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PubMed2002

Results of a tapered cementless femoral stem implanted in varus.

Varus placement of the femoral component in total hip arthroplasty has been associated with poor outcomes. The purpose of this study was to examine results of total hip arthroplasty with varus alignment of a tapered titanium femoral prosthesis (Alloclassic; Sulzer, Zurich, Switzerland) at a minimum 5-year follow-up. Of a consecutive series of 585 patients, 23 met the inclusion criteria. Harris hip scores averaged 97, and all implants were clinically and radiographically stable at the most recent follow-up. In this series of patients, varus alignment of the prosthesis did not have an adverse effect on outcome. Although malalignment of the femoral prosthesis may compromise the results of some designs, the Alloclassic prosthesis has proved to be reliable and forgiving despite varus malalignment at 5 to 11 years' follow-up.

Arthroplasty, Replacement, Hip↗

PubMed2002

The effects of varus tibial alignment on proximal tibial surface strain in total knee arthroplasty: The posteromedial hot spot.

The aim of this study was to determine the effect of varus tibial alignment on proximal tibial strain in total knee arthroplasty. Fourteen paired fresh-frozen cadaver tibiae had photoelastic coating applied. The right tibiae were cut in neutral alignment, and the left tibiae were cut in 5 degrees of varus. Components were cemented and loaded with 3 x body weight, varying medial to lateral load. Surface microstrain was measured. There was a statistically increased hot spot of highly concentrated strain in the posteromedial quadrant of the proximal tibia in varus-cut bones (P<.05). In neutral alignment, the strain was nearly equal medial and lateral. The increased strain observed helps elucidate the mechanism of increased failure rates of a total knee arthroplasty inserted in varus alignment. Neutral alignment may have a protective effect.

Arthroplasty, Replacement, Knee↗

PubMed2004

The impacted varus (A2.2) proximal humeral fracture: prediction of outcome and results of nonoperative treatment in 99 patients.

UNLABELLED: BACKGROUND AND PATIENTS: The outcome of the impacted varus proximal humeral fracture has not been described. We present the results of a prospective analysis of 99 such fractures. RESULTS: This fracture was relatively common in the elderly population and non-operative treatment sometimes resulted in increased varus angulation. Decreased shoulder function was associated with increasing age but not with increasing varus angulation. After nonoperative management the outcome was good, regardless of the degree of varus, 1 year after fracture. Age was the main predictor of outcome. Physiotherapy did not improve outcome.

Adolescent↗

PubMed1996

Split posterior tibial tendon transfer for varus deformity of hindfoot.

Sixteen patients (23 feet) who underwent split posterior tibial tendon transfers were evaluated. The patients were seen on a followup basis for a minimum of 1 year postoperatively. The causes were spastic cerebral palsy in 13 feet, spastic-athetoid cerebral palsy in 3 feet, hydrocephalus in 3 feet, and other diseases in 4 feet. The indication for surgery was varus deformity during the stance phase of gait and increased varus deformity during the swing phase of gait because of spasticity of the posterior tibial muscle. Heel cord lengthening was done on 17 feet. Preoperative and postoperative gaits were evaluated while the patients were walking. Axial radiographs of the calcaneus and the tibia were taken of all patients while they were weightbearing. There were 15 excellent, 6 good, and 2 poor results. The poor ratings were assigned to patients who had recurrence of varus deformity; there were no cases of overcorrection. Split posterior tibial tendon transfer was effective for treating spastic varus deformity of the hind part of the foot. This treatment also could be considered for a patient with spastic-athetoid cerebral palsy, if the deformity was determined to be caused by overactivity of the tibialis posterior muscle.

Adolescent↗

PubMed2002

Varus and valgus flexion laxity of total knee alignment methods in loaded cadaveric knees.

