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PubMed2001

Ligamentous stabilizers against posterolateral rotatory instability of the elbow.

BACKGROUND: The lateral ulnar collateral ligament, the entire lateral collateral ligament complex, and the overlying extensor muscles have all been suggested as key stabilizers against posterolateral rotatory instability of the elbow. The purpose of this investigation was to determine whether either an intact radial collateral ligament alone or an intact lateral ulnar collateral ligament alone is sufficient to prevent posterolateral rotatory instability when the annular ligament is intact. METHODS: Sequential sectioning of the radial collateral and lateral ulnar collateral ligaments was performed in twelve fresh-frozen cadaveric upper extremities. At each stage of the sectioning protocol, a pivot shift test was performed with the arm in a vertical position. Passive elbow flexion was performed with the forearm maintained in either pronation or supination and the arm in the varus and valgus gravity-loaded orientations. An electromagnetic tracking device was used to quantify the internal-external rotation and varus-valgus angulation of the ulna with respect to the humerus. RESULTS: Compared with the intact elbow, no differences in the magnitude of internal-external rotation or maximum varus-valgus laxity of the ulna were detected with only the radial collateral or lateral ulnar collateral ligament intact (p > 0.05). However, once the entire lateral collateral ligament was transected, significant increases in internal-external rotation (p = 0.0007) and maximum varus-valgus laxity (p < 0.0001) were measured. None of the pivot shift tests had a clinically positive result until the entire lateral collateral ligament was sectioned. CONCLUSIONS: This study suggests that, when the annular ligament is intact, either the radial collateral ligament or the lateral ulnar collateral ligament can be transected without inducing posterolateral rotatory instability of the elbow.

Aged↗

PubMed2002

Long-term outcome after tibial shaft fracture: is malunion important?

BACKGROUND: Fractures of the shaft of the tibia often heal with some angulation. Although there is biomechanical evidence that such angulation alters load transmission through the joints of the lower limb, it is not clear whether it can eventually lead to osteoarthritis. METHODS: One hundred and sixty-four individuals who had sustained a tibial shaft fracture were assessed in a research clinic thirty to forty-three years after the injury. The subjects were evaluated with regard to self-reported lower limb joint pain, stiffness, and disability (assessed with the Western Ontario and McMaster Universities [WOMAC] osteoarthritis questionnaire); clinical signs of osteoarthritis; and radiographic evidence of osteophytes and joint-space narrowing in the knees, ankles, and subtalar joints. RESULTS: Twenty-two (15%) of the 151 subjects who reported no other knee injury reported at least moderate knee pain, and eight (6%) of the 145 subjects who reported no other ankle injury reported at least moderate ankle pain. Seventeen (13%) of the 135 subjects who reported no other knee or ankle injury reported at least moderate disability. The ipsilateral side demonstrated a higher prevalence than the contralateral side in terms of pain with passive ankle movement (nineteen versus nine subjects, p = 0.02), pain with passive subtalar movement (fifteen versus four subjects, p = 0.01), and radiographic signs of ankle joint space narrowing (twelve subjects versus one subject, p = 0.0055). Knee osteoarthritis was frequently bilateral. Forty-seven fractures (29%) healed with coronal angulation of > or = 5 degrees. Apart from an association between shortening of > or = 10 mm and self-reported knee pain (p = 0.016), there were no significant univariate associations between these malunions and the development of osteoarthritis. Seventeen (15%) of 114 eligible subjects had overall malalignment of the lower limb, defined as a hip-knee-ankle angle outside the normal range of 6.25 degrees of varus to 4.75 degrees of valgus. This malalignment was due to the fracture malunion in nine subjects and predated the fracture in eight. In limbs with varus or valgus malalignment, there was an excess of subtalar stiffness (p = 0.04) and a nonsignificant trend toward more frequent knee pain. In limbs with varus malalignment, there was a nonsignificant trend toward more frequent radiographic evidence of osteoarthritis in the medial compartment of the knee joint. Most of the subjects in whom osteoarthritis was observed had normal overall alignment of the lower limb. CONCLUSIONS: The thirty-year outcome after a tibial shaft fracture is usually good, although mild osteoarthritis is common. Fracture malunion is not the cause of the higher prevalence of symptomatic ankle and subtalar osteoarthritis on the side of the fracture. Although varus malalignment of the lower limb occurs occasionally and may cause osteoarthritis in the medial compartment of the knee, other factors are more important in causing osteoarthritis after a tibial shaft fracture.

