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PubMed2004

[Distal femoral varus osteotomy for symptomatic genu valgum: long-term results and review of the literature].

PURPOSE OF THE STUDY: We report our experience with eleven patients treated for disabling genu valgum from 1979 to 1994. MATERIAL AND METHODS: Genu valgum resulted from femoral deformation in all patients. Ten had a congenital condition and one a post-traumatic knee. IKS scores were used for the clinical evaluation. The lateral femorotibial joint space and the lateral femoral angle (LFA) were measured on plain films. Goniometry was used to measure the axis of the loaded lower limb. All patients underwent osteotomy of the distal femur for varisation and plate fixation. One patient required revision for a unicompartment lateral prosthesis subsequent to fracture of the homolateral lateral tibial plateau. Mean follow-up was 10.5 years (3.5-21.5). RESULTS: There were no cases of nonunion. Four patients had a good or excellent knee score. Eight patients had a good or excellent function score. Osteoarthritis worsened in two patients. The mean LFA increased from 72.5 degrees preoperatively to 83.5 degrees postoperatively and a last follow-up. Mean genu valgum was 13 degrees preoperatively and 2 degrees at last follow-up. All patients except one were satisfied or very satisfied. Insufficient correction appeared to be the main complaint. DISCUSSION: These results and results reported in the literature demonstrate that distal femoral osteotomy for disabling genu valgum is an effective treatment if the correction is complete and osteosynthesis effective, providing long lasting results when femoral deformation is involved and osteoarthritis limited.

Adult↗
PubMed2003

The biomechanical properties of the finger metacarpophalangeal joints to varus and valgus stress.

PURPOSE: The purpose of this study was to determine the normal biomechanical properties of the passive capsuloligamentous structures about the finger metacarpophalangeal (MCP) joints subjected to dynamic varus/valgus loading and to equate these findings to the clinical situation. METHODS: The finger MCP joints from 9 fresh-frozen cadaver hands were tested in a custom-designed testing apparatus that applied a varus/valgus force in each direction. Testing was performed at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of MCP joint flexion. Load-displacement curves were generated for each specimen. A nonlinear hysteresis curve was apparent on loading and unloading. A region of collateral ligament laxity was identified whereby minimal torque (< 0.5 Nm) caused progressive joint angulation. Subsequently incremental load was required to produce further joint angulation. The slope of this region was used to calculate early and late collateral ligament stiffness. RESULTS: The index and long fingers showed a significant decrease in the region of collateral ligament laxity between 0 degrees and 90 degrees. The long finger collateral ligament laxity also diminished significantly between 30 degrees and 90 degrees. The collateral ligament laxity did not significantly change in the ring and small digits throughout MCP joint flexion. The early or late phase of collateral ligament stiffness was not affected by the amount of MCP joint flexion across any of the digits, except in late radial collateral ligament stiffness of the long finger between 0 degrees and 60 degrees. CONCLUSIONS: The additional stability and clinical observation of tightening of the MCP in flexion appears related to the decreased laxity of the collateral ligaments and not to alterations in the biomechanical properties of the collateral ligaments.

Biomechanical Phenomena↗
PubMed2002

Underestimation of varus angulation in knees with flexion deformity.

In order to investigate the change in limb alignment in cases of knee flexion deformity, 17 male volunteers aged from 25 to 35 years with no complaints and no knee disorders were selected. The femorotibial angle (FTA), which is the lateral angle at the intersection between the femoral axis and the tibial axis in an anteroposterior radiograph, was employed as an index of limb alignment. FTA in standing on one leg with and without knee flexion was measured. The mean standing FTA was 179.4+/-19 degrees in full extension, which decreased to 176.9+/-2.5 degrees in a mean flexion position of 18+/-3.3 degrees (range 15-25 degrees ) (P<0.002), and in all cases, standing FTA in flexion was smaller (more valgus-angulated) than that in full extension. There was a significant positive relationship with a straight regression line (D=0.101KFA + 0.296, R=0.8505) between the angle of knee flexion (KFA) and the difference (D) in standing FTA between full extension and knee flexion. We conclude that limb alignment became more valgus-angulated with an increase in flexion deformity.

Adult↗
PubMedDate not supplied

Biomechanics of the first ray. Part II: Metatarsus primus varus as a cause of hypermobility. A three-dimensional kinematic analysis in a cadaver model.

