected. The current photogrammetric investigation aimed to analyze these pathways when assessed in the sagittal plane in patients with preoperative varus or valgus deformity. A total of 40 patients either with varus or valgus deformity (20 in each group) were examined before and 6 months after implantation of PFC-SIGMA prostheses. Apart from the influence of knee joint deformity, a so-called soft tissue ratio was investigated. Therefore, the relation of thigh and femur as well as lower limb and tibia diameters was calculated and combined in one value. The investigation unit consisted of a standardized chair with passive knee joint movement (90-0 degrees flexion) supported by an electric motor. The position of predefined skin markers was assessed by digital camera with online transmission to a PC. The instant center pathway was then evaluated applying the Reuleaux technique based on the changes of skin marker positions. Results showed the following characteristics: small values of soft tissue ratio were represented by round or oval courses of the pathway whereas increasing ratios led to triangular and slightly increased dimensions of the courses. Varus deformity was primarily combined with an increase of the pathway's dimension and in contrast, valgus deformity showed decreased pathways. In each case, dimensions normalized after prosthesis implantation. The instant center pathway of knee joint motion showed for both patient groups characteristic phenomena. They were clearly associated with constitutional and clinical features of each patient.

Aged↗
PubMed2004

[Current status of valgus angle, tibial head closing wedge osteotomy in media gonarthrosis].

In young and active patients, closing-wedge high tibial osteotomies are reliable procedures in the treatment of osteoarthritis of the medial compartment of the knee. This has been consistently shown throughout the last 2 decades. The present study analyzes the long-term results of 217 patients after an average of 9 years and compares them to the results in the literature. Besides correction of the alignment, other prognostic factors such as the patients' age, overweight, the preoperative degree of osteoarthritis, but also a newer prognostic factor described by the Lyon knee school have been evaluated. The authors found that the "tibial bone varus angle" might be helpful to differentiate between a bony deformity of the proximal tibia, amenable to correction by osteotomy, and a secondary bony erosion of the medial tibial plateau, with a worse prognosis.

Adult↗
PubMed2004

[Tibial realignment with external fixator].

External fixation is a proved method for high tibial osteotomies. It is easy to access, allows postoperative corrections of the alignment, and can be removed without additional narcosis. Disadvantages are the frequent infection of the pin tracks and discomfort in bearing compared to internal fixation. In our own study no difference between unilateral and bilateral fixation could be found regarding loss of correction and complications. The advantage of unilateral fixation is the possibility of doing an open-wedge procedure by unilateral continuous callus distraction (hemicallotasis). This is indicated if medial collateral instability can be compensated by the open-wedge technique. The occurrence of neural injuries was significantly less frequent after hemicallotasis. Regular radiological and clinical control of the axis is necessary to prevent loss of correction, which was significantly more frequent in open-wedge osteotomies.

Bone Malalignment↗
PubMed2004

[Possibilities of computer-assisted navitation in knee para-articular osteotomies].

Osteotomies in the knee region for incipient osteoarthritis in active patients have become increasingly popular in recent years. A computer-guided navigation system should help increase the surgeon's accuracy and lower the risk of intraoperative complications for this technically demanding type of surgery. Furthermore, computer navigation might be a powerful research and educational tool. The technical principles and the clinical implications of this system for knee osteotomies are described in the following article.

Bone Malalignment↗
PubMed1999

[Osteotomies of the mid- and back-foot in recurrent club foot].

There are no clear guidelines on the treatment of relapsed clubfoot, which is a relatively frequent and difficult problem in paediatric orthopaedics. Numerous operative interventions are mentioned in the literature as suitable for correction of a residual deformity of the food. There are numerous soft tissue procedures (release operations, tendon extensions, tendon transfers and redressement by means of a fixateur externe) and osseous interventions (osteotomies, arthrodeses) that can be carried out in isolation or in combination. In the present article two types of osteotomy are described that make it possible to correct the most frequent forms of relapsed clubfoot: combined closing wedge cuboid and opening wedge cuneiform osteotomy for correction of adductus and supination of the forefoot and the calcaneal osteotomy after Dwyer for correction of varus position of the calcaneal part of the foot. The combined osteotomy in the midfoot involves shortening of the lateral ray with simultaneous lengthening of the medial ray, with the wedge out of the cuboid bone inserted into the medial cuneiform bone, which leads mainly to correction of the adductus, but does also make it possible to achieve partial correction of the supination with an osteotomy right through the cuneiform bone. In the case of rigid foot deformities it is advisable to carry out preliminary stretching by means of a fixateur externe, while in the case of a bean-shaped foot a combination of osteotomy and medial and lateral release is recommended. Results of a follow-up study of our own patients treated with this operation have shown that no revision operations were necessary in any of the patients with idiopathic clubfoot. Other types of osteotomy described in the literature as suitable for correction of residual forefoot adductus and supination are also mentioned in this paper. Thecalcaneal osteotomy after Dwyer, for which a lateral approach is always used, generally leads to satisfactory correction of varus position of the calcaneal part of the foot. It the calcaneus is found to have a short posterior part this osteotomy is modified so that instead of taking the form of a wedge osteotomy with lateral closing it is followed by a lateral displacement. In this way it is possible to prevent making the already short posterior calcaneus even shorter. Both the combined midfoot osteotomy and the calcaneal osteotomy after Dwyer can be performed alone or in combination with each other or with different operative interventions.