Aged↗

PubMed2002

Double level osteotomy of the knee: a method to retain joint-line obliquity. Clinical results.

BACKGROUND: Although general guidelines have been proposed for proximal tibial and supracondylar osteotomies, double level osteotomy provides the advantage of maintaining neutral joint-line obliquity in addition to correcting limb malalignment around the knee. The goal of this prospective study was to determine the outcome of double level osteotomy of the knee performed after analysis with computer-aided preoperative planning software in patients with varus malalignment. METHODS: Twenty-nine double level osteotomies of the knee were performed in twenty-four patients. The patients were followed for an average duration of 82.7 months (range, twenty-seven to 137 months). All knees had moderate-to-severe varus deformity and arthritis. The mean preoperative mechanical tibiofemoral angle was 193.9 degrees (that is, 13.9 degrees of varus). Preoperative and postoperative evaluations included clinical (scores according to the Knee Society system), radiographic, and computer-aided analysis of the mechanical status of the knee joint. Failure was defined as conversion of an osteotomy to a total knee arthroplasty or the presence of severe pain in a patient who declined arthroplasty. RESULTS: The mean clinical and functional scores according to the Knee Society system improved from 34 and 64 points, respectively, before the osteotomy to 90 (p < 0.0001) and 81 points (p = 0.079) at the time of the final follow-up examination. One patient was lost to follow-up. One of the twenty-nine knees was subsequently converted to total knee arthroplasty forty-nine months postoperatively. The cumulative rate of survival at 100 months was 96% (95% confidence interval, +4.5 to -8.7), with eight patients remaining at risk. CONCLUSIONS: Double osteotomy is a valuable procedure for patients with such a large varus deformity that appropriate realignment and load transfer to the unaffected compartment, together with an acceptable joint-line obliquity, cannot be achieved by a single osteotomy.

Adult↗

PubMed2003

Reduction of a dislocation of the hip due to developmental dysplasia. Implications for the need for future surgery.

BACKGROUND: Recent reports on the treatment of a dislocation of the hip due to developmental dysplasia have documented conflicting data on the importance of the ossific nucleus in the development of postreduction ischemic necrosis. Delaying reduction until the ossific nucleus is present bypasses the time-period of maximal osseous remodeling of the hip, thereby possibly increasing the need for future operations. We hypothesized that hips with an ossific nucleus are more likely to have subsequent reconstructive procedures. METHODS: A retrospective review of the medical records at two tertiary-care children's hospitals was completed to identify all patients who had had reduction of a dislocation of the hip due to developmental dysplasia, performed between 1979 and 1993, when they were less than two years old. Patients were excluded if the medical records or radiographs were inadequate, the duration of follow-up was less than three years after the final reduction, a previous reduction had been performed at an outside facility, or the patient had a neuromuscular disease or a teratologic dislocation. We identified 124 patients (153 hips) who satisfied the criteria for inclusion. The average age at the time of the reduction was eleven months, and the average duration of follow-up was 7.2 years. RESULTS: Overall, fourteen of the sixty-three hips without an ossific nucleus had a reconstructive procedure: thirteen had a varus rotational osteotomy of the proximal part of the femur and one had a combined pelvic and varus rotational femoral osteotomy. Forty of the ninety hips with an ossific nucleus had a reconstructive procedure: twenty-seven had a varus rotational osteotomy, eight had a pelvic osteotomy, and five had a combined pelvic and varus rotational osteotomy (p < 0.05). In addition, secondary reconstructive procedures were performed in 17% (ten) of the fifty-nine patients who were less than six months old and in 35% (thirty-three) of the ninety-four patients who were at least six months old, which was a greater than twofold increase. The effect of age was further emphasized at the other age cutoff points. CONCLUSION: Delaying the reduction of a dislocated hip until the appearance of the ossific nucleus more than doubles the need for future surgery to make the hip as anatomically normal as possible. Despite finding a slight increase in the rate of ischemic necrosis after reduction of the hips without an ossific nucleus, we advocate early reduction of a dislocation of a hip due to developmental dysplasia to optimize the development of the hip with the minimum number of operations

Adolescent↗

PubMed2004

The effect of radial head excision and arthroplasty on elbow kinematics and stability.