Variation in functional stability of the first metatarsocuneiform joint was analyzed between transverse plane deviated (adducted) and corrected first metatarsal positions in a closed kinetic chain model. Six fresh frozen cadaver specimens with intact ankles and feet were fitted with a custom fabricated titanium metatarsal jig, which allowed for manipulation of the first metatarsal in the transverse plane. Specimens were mounted into a custom-made acrylic load frame and axially loaded to 400 N. Radiowave three-dimensional tracking transducers were attached to the following osseous segments: first metatarsal head and base, medial cuneiform, and second metatarsal. A dorsally directed load was applied to the first metatarsal segment and resultant movements were measured. Repeated testing was performed on a transverse deviated and corrected first metatarsal positions with the hallux plantargrade and maximally dorsiflexed to engage the windlass mechanism. With the windlass mechanism engaged and first metatarsal corrected, a 26% increase in first ray plantarflexion occurred from a deviated to a corrected first metatarsal position (p < or = .05). This suggests that the windlass mechanism is more efficient when the first metatarsal, sesamoid apparatus, and hallux position are properly aligned with the orientation of the plantar aponeurosis. Clinically, this may explain the correlation of first ray hypermobility with the progression of bunion severity. Our study validates the earlier work of Hicks and adds additional insight into the functional stability in the medial column of the foot.

Acrylic Resins↗
PubMed2004

Management of congenital talipes equino varus in Scotland: a nationwide audit.

The Scottish Talipes Register is a record of all newly diagnosed cases of idiopathic congenital talipes equinovarus (CTEV) in Scotland over a four.year period. Two hundred and sixteen children were entered into the register, which recorded initial management and all subsequent interventions, both non-operative and operative. The data, therefore, represent a record of the different management regimens used within Scotland highlighting the variations in duration of conservative management and variations in surgical intervention following different methods of conservative management.

Casts, Surgical↗
PubMed2001

Modified technique for varus derotation osteotomy of the proximal femur in children.

BACKGROUND: The results of a study in which the Richards' intermediate hip screw and the AO (Association for the Study of Internal Fixation (ASIF)) 908 fixed-angle blade plate were compared for use in proximal femoral osteotomy in children have previously been reported. In that study loss of position at the osteotomy site was reported as a specific complication associated with the use of the Richards' intermediate hip screw. METHODS: The authors devised a simple modification of surgical technique using the Richards' intermediate hip screw to enhance the stability of the fixation. In the present article the results of a prospective study of that modified technique are reported and compared with the results of the previous study. RESULTS: During a 2-year period 24 proximal femoral osteotomies were performed on 12 children with cerebral palsy, using the modified technique by two surgeons. Only two of the 12 patients (16%) required postoperative immobilization in a hip spica cast. This represents a significant reduction in the level of spica casting when compared with the previous cohort study (61%). CONCLUSION: A simple modification of surgical technique improves the stability of fixation in proximal femoral osteotomy in children who have cerebral palsy. This resulted in a decreased need for supplementary hip spica casting and may reduce morbidity.

Bone Plates↗
PubMed2001

Arthroscopic decompressive medial release of the varus arthritic knee: Expanding the functional envelope.

We present the rationale and technique for treating medial knee osteoarthritis by dynamically unloading the medial compartment of the knee. Recent advances in kinematic studies indicate a dynamic linkage between differing degrees of freedom in the knee joint. Both the adduction moment and the foot progression angle are important determinants of medial compartment loading. The medially osteoarthritic knee has progressive compromise of free motion in more than 1 plane. Arthroscopic decompressive medial release unloads the medial compartment by release of the medial capsule and medial collateral ligament in the presence of intact cruciate ligaments, which may allow a decreased adduction moment and decrease of the external rotation restraint in extension found in more severely osteoarthritic knees. A case series of 38 patients with medial gonarthrosis was treated by this technique at the Hermanos Ameijeiras Hospital in Havana, Cuba. All patients had good results without postoperative valgus instability or significant complications. We feel that this technique warrants further clinical and biomechanical study for its use in isolation or in combination with high tibial osteotomy or minimally invasive selective osteotomy for the treatment of medial gonarthrosis of the knee. A minimally invasive, selective approach to biomechanical factors in osteoarthritis may be combined with other modulating techniques in efforts to forestall or prevent the need for total joint replacement.

Animals↗
PubMedDate not supplied

[Is unicondylar knee prosthesis a current possibility in primary management of varus gonarthrosis?--A prospective matched-pair study].

