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Realignment arthrodesis of the rearfoot and ankle: a comprehensive evaluation.

Ankle and tibiotalocalcaneal arthrodeses are performed for the treatment of painful, arthritic, unstable, and deformed rearfoot and ankle joints. Surgical complications are not uncommon (approximately 30%); some can be attributed to poor preoperative planning and inadequate intraoperative position. Several authors have attempted to define the optimal position for ankle arthrodesis without objective multiplanar radiographic analysis and consistent reference points. This investigation explored the effects of ankle and tibiotalocalcaneal realignment arthrodeses on static lower-extremity position in 20 patients. The most common preoperative diagnosis was severe degenerative joint disease following ankle fractures and ankle instability. Seven tibiotalocalcaneal arthrodeses and 13 isolated ankle arthrodeses were performed (mean follow-up, 22 months). Average time to radiographic osseous union of the isolated ankle and tibiotalocalcaneal arthrodeses was 11 and 7 weeks, respectively. Medical complications occurred in 2 patients (10%). There were no statistically significant differences between preoperative and postoperative angular relationships. This study objectively quantifies multiplanar foot-to-leg realignment and defines the optimal clinical and radiographic positions for ankle and tibiotalocalcaneal realignment arthrodeses.

Ankle↗
PubMed1999

A new technique for determining proper mechanical axis alignment during total knee arthroplasty: progress toward computer-assisted TKA.

Successful total knee arthroplasty (TKA) relies on proper positioning of prosthetic components to restore the mechanical axis of the lower extremity. This report presents and analyzes a new noninvasive method using the Optotrack (Northern Digital Inc, Ontario, Canada) to accurately determine the center of the femoral head. This method, together with direct digitization of the bony landmarks of the knee and ankle intraoperatively, permits placement of the lower extremity in proper alignment intraoperatively. It also permits the surgeon to follow all the angles of movement or rotation and all displacements that occur at each step of the operative procedure. knee intraoperatively via a customized Windows-based program. In addition to presenting our first case, which, importantly, represents the first computer-assisted TKA in a patient, we report on the accuracy and reproducibility of the technique for locating the center of the femoral head obtained during an extensive series of cadaver studies. Location of the femoral head, a major aspect of effecting neutral mechanical axis alignment, appears to be possible to within 2-4 mm, which corresponds to an angular accuracy of better than 1 degree. This method requires no computed tomography scans or other preliminary marker placement. The only basic requirement other than the instrumentation described is a freely mobile hip, which is generally present in TKA patients.

Arthroplasty, Replacement, Knee↗
PubMed1999

Definition, quantification, and correction of translation deformities using long leg, frontal plane radiography.

The surgical realignment of mechanical axis deviation is necessary to prevent early joint degeneration. Modern types of external fixation systems allow alignment of the mechanical axis to exact degrees. Predominately, these are corrections of angulation deformities. In some cases, the analysis of the mechanical axis deviation does not show any angulation deformity, but rather a parallel staggering of the mechanical axis lines of a bone. Such parallel staggering of the mechanical axis lines is defined as a translation deformity of the bone. In combined deformities with angulation and translation, the center of deformity can be established proximal or distal to the limit of the bone. In translation deformities, the realignment of the mechanical axis requires a parallel restaggering made by a translation-osteotomy or by a counterangulated double osteotomy. In complex deformities with angulation and translation, the translation requires separate corrective planning. In frontal plane radiographs of the standing leg, the components of angulation and translation can be established graphically or by simple trigonometric formulas. The analysis and surgical procedure to realign translation deformities or a combination of translation and angulation deformities using an unilateral fixator device are discussed.

Adult↗
PubMed1999

[CT determination of leg length and torsion in children and adolescents].

Because of different projections and axis constructions, the length and torsion of the lower extremities are sensitive to the measuring method. To judge pathological deformities in children or adolescents it is necessary to know the reference values. In this study, 78 children and adolescents 2-18 years old were included who had a femoral or tibial shaft fracture. Torsion and length were determined by computed tomography at least 3 months after internal fixation according the Ulm method. Only healthy bones were considered for this study. The mean internal torsion of the femur decreased during the growth period from 34.2 degrees +/- 10.3 degrees (x +/- SD) to 19.3 degrees +/- 9.5 degrees. There was only a weak correlation between the age and torsion of the femur. The mean external torsion of the tibia was 32.3 +/- 10 degrees. The 95th percentiles of the intraindividual torsional differences were 14 degrees (x = 4.1 degrees) of the femur (n = 30) and 12 degrees (x = 4.7 degrees) of the tibia (n = 48). The median femoral and tibial intraindividual length differences were 2 mm. The corresponding 95th percentiles were 10 and 9 mm. The aim of the study was to determine the age-dependent torsion and length and their respective differences with a standardized CT method. The range of the normal values was much greater than published in the literature.

Adolescent↗
PubMed2000

Preoperative planning in deformity correction and limb lengthening surgery.

A simple method of preoperative planning in deformity correction and limb lengthening surgery is described and illustrated with two cases of deformity associated with length discrepancy. Frontal and lateral radiographs allow defining a deformity in its actual plane. Tracings are made, axes are marked, and the deformity is analyzed graphically. A problem list is created on a worksheet. The osteotomies are made with scissors on the worksheet and the segments are angulated into position to test the correction. The method of fixation is selected and the patient seen preoperatively to address issues to be encountered during the correction.

Adolescent↗
PubMed2000

[Para-articular knee osteotomies].

Osteotomy close to the knee is an established method to treat degenerative osteoarthritis of the knee with varus or valgus deformity. However, indications, surgical techniques and results are discussed controversially. This article gives an overview of those surgical procedures most commonly used for correcting valgus and varus deformities. Supported by our results it is shown that osteotomy of the tibia for degenerative osteoarthritis together with operative arthroscopy in the same operative session gives better results compared to osteotomy alone. Despite the success of arthroplasty of the knee, osteotomy has it's place in the treatment of osteoarthritis.

Arthroscopy↗
PubMed2000

Computer and robotic assisted osteotomy around the knee.

The outcome variability and failures of conventional osteotomy have been attributed to lack of preoperative planning and inaccuracy in performing the correction. We present a computer and robotic assisted surgery system that can aid in accurate surgical planning for realignment, and in precisely implementing the plan in theatre. The approach seeks to avoid the cost and risks associated with the use of CT, and the insertion of fiducial markers, which are characteristic of existing computer assisted surgical systems. The paper details the architecture of the system as a whole, placing particular emphasis on planning technique. It is anticipated that the increased accuracy possible with the system will prove particularly useful for correcting multi-plane deformities, which are more problematic with conventional techniques.

Bone Malalignment↗
PubMed2001

Computer simulation of osteotomy correction.

This paper describes a novel approach to correct osteotomy deformities of long bones using virtual reality and image processing techniques on personal computers. The discussed method allows to simulate osteotomy corrections by implementing a single cut and a rearrangement of the dissected bone parts. It allows the surgeon to directly control the pre-operative situation and the post-operative result of the simulation by comparing bone-length, angles, and torsion of the bone. In addition, he or she obtains the coordinates and angles of the planned cut relative to anatomical landmarks.

Bone Malalignment↗