BACKGROUND: Radial head fractures are common injuries. Comminuted radial head fractures often are treated with radial head excision with or without radial head arthroplasty. The purpose of the present study was to determine the effect of radial head excision and arthroplasty on the kinematics and stability of elbows with intact and disrupted ligaments. We hypothesized that elbow kinematics and stability would be (1) altered after radial head excision in elbows with intact and disrupted ligaments, (2) restored after radial head arthroplasty in elbows with intact ligaments, and (3) partially restored after radial head arthroplasty in elbows with disrupted ligaments. METHODS: Eight cadaveric upper extremities were studied in an in vitro elbow simulator that employed computer-controlled actuators to govern tendon-loading. Testing was performed in stable, medial collateral ligament-deficient, and lateral collateral ligament-deficient elbows with the radial head intact, with the radial head excised, and after radial head arthroplasty. Valgus angulation and rotational kinematics were determined during passive and simulated active motion with the arm dependent. Maximum varus-valgus laxity was measured with the arm in a gravity-loaded position. RESULTS: In specimens with intact ligaments, elbow kinematics were altered and varus-valgus laxity was increased after radial head excision and both were corrected after radial head arthroplasty. In specimens with disrupted ligaments, elbow kinematics were altered after radial head excision and were similar to those observed in specimens with a native radial head after radial head arthroplasty. Varus-valgus laxity was increased after ligament disruption and was further increased after radial head excision. Varus-valgus laxity was corrected after radial head arthroplasty and ligament repair; however, it was not corrected after radial head arthroplasty without ligament repair. CONCLUSIONS: Radial head excision causes altered elbow kinematics and increased laxity. The kinematics and laxity of stable elbows after radial head arthroplasty are similar to those of elbows with a native radial head. However, radial head arthroplasty alone may be insufficient for the treatment of complex fractures that are associated with damage to the collateral ligaments as arthroplasty alone does not restore stability to elbows with ligament injuries.

Aged↗

PubMed2004

Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow.

BACKGROUND: Comminuted radial head fractures associated with an injury of the medial collateral ligament can be treated with a radial head implant. We hypothesized that lengthening and shortening of the radial neck would alter the kinematics and the pressure through the radiocapitellar joint in the medial collateral ligament-deficient elbow. METHODS: The effects of lengthening (2.5 and 5 mm) and shortening (2.5 and 5 mm) of the radial neck were assessed in six human cadaveric upper extremities in which the medial collateral ligament had been surgically released. The three-dimensional spatial orientation of the ulna was recorded during simulated active motion from extension to flexion. Total varus-valgus laxity and ulnar rotation were measured. Radiocapitellar joint pressure was assessed with use of pressure-sensitive film. RESULTS: Radial neck lengthening or shortening of >/=2.5 mm significantly changed the kinematics in the medial collateral ligament-deficient elbow. Lengthening caused a significant decrease (p < 0.05) in varus-valgus laxity and ulnar rotation (p < 0.05), with the ulna tracking in varus and external rotation. Shortening caused a significant increase in varus-valgus laxity (p < 0.05) and ulnar rotation (p < 0.05), with the ulna tracking in valgus and internal rotation. The pressure on the radiocapitellar joint was significantly increased after 2.5 mm of lengthening. CONCLUSIONS: This study suggests that accurate restoration of radial length is important and that axial understuffing or overstuffing of the radiohumeral joint by >/=2.5 mm alters both elbow kinematics and radiocapitellar pressure. CLINICAL RELEVANCE: This in vitro cadaver study indicates that a radial head replacement should be performed with the same level of concern for accuracy and reproducibility of component position and orientation as is appropriate with any other prosthesis.

Aged↗

PubMed2006

Femoral deformity in tibia vara.