Both total knee alignment methods, the anatomic and classic, seek to achieve stability in flexion and extension. However, posterior femoral condyle referencing (anatomic alignment) combined with perpendicular tibial resection (classic alignment) results in a 3 degree relative internal rotation of the femoral component with lateral joint opening. The current cadaver study investigated the influence of total knee alignment methods and femoral component malrotation (3 degrees and 6 degrees internal and external malrotation) on femorotibial laxity. Varus and valgus excursion tests were done at 0 degrees, 30 degrees, 60 degrees, and 90 degrees knee flexion under vertical loading conditions of 150 N. None of the alignments produced increased laxity in extension. The largest laxity was found on the varus test at 60 degrees flexion with the femoral component at 6 degrees internal rotation. A 3 degree internal rotation of the femoral component showed increased varus laxity only for the combined alignment method. This finding shows that the femoral component position of the combined alignment method is a 3 degree relative internal malrotation and that an additional internal malrotation may compromise varus stability. Posterior femoral condyle referencing did not provide proper femoral component rotation. A ligament tensor may be helpful in determining femoral component rotation after soft tissue release in extension is performed.

Arthroplasty, Replacement, Knee↗

PubMedDate not supplied

Separation of the proximal femoral epiphysis after derotation varus osteotomy of the femur.

Proximal femoral varus and derotation osteotomy is a common procedure performed in the management of developmental dysplasia of the hip. This procedure imposes high shear stress on the femoral epiphysis, depending on the degree of varus obtained. We report two cases of proximal femoral epiphyseal slip after varus derotation osteotomy and discuss the management and outcome. Such epiphyseal slip may or may not be symptomatic, and a careful radiologic examination should be carried out in suspected cases. Management should be individualised. Surgical correction of varus may be required.

Epiphyses, Slipped↗

PubMedDate not supplied

Medial approach for corrective osteotomy of cubitus varus: a cosmetic incision.

Osteotomies described previously to correct cubitus varus had been associated with unsatisfactory results such as a prominent lateral scar and condyle and injury to the triceps. The authors evaluated the results of a medial approach for the corrective osteotomy of 14 consecutive children (mean age 8.4 years) with cubitus varus. The incision was made medially and the ulnar nerve was identified and protected. An image intensifier was used to identify the wedge. Lateral closing wedge osteotomy was performed and secured with cross K-wires, and the distal fragment was translated medially to reduce the lateral prominence. Both hyperextension and internal rotation deformity could be corrected with the osteotomy. The mean carrying angle and hyperextension of the elbow of 19.3 degrees varus and 22.2 degrees were corrected to 2.4 degrees valgus and 8.8 degrees respectively. Radiographically, the Baumann's angle and the flexion angle were improved from 90.1 degrees to 77.3 degrees and 24.2 degrees to 37.2 degrees respectively. No patient had a prominent lateral condyle, and the operative scars were well concealed along the medial aspect of the elbow. There was one case of transient ulnar nerve paresis with residual varus.

Child↗

PubMedDate not supplied

CT measurement of the calcaneal varus angle in the normal and fractured hindfoot.

The calcaneal varus angle is an important parameter used by orthopedic surgeons in their assessment of calcaneal fractures, and restoration of this angle is a major goal in the intraoperative reduction of such fractures. Plain radiographic techniques for the measurement of this angle may be difficult to apply. It is much simpler to measure this angle on CT, which is superior in demonstrating the complex anatomy of the calcaneus. However, a standardized method of measuring this angle by CT has not yet been developed. We measured the calcaneal varus angle in 48 subjects (31 normal feet and 62 feet with fractured calcanei) with three methods. The axial calcaneocuboid angle (the angle in the axial plane between the longitudinal axis of the calcaneus and a line drawn perpendicular to the calcaneocuboid joint) measured 25.3 +/- 7.3 degrees (mean +/- 1 SD) in normal feet and 28.9 +/- 8.5 degrees in fractured feet. The axial talocalcaneal angle (the angle between the longitudinal axes of the talus and the calcaneus in the axial plane) measured 20.9 +/- 9.2 degrees in normal feet and 29.2 +/- 11.3 degrees in fractured feet. The coronal talocalcaneal angle (the angle between the vertical axes of the talus and calcaneus in the coronal plane) measured 12.5 +/- 3.8 degrees in normal feet and 21.8 +/- 7.6 degrees in fractured feet. There was a statistically significant difference between the varus angle for normals and for fractured calcanei by all three methods of measurement (p less than or equal to 0.05). These measurements provide preliminary normative data for three methods of estimating the calcaneal varus angle in the normal and fractured hindfoot. These may be of value not only in the surgical restoration of the normal anatomic alignment of the fractured hindfoot but also in the preoperative assessment of congenital foot abnormalities. Although clinical validation is not yet available, our study suggests that the axial calcaneocuboid angle has several significant advantages over the other two methods.