Bone Malalignment↗
PubMed2005

Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment.

The patellofemoral pain syndrome (PFPS) remains a challenging musculoskeletal entity encountered by clinicians. Reviewing the literature, conflicting data seem to exist regarding the effect of non-operative treatment in PFPS patients. A possible explanation may be lack of a clear classification system of patients with PFPS. It is our opinion that the term PFPS still is a 'wastebasket', which probably comprises several different entities. Therefore, it seems important to subdivide this broad group of patients into different categories with a specific rehabilitation approach. In this study, we introduce a classification system, which reflects a consensus reached by the European Rehabilitation Panel. This classification system should help the clinicians to identify the cause(s) of patellofemoral pain, and consequently help to select the most appropriate non-operative treatment. The authors are aware that no rehabilitation protocol will work for all PFPS patients, since the underlying mosaic of pathophysiology and tissue-healing responses are unique. Therefore, the aim of this study with a classification system was to guide the clinician through clinical examination in order to develop a non-operative treatment protocol, specific for each individual with PFPS.

Bone Malalignment↗
PubMed2005

Internal derangements of the knee associated with patellofemoral joint degeneration.

The objective of the present study was to evaluate whether internal derangements of the knee joint are associated with patellofemoral joint (PFJ) degeneration. Data were collected prospectively from 1,000 consecutive knee arthroscopies. Chondral lesions were observed in 854 patients, and these patients were included in this study. Patients' details (age, sex, duration of symptoms, injuries, and possible mechanism of injury), operative details (types and number of portals, equipment used), intra-articular findings (articular, meniscal and synovial lesions, and stability characteristics) and procedures performed were recorded. Articular lesions were noted on anatomic articular maps of the different functional zones, using a system which presaged the current ICRS system. Using this zoning system, it was easy for the authors to separate the patients with isolated patellofemoral degeneration and arthritis and to do the statistical analysis. Increased incidence of isolated patellofemoral degeneration was noted in patients with synovial shelves, in comparison with patients without shelves (24.7% vs. 15.5%, respectively; P=0.001). Patients with severe patellofemoral maltracking were found to have increased incidence of isolated patellofemoral degeneration in comparison with patients without patella maltracking (64.7% vs. 18% respectively; P<0.001). In conclusion, patellofemoral maltracking and synovial shelves of the knee are highly associated with PFJ degeneration. On the contrary, meniscal tears and ligamentous injuries are associated mainly with degeneration of other compartments of the knee joint and not the PFJ.

Adult↗
PubMed1997

Significance of corrective growth of opposite physes in the surgical correction of deformity following epiphyseal injury around the knee joint.

Deformation due to growth disturbance after epiphyseal fractures around the knee may involve more than the primarily injured epiphysis, as spontaneous corrective growth of the opposite epiphyseal plate can take place in an attempt to maintain overall alignment of the leg. As a result, there will be an inclination in the knee joint line if corrective osteotomy is only performed for the primary angulation. We report two cases of this complex deformity in which corrective osteotomies of both the distal femur and the proximal tibia were performed, resulting in correct alignment of the overall leg axis and knee joint axis.

Adolescent↗
PubMed1998

Modified Elmslie-Trillat procedure for instability of the patella.

The purpose of this study was to determine whether or not the modified medial transfer of the ligamentum patellae in case of objective instability of the patella is an adequate therapy and if it is possible to improve the patellar congruence angle by this method. Between October 1987 and April 1993, 41 operations were performed in 37 patients with medialization of the medial third of the ligamentum patellae with the corresponding part of the tibial tubercule. Four patients needed a bilateral operation; the two interventions were not performed at the same time. Thirty-six operated knees (88%) were examined at a median clinical and radiological follow-up of 62.8 months (+/- 15.8 SD). For evaluation, the objective and subjective Turba score was used, and pre- and postoperative X-rays were compared. The patients' average age at the time of intervention was 23.2 years (+/- 7 years SD). The operation was performed 39 times for recurrent dislocation or subluxation, for patella alta with cartilage tissue damage, and for first time traumatic dislocation. The only postoperative complication was a temporary peroneal paresis. There were no redislocations seen at the follow-up. One patient with repeated subluxations underwent an additional lateral release combined with a repair of the medial retinaculum. In all other cases, the Turba score showed good or excellent results (subjective 1.9; objective 0.8), the patellar congruence angle was significantly improved (P < 0.001), and there were no medial subluxations. We conclude that the transfer of the medial third of the ligamentum patellae for objective instability of the patella is a minimally invasive and adequate technique to improve significantly a pathological patellar congruence angle.