BACKGROUND: Previous studies have suggested that compensatory valgus deformity of the femur is common in patients with tibia vara, or Blount disease. The availability and routine use of standing long-cassette radiographs of the lower extremities to assess angular deformities has allowed quantitative evaluation of this hypothesis. METHODS: The cases of all patients with tibia vara, two years of age or older, seen at our institution prior to treatment, over a thirteen-year period, were reviewed. Seventy-three patients with a total of 109 involved lower limbs were identified and were classified as having either infantile tibia vara (thirty-seven patients with fifty-six involved limbs) or late-onset tibia vara (thirty-six patients with fifty-three involved limbs). Standardized standing radiographs of the lower extremity were examined to assess the deformity at the distal part of the femur and the proximal part of the tibia by measuring the lateral distal femoral angle and the medial proximal tibial angle. RESULTS: The distal part of the femur in the children with infantile tibia vara either was normal or had mild varus deformity, with a mean lateral distal femoral angle of 97 degrees (range, 82 degrees to 129 degrees). The mean medial proximal tibial angle in these children was 72 degrees (range, 32 degrees to 84 degrees). Older children with infantile tibia vara were noted to have little distal femoral deformity, with no more than 4 degrees of valgus compared with either normal values or the contralateral, normal limb. Children with late-onset tibia vara had a mean lateral distal femoral angle of 93 degrees (range, 82 degrees to 110 degrees) and a mean medial proximal tibial angle of 73 degrees (range, 52 degrees to 84 degrees). On the average, the varus deformity of the distal part of the femur constituted 30% (6 degrees of 20 degrees) of the genu varum deformity in these patients. CONCLUSIONS: Patients with infantile tibia vara most commonly had normal alignment of the distal parts of the femora; substantial valgus deformity was not observed. Distal femoral varus constituted a substantial portion of the genu varum in children with late-onset disease. When correction of late-onset tibia vara is planned, the surgeon should be aware of the possibility that distal femoral varus is a substantial component of the deformity.

Adolescent↗

PubMed2006

Lateral acetabular growth stimulation following a labral support procedure in Legg-Calve-Perthes disease.

BACKGROUND: The main goal of containment treatment in cases of Legg-Calvé-Perthes disease is to prevent hip deformity, which leads to arthritis in adulthood. Recently, the shelf arthroplasty (the labral support procedure) has been proposed as a method of containment. The purpose of the present study was to evaluate growth stimulation of the acetabulum in patients with unilateral Legg-Calvé-Perthes disease by measuring acetabular depth and height following treatment with the labral support procedure. Uninvolved, contralateral hips and hips that were treated with proximal femoral varus osteotomy were used to compare growth. METHODS: Sixty-five consecutive patients with unilateral Legg-Calvé-Perthes disease that had been treated with the labral support procedure (forty-nine) or a proximal femoral varus osteotomy (sixteen) were evaluated on the basis of radiographic and clinical data that had been obtained at the time of surgery as well as at one, three, and five years after surgery. Acetabular dimensions (depth, height, and total depth with shelf) were measured and, to eliminate radiographic magnification error, the data were expressed in ratios between the involved and uninvolved sides. RESULTS: Preoperatively, both surgical groups were comparable. Acetabular depth indexes at the time of surgery were not different between the groups (p = 0.46). At one, three, and five years postoperatively, the mean depth indexes in the labral support group were significantly higher than those in the proximal femoral varus osteotomy group (F = 5.417, p = 0.001), and trend analysis showed a significant quadratic effect over time in the labral support procedure group (F = 13.132, p = 0.001). The acetabular height indexes at the time of surgery were not different between groups and showed 11% to 13% acetabular overgrowth. The acetabular height indexes in both groups remained unchanged at the time of follow-up (F = 2.82, p = 0.1). The total depth index showed decreasing linear trend values over the period studied (F = 35.115, p = 0.001). CONCLUSIONS: Overgrowth of the acetabulum occurs naturally and early in the course of Legg-Calvé-Perthes disease and is more pronounced in terms of height. The labral support procedure induces additional lateral growth of the true acetabulum (excluding the shelf) for three years following surgery, whereas a proximal femoral varus osteotomy does not. Thus, beneficial effects of the labral support procedure are lateral acetabular growth stimulation, prevention of subluxation, and shelf resolution after femoral epiphyseal reossification. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Acetabulum↗

PubMed2000

Comparison of first ray dorsal mobility among different forefoot alignments.