Adult↗

PubMedDate not supplied

The effect of tibial rotation on varus deformity measurement.

PURPOSE: Tibial osteotomy is used to treat a variety of orthopedic conditions, including reduction in pain and improvement of deformity and function. In templating for surgery, accurate radiographic measurement aids in planning for correction. The purpose of our study was to examine the effect of internal rotation and external rotation on measurement of tibial sawbone models with 5 closing wedge varus deformities at 10-degree increments between 10 and 50 degrees. One sawbone without deformity served as the control. STUDY DESIGN: A total of 66 radiographs were measured by 5 individuals. Measurement deviations from the control in each of the 10 positions of rotation were assessed. RESULTS: In the analysis of variance models, increased rotation and varus angulation were associated with increased deviation compared with the control. In external rotation for every 10 degrees of varus angulation, the degree deviation increased 0.69 degrees. In IR for every 10 degrees of angulation, the degree deviation increased by 0.84 degrees. Internal rotation had the greatest impact. Mean differences between different rater's measurements were small (1.1+/-1.2 degrees) and correlations suggested high interrater reliability. CONCLUSIONS: As the degree of rotation from neutral increased and varus angulation increased, deviation from neutral increased. CLINICAL RELEVANCE: Clinically, the results of this study support the importance of proper alignment of the tibia during radiography to more precisely template surgery.

Artifacts↗

PubMed1982

Cubitus varus deformity following supracondylar fractures of the humerus in children.

A retrospective study of 63 patients with cubitus varus deformity following supracondylar fracture of the humerus was carried out in order to identify the causes of cubitus varus, to define the best method for prevention, and to evaluate the indications for and results of treatment of the established deformity. There was no evidence of growth disturbance in any of our patients after a mean follow-up of 5 years postfracture. Cubitus varus was found to be secondary to medial tilting of the distal fragment. Failure to recognize this initial or subsequent medial tilt during early treatment of the fracture was the major factor in the development of cubitus varus deformity, thus explaining the average delay in diagnosis of 6 to 10 weeks postfracture. Since all patients regained essentially normal use of the upper extremity after the fracture, cosmesis was the primary indication for corrective surgery. Fifteen supracondylar osteotomies are reported with 33% unsatisfactory results. Prevention of this deformity by careful clinical and radiological evaluation during initial treatment of the supracondylar fracture is emphasized.

Child↗

PubMed2007

Varus rotational osteotomies for adults with hip dysplasia: a 20-year followup.

Untreated hip dysplasia predisposes young adults to early arthritis. Varus rotational osteotomies are considered one option to delay or eliminate total hip arthroplasty. We update a report from 1991 by retrospectively reviewing 40 of 48 patients (83.3%) who had 45 varus rotational osteotomies from 1971 to 1986 with a minimum followup of 15 years (mean, 22.6 years; range, 15-34 years). Results were assessed using Hospital for Special Surgery hip scores and radiographic parameters. The average age of the patients at followup was 57.2 years (range, 38-81 years). Fourteen patients (35%) (16 hips) had no additional procedures at 21.2 years followup (range, 15-27 years). The average Hospital for Special Surgery hip score was 33.7 with a Tönnis scale of 1.7 (mild-moderate osteoarthritis). Twenty-six patients (65%) (29 hips) had total hip arthroplasties an average of 9.75 years (range, 2-27 years) after varus rotational osteotomy. As in the initial study, the degree of preoperative osteoarthritis was a predictive value for success of the varus rotational osteotomy. Additionally, younger patients with minimal hip subluxation and osteoarthritis, and a better preoperative Hospital for Special Surgery hip score were predictors of success.

Adolescent↗

PubMed2004

Chondral resurfacing and high tibial osteotomy in the varus knee.