Adolescent↗
PubMed2001

Acute effects of the Protonics system on patellofemoral alignment: an MRI study.

This study used magnetic resonance imaging (MRI) to determine whether changes in patellofemoral alignment occur after initial treatment with the Protonics exercise device. The first scan was obtained before the device was used. After performing a set of exercises with no resistance on the device the device was removed, and a second scan was obtained. The same set of exercises was again performed with resistance on the device set at the appropriate level, and a final scan was obtained with the device removed. An isometric leg press was maintained as each image was obtained to simulate more closely a functional weight-bearing activity. Subjects were 26 women with complaints of patellofemoral pain. The main outcome measures were: patellar tilt angle, bisect offset, and lateral facet angle. Nonparametric repeated measures analysis of variance tests showed no differences between test conditions for any of the three measures of patellofemoral alignment. We conclude that after an initial treatment session using the Protonics system there is no change in patellofemoral alignment as determined by MRI.

Adolescent↗
PubMed2004

Minimally invasive unicompartmental knee replacement with a nonimage-based navigation system.

In a prospective study, two groups of 20 unicompartmental knee replacements (UKR) each were operated either using a CT-free navigation system or the conventional minimal invasive technique. Radiographic assessment of postoperative alignment was performed by long-leg coronal and lateral radiographs. The results revealed a significant difference between the two groups in favor of navigation. In the computer-assisted group, 95% of UKRs were in a range of 4-0 degrees varus (mechanical axis) compared with 70% in the conventional group. The only inconvenience was a prolonged operation time (+19 min). Due to the limited exposure, the navigation system is helpful in achieving a more precise component orientation. The danger of overcorrection is diminished by real-time information about the leg axis at each step during the operation.

Aged↗
PubMed2004

Prosthetic alignment and sizing in computer-assisted total knee arthroplasty.

We implanted 60 posterior stabilized total knee prostheses (P.F.C. Sigma, DePuy, Warsaw, USA). In 30 cases, we used a CT-free navigation system (Vector Vision, Brain LAB, Heimstetten, Germany), and in 30 matched-paired controls, we used a conventional manual implantation. We compared postoperative long-leg radiographs in the two groups. The results revealed a significant difference in favor of navigation. In addition, we compared the preoperative anteroposterior dimension of the femoral condyle with the postoperative value. While there were no significant differences in the preoperative anteroposterior dimension of the femoral condyle between the two groups, the postoperative value in the navigation group was significantly larger than that of the preoperative value. Therefore, surgeons using navigation systems should guard against the possibility of oversizing when determining the size of the femoral component.

Aged↗
PubMed2002

Analysis of limb alignment in the pathogenesis of osteoarthritis: a comparison of Saudi Arabian and Canadian cases.

A study was made of alignment abnormalities and bone deformities in Saudis with osteoarthritis (SOA). Data from standardized radiography of hips and knees were: hip-knee-ankle angle (HKA), condylar-hip angle (CH), tibial plateau-ankle angle (PA), and joint surface (condylar-plateau) angle (CP). Females dominated the <50 years SOA subgroup (1.8:1), having also early onset OA with severe bowlegged deformity (mean HKA -11 degrees) and major shifts in CH, PA, and CP relative to normal parameters. In the females, links were noted between severe disease and osteomalacia or osteoporosis, requiring prospective studies. An association between femoral deformity (CH) and OA, first reported in Canadians with OA (COA), was confirmed in SOA (especially in males of all ages). The condition implies heightened mechanical risk of onset or progression at medial joint surfaces. Further, it calls for the fresh appraisal of surgical options based on biomechanical analysis of each case, including femoral osteotomy where necessary.

Adult↗
PubMed2000

[Functional changes in the quadriceps femoris muscle in patients with varus gonarthrosis].

In osteoarthritis (OA) of the knee, arthrogenous muscle inhibition (AMI) is considered to be one of the reasons of quadricep muscle weakness. Its influence on functional impairment such as gait alterations, however, still remains unclear. Fourty-seven patients with knee OA (mean age 64 +/- 5.2 years, 36 women, 11 men) and 47 age- and gender-matched healthy controls were investigated for voluntary activation (VA) and maximum voluntary contraction (MVC) of the quadricep muscle. In addition, these two parameters of AMI have been correlated with the extent of gait alterations. Measurement of VA and MVC were performed by a twitch interpolation technique; for gait analysis an optoelectronic motion analysis system (ELITE, Italy) was used. Quadricep MVC and VA were significantly lower in OA than in control knees. Moreover, in addition to reduced walking velocity and step cadence, gait analysis revealed significantly lower stance phase re-extension angles in OA patients (mean 2.7 degrees +/- 2.6) than in control knees (mean 10.7 degrees +/- 4.9). Hereby, in OA knees there was a significant correlation between MVC and VA deficits and the reduction of re-extension angles. The work shows that knee OA is characterized by severe alterations of the quadricep motor function due to arthrogenous muscle inhibition. Hereby, quadricep AMI represents one major reason for functional impairment in knee OA.

Aged↗