STUDY DESIGN: Experimental design using 1-way analysis of variance and regression analysis to test the influence of 3 forefoot alignments on the dorsal mobility of the first ray. OBJECTIVES: To determine the effect of forefoot alignment on the magnitude of first ray dorsal mobility to an imposed load and to describe any association between forefoot alignment and age on dorsal mobility of the first ray. BACKGROUND: Instability of the first ray has been implicated as a primary mechanical etiology of many foot problems. It has been proposed that a relationship exists between forefoot alignment and mobility of the first ray, with a varus aligned forefoot contributing to the development of an unstable first ray. METHODS AND MEASURES: Sixty female (n = 34) and male (n = 26) subjects aged 18-77 were assigned into valgus, neutral, and varus foot groups (20 per group) based on a clinical measurement of forefoot alignment. A load cell device measured dorsal mobility of the first ray under a standard load of 55 N. Within-day repeat measures were taken from a subsample of subjects. In addition to reliability analysis, analysis of variance and regression analyses tested the relationship between forefoot alignment, age and sex, and mobility of the first ray. RESULTS: The forefoot valgus group demonstrated significantly less dorsal mobility of the first ray than neutral or varus groups. The varus and neutral groups were not significantly different from one another. Forefoot alignment and sex were significant linear predictors (R2 = 0.40) of first ray dorsal mobility. Age had no significant association to dorsal mobility of the first ray. CONCLUSION: Subjects having a valgus aligned forefoot had less dorsal excursion of the first ray than subjects having a neutral aligned forefoot. This investigation provides evidence supporting a relationship between forefoot alignment and mobility of the first ray.

Adolescent↗

PubMed1976

[Coxa valga in childhood. Does it need treatment? (author's transl)].

Coxa valga in a child is not necessarily a pathological condition which needs treatment as long as the acetabulum shows adequate development for the patients age and constitution. Varus osteotomy is not indicated in these cases and may even result in poor development of the hip following operation. The author demonstrates a case in which fracture of the femoral neck on one side healed in varus position. Varus osteotomy was subsequently done on the other side to equalize both hips. This resulted in extreme valgus position and narrowing of the joint space of both hips at puberty. The neck-shaft angle of the femur changes constantly during childhool. Valgus position of the femoral neck with good development of the acetabulum occurs frequently and does not lead to secondary osteoarthritis in later life. Prophylactic correction by varus osteotomy should therefore be abandoned unless there is true dysplasia of the hip.

Child↗

PubMed1999

[Tibia vara in adolescents. Apropos of 19 cases].

PURPOSE OF THE STUDY: Clinical, and radiological aspects and treatment of adolescent tibia have been studied in a review of 19 children native of the Caribbean. MATERIAL: 23 cases of adolescent tibia vara in 19 children have been collected (14 males and 5 females, aged from 9 to 14). METHODS: Clinical aspects (weight, lower limb axis), radiological signs (aspect of the physis, mechanical axis, epiphyseal slope) were studied pre and post-operatively. RESULTS: All the boys presented an important overweight. Pain was the first symptom, characterized by a progressive varus deformity on a leg which was previously straight. Radiological findings consisted in metaphyseal varus and widening of the medial part of the physis. Mechanical femoro-tibial axis varied from 10 degrees to 55 degrees varus, medial epiphyseal slope from 12 degrees to 30 degrees. Average mechanical femoral angle was 92 degrees and accounted for a mean femoral varus deformity of 4 degrees. 23 knees were operated, 4 after fusion of the whole physis. 10 lateral hemi-epiphysiodesis were performed with a mean correction of 4 degrees every year until fusion. In 3 cases a tibial osteotomy was made in a second time, at the end of growth. In 6 cases of late treated patients, an isolated tibial osteotomy of valgisation was performed. In 7 cases of important deformity before closure of the physis, tibial osteotomy was associated with lateral epiphysiodesis. In one case, a lateral closing wedge osteotomy was performed, associated to an elevation of the medial tibial plateau and a lateral hemi-epiphysiodesis. DISCUSSION: Histopathological examination of the physis showed similarities between adolescent tibia vara, infantile tibia vara and Slipped capital femoral epiphysis: the entire physeal plate was involved. Concerning pathogenesis of adolescent tibia vara, mechanical factors are predominant, with abnormal pressures across the medial part of the physis. CONCLUSION: Adolescent tibia vara occur in obese black children and can be considered as an epiphysiolysis of the upper end of the tibia.