BACKGROUND: Treatment of patients with degenerative knees and varus malalignment presents a difficult clinical problem. HYPOTHESIS: Combining a medial opening wedge high tibial osteotomy with the microfracture chondral resurfacing procedure is a viable treatment option. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: A group of 38 consecutive patients (mean age, 51.3 years; range, 34 to 72 years; 29 men and 10 women) with varus malalignment and chondral lesions who were treated with chondral resurfacing (an abrasion and microfracture technique) combined with a medial opening wedge high tibial osteotomy. All patients had >5 degrees of varus malalignment. Patients were evaluated preoperatively with the Lysholm and Western Ontario & McMasters Universities Osteoarthritis Index scoring systems and at a minimum of 2 years follow-up. RESULTS: Thirty-three of 38 patients (87%) were available for 2-year follow-up (average, 45 months; range, 24 to 80 months). Lysholm scores improved from a preoperative score of 43.5 to 78.0 at follow-up; Western Ontario & McMasters Universities Osteoarthritis Index scores improved from 45.8 to 16.2. The average Tegner score was 5.0. CONCLUSIONS: Combining a medial opening wedge high tibial osteotomy with the microfracture chondral resurfacing procedure in the varus knee is an effective method of decreasing pain and increasing function at a minimum of 2 years follow-up.

Adult↗

PubMedDate not supplied

Tarsal coalition presenting as a pes cavo-varus deformity: report of three cases and review of the literature.

The diagnosis of idiopathic pes cavo-varus is one of exclusion. Typically a neuropathic etiology is sought. Equally well known is the association of rigid flatfoot deformity with calcaneonavicular and subtalar coalition. Less well known is the association of pes cavo-varus with tarsal coalition. This is a report of three patients who presented with cavo-varus deformities without underlying neurologic abnormalities, one with a calcaneonavicular coalition and two with subtalar coalitions, the latter an entity not previously described in association with pes cavo-varus, to our knowledge.

Adolescent↗

PubMed2004

Curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head.

We reviewed the outcome of curved intertrochanteric varus osteotomy in the treatment of osteonecrosis of the femoral head in 20 hips. A mean varus angulation of 31 degrees was obtained by the osteotomy. The ratio of intact area on the weight-bearing portion increased from 19% to 61%. The mean elevation and lateral displacement of the greater trochanter were 1.2 cm and 0.5 cm, respectively. These changes in the position of the greater trochanter were very small when compared with those after conventional varus wedge osteotomy. Nonunion or delayed union was not observed. Quantitative analyses showed aggressive bone remodelling in the medial intertrochanteric region. Eighteen hips survived without collapse after a mean follow-up of 48 months. We conclude that curved varus osteotomy can be used to preserve the hip joint in patients with osteonecrosis of the femoral head.

Adolescent↗

PubMed1998

Gait analysis before or after varus osteotomy of the femur for hip osteoarthritis.

SUMMARY OF BACKGROUND: Intertrochanteric varus osteotomy of the femur for hip osteoarthritis is expected to bring improved congruity and increased weight-bearing surface area of the hip joint. Before surgery, we usually make a tracing on a paper using an anteroposterior roentgenogram of the hip to simulate the operating procedures and obtain better conditions in the hip. Nevertheless, there have been some cases in which this procedure does not provide satisfactory postoperative results in terms of relief of pain or locomotion, with long-term limp due to weakness of the hip abductor muscle group and shortening of the leg. OBJECTIVES: To confirm if the improved congruity and increased covering of the weight-bearing surface area obtained by varus osteotomy can be actually reproduced during walking, and to evaluate the kinetic mechanism of the effects of this procedure using gait analysis. METHODS: We measured the strength ratio of the hip abductor muscles as the percent of the opposite side, and analyzed the pelvic movement and data of dynamic electromyography (EMG) recorded during locomotion in 24 female patients who underwent unilateral intertrochanteric varus osteotomy of the femur for hip osteoarthritis, 30 non-surgically-treated female patients with hip osteoarthritis, and 54 healthy women. In the operated patients, the roentgenograms obtained during one-legged stance on the affected side disclosed that 10 were positive for Trendelenburg's phenomenon (T(+) group) and 14 were negative for Trendelenburg's phenomenon (T(-) group). All subjects walked with bare feet at a comfortable pace on a walkway containing a force plate. Photo switches were placed in a walkway to measure the gait velocity and to determine the stance phase time of one gait cycle. Frontal and sagittal trajectories of body surface markers for computerized joint-angle motion analysis were acquired using the Quick-MAG system. EMG data for the gluteus maximus, gluteus medius, tensor fascia latae, and lateral hamstrings recorded using surface electrodes were integrated to quantify as the percent of maximum voluntary contraction (% MVC). RESULTS: This study disclosed that the stance phase time was shorter and the strength ratio of the hip abductor muscles was lower in the operated patients than those in the other 2 groups, and the change of the pelvic obliquity was smaller and the % MVC of the gluteus medius and tensor fascia latae were greater than those in the normal subjects. The change of the pelvic tilt showed the same pattern with those of the pelvic obliquity. The T(+) group showed decreased strength ratio of the hip abductor muscles and increased % MVC for the gluteus medius and the tensor fascia latae compared to the T(-) group, but the changes of both the pelvic obliquity and pelvic tilt did not significantly differ in the 2 groups. CONCLUSION: This study showed the postoperative reappearance of the simulated conditions in the hip before varus osteotomy of the femur, providing evidence that the pelvis was horizontally maintained during walking due to decreased stance phase time and increased performance of the hip abductor muscles after this procedure.