AIM: In the present study, we performed a follow-up investigation comparing middle-term results after unicompartmental and bicompartmental knee arthroplasties. MATERIAL AND METHODS: We used matched pairs with 18 patients in each group. The first group was treated with the unicompartmental slegde prosthesis (Type Wessinghage), the second with the cementless nonconstrained bicondylar prosthesis (Type Natural knee). The mean time of follow-up was 4.5 years. (SD +/- 0.6). The average age of the patients in both groups was 59 years (SD +/- 3). Both groups included 12 female and 8 male patients. All patients suffered from primary medial osteoarthritis of the knee. In all cases, the contralateral knee also had signs of manifest osteoarthritis. The determination and evaluation of the results of the investigation were made according to the score of the American Knee Society. We also reviewed the radiological findings concerning placement of the prosthesis, radiolucent lines, and patella position in the femoral shield. RESULTS: At follow-up examination, there were no significant differences in the knee score between the patients undergoing unicompartmental or total knee replacement. However, patients with the Wessinghage sledge tended to show better results. The mean knee score was 94.3 +/- 4.9 in the Wessinghage group and 91.9 +/- 8.3 in the Natural knee group. Evaluation of the radiographs revealed radiolucent lines in the group with total replacement. In contrast, in 7 of 18 patients with the unicompartmental prostheses we found radiolucent lines at the tibial component of 1 mm or more, which, however, did not cause clinical symptoms. CONCLUSION: Our results show, that the unicompartmental arthroplasty is still an effective method for the treatment of the osteoarthritis, especially concerning the conditions for possibly needed revisions.

Aged↗
PubMedDate not supplied

[Predictors of tibial head transposition in the therapy of varus knee osteoarthritis].

PURPOSE: The aim of this study was to find predictors for the clinical outcome in patients who underwent a high tibial osteotomy (HTO). METHOD: Between 1984 and 1996 a high tibial valgus osteotomy was performed in 155 patients with genu varum. 133 HTO patients were available for follow-up at an average postoperative time of 9.3 +/- 3.0 years. The degree of osteoarthritis was evaluated by radiological (Kellgren) and arthroscopic scoring systems (Outerbridge). Survival time of HTO was estimated using Kaplan-Meier survivorship analysis. RESULTS: The survival rate of HTO was 95 % after 5 years and 77 % after 10 years. In the medial compartment of knee joints with a preoperative Outerbridge stage III/IV or Kellgren stage III/IV the survival rate of HTO was significantly lower when compared to stages 0/I/II (p < 0.05). Age, sex, tibial malalignment and severity of osteoarthritis in the lateral compartment had no influence on survival rates. The pre-postoperative comparison of radiologically visible signs of osteoarthritis showed mainly either no (46.5 %) or only small (50.5 %) progression. We found that patients who underwent a HTO had good and very good clinical outcomes. CONCLUSION: We identified severity of preoperative radiological osteoarthritis and intraoperative chondromalacia as predictors of survival rate.

Female↗
PubMedDate not supplied

[Idiopathic varus gonarthrosis: diminished nociceptive vs. unchanged somatosensory sensitivity].

Neuromuscular control deficits are supposed to contribute to the development of osteoarthritis (OA). Pain measurements were performed to clarify whether nociceptive afferents differ between OA patients and healthy subjects. Thermal pain thresholds were significantly higher in OA subjects as compared to controls, but there was no difference in perceptual thresholds after electrical stimulation. Lateralization, gender, site of OA changes, previous operations, or medication did not affect these findings.

Adult↗
PubMedDate not supplied

[Histological findings of the femoral quadriceps muscle in varus and valgus gonarthrosis].

A pronounced valgization or varization of the lower extremity leads to changes in skeletal muscle which are histologically and morphometrically demonstrable in biopsies of Mm. vastus lateralis et medialis of patients with chronically anomalous stressing of the knee joint. During chronic over-stressing, increased thickness in type I and type II muscle fibers can be observed in both Mm. vastus medialis and lateralis, whereas type II fibers demonstrate a greater variability and there is a greater occurrence in type I fibers. Our investigations show that a chronic anomalous stressing influences both the size and energy metabolism of a skeletal muscle cell in a manner which can be interpreted as a functional adaptation.

Aged↗
PubMed1981

[Biomechanical examination of stress distribution in the femoral neck for varus-implanted and valgus-implanted cups (author's transl)].

The contents of this contribution pertain to the above mentioned article of Gerngross et al. The problem of fracture propagation is indeed of very local character, limited either to the discontinuity in the immediate neighbourhood of the cup lip or to the notch accidentally formed in the femoral neck by the milling cutter during surgery. Strain measurements performed far removed from the area of stress concentration do not bear sufficient evidence to support the conclusions drawn. The presentation of results is misleading because a comparison of stress or strain within the bone at chosen moments during the walking cycle is valid only if the relevant loading conditions, with respect to direction as well as magnitude, are applied. Finally, the description of the strain measurement and evaluation procedure is inadequate and questionable.

Biomechanical Phenomena↗