Adult↗

PubMed1995

Varus tension testing of fixation devices used in proximal tibial osteotomy.

Varus tension testing was performed on 26 matched pairs of tibias after high tibial osteotomy with three different fixation techniques--Coventry stepped staple, Mansat staple blade, and modified tension-band. Biomechanical testing revealed that in group I the Coventry stepped staple and Mansat staple blade yielded similar force at failure values of 132.44 +/- 29.29 and 137.34 +/- 40.84, respectively. In group II, the varus force at failure value was 170.45 +/- 83.95 for the modified tension band device versus 115.27 +/- 67.21 for the Coventry stepped staple device. In group III, the varus force at failure value was 180.26 +/- 82.36 for the modified tension band device versus 109.14 +/- 60.96 for the Mansat staple blade. The findings in this study suggest that the modified tension band technique provides a greater varus force at failure value, approximately 160-170%, compared to the other two techniques. In addition, this device is easy to apply and less expensive, and most orthopaedic surgeons are already familiar with its use.

Biomechanical Phenomena↗

PubMed1999

Posterior tibial slope in the normal and varus knee.

Posterior tibial slope was evaluated in 30 normal and 30 varus knees using magnetic resonance imaging. The mean tibial posterior slope in the medial plateau was 10.7 degrees (range: 5 degrees - 15.5 degrees) in the normal knees and 9.9 degrees (range: 1.5 degrees - 19 degrees) in the varus knees. The mean tibial posterior slope in the lateral plateau was 7.2 degrees (range: 0 degrees - 14.5 degrees) in the normal knees and 6 degrees (range: 1 degrees - 13 degrees) in the varus knees. Although these differences were not statistically significant, there was a large range in the posterior tibial slope in both groups. When 10-mm thickness of bone was resected in the middle of the lateral plateau in total knee arthroplasty, the thickness of the bone resection in the anterior and posterior part of the lateral plateau was measured. The presumed thickness of bone was 10.1 mm (range: 7.3-13.9 mm) in the anterior part and 7.5 mm (range: 5-10.3 mm) in the posterior part. A large range in the measured thickness of bone also was detected in the varus knees. These results suggest that the shape of the proximal tibia varies among individuals and that the cutting angle should be determined in each case to avoid any mismatch of the patient's posterior slope of the tibia after implantation.

Case-Control Studies↗

PubMed1999

Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity.

The clinical results of using medial epicondylar osteotomies to correct varus deformities in total knee arthroplasties were investigated. Unlike the traditional method of subperiosteal stripping of tibial ligaments, this alternative does not damage ligaments. Between 1991 and 1996, the senior author performed medial epicondylar osteotomies in 80 patients (93 knees) with primary total knee arthroplasty; of these, 60 patients (70 knees) were available for 2- to 4-year followup. At followup, no patients reported knee instability. Mean varus and valgus stability measured 14.2 points (Knee Society scale, 0-15 points). The Knee Society clinical score was 93 points, compared with a preoperative score of 42 points. The mean range of motion at followup was 111 degrees, compared with a preoperative mean of 101 degrees. The postoperative tibiofemoral angle on full limb radiographs taken with the patient weightbearing averaged 7 degrees valgus, compared with an average 6 degrees varus preoperative angle. Ninety-five percent of the patients were satisfied and reported less pain and improved knee function. Bone union occurred in 54% of the knees and fibrous union occurred in 46%. Focal tenderness, restricted motion, or other symptoms were not associated with fibrous union. The results show that epicondylar osteotomy for varus knee deformity provides excellent patient satisfaction, knee stability, motion, and deformity correction.

Adult↗