Adolescent↗

PubMed1999

Metallic radial head arthroplasty improves valgus stability of the elbow.

The stabilizing influence of radial head arthroplasty was studied in eight medial collateral ligament deficient anatomic specimen elbows. An elbow testing apparatus, which used computer controlled pneumatic actuators to apply tendon loading, was used to simulate active elbow flexion. The motion pathways of the elbow were measured using an electromagnetic tracking device, with the forearm in supination and pronation. As a measure of stability, the maximum varus to valgus laxity over the range of elbow flexion was determined from the difference between varus and valgus gravity loaded motion pathways. After transection of the medial collateral ligament, the radial head was excised and replaced with either a silicone or one of three metallic radial head prostheses. Medial collateral ligament transection caused a significant increase in the maximum varus to valgus laxity to 18.0 degrees +/- 3.2 degrees. After radial head excision, this laxity increased to 35.6 degrees +/- 10.3 degrees. The silicone implant conferred no increase in elbow stability, with a maximum varus to valgus laxity of 32.5 degrees +/- 15.5 degrees. All three metallic implants improved the valgus stability of the medial collateral ligament deficient elbow, providing stability similar to the intact radial head. The use of silicone arthroplasty to replace the radial head in the medial collateral ligament deficient elbow must be questioned. Metallic radial head arthroplasty provides improved valgus stability, approaching that of an intact radial head.

Aged↗

PubMed1999

The effect of medial release on flexion and extension gaps in cadaveric knees: implications for soft-tissue balancing in total knee arthroplasty.

This cadaver study examined the effects of medial structure release for varus deformity correction during total knee arthroplasty. Twelve specimens were used to investigate the amount of varus correction achieved with sequential release of medial structures. Varus-valgus and internal-external rotation angles were measured using the Isotrack II motion tracking system. Each release sequence was tested at full extension and 45 degrees and 90 degrees of flexion to compare any differences obtained in the joint gaps. After release of the posteromedial capsule oblique ligament complex, superficial medial collateral ligament (MCL), pes anserinus, and semimembranosus tendons, valgus rotation increased to 6.9 degrees in full extension and 13.4 degrees in 90 degrees of flexion. The largest increase (3.2 degrees) in valgus rotation occurred after the superficial MCL was released. Initial release of the superficial MCL led to a more gradual correction with release of subsequent structures. Changes seen in 90 degrees flexion were significantly greater than those in full extension. While the cadaveric model is limited by the lack of deformity in the specimens, the data provide several clinically relevant conclusions. In many cases requiring major medial release for severe varus deformity, potential flexion-extension differences in the resulting tibiofemoral gaps may require new consideration. These data may help explain the heightened interest in and variety of approaches for addressing femoral component rotation and issues of flexion stability since a significantly larger correction is obtained in flexion. Minimal changes in internal-external rotation of the tibia occurred until both the pes anserinus and semimembranosus tendons were released (4 degrees of external rotation).

Aged↗

PubMed2001

[The influence of the amount of variation of cervical-thoracic angle on the hip status and radiological results of the treatment of developmental hip dysplasia by torsion osteotomy].

The aim of this paper was to determine the differences in hip remodeling and final outcomes of hip dysplasia treatment by fixing a certain amount of varus during varus-detorsion osteotomy of the proximal femur. The analysis included 33 children who underwent 48 osteotomies. During final follow-up at skeletal maturity it was found that the amount of varus fixed during the osteotomy influenced significantly femur remodeling and some containment measurements. However it played only slight part in acetabular remodeling. The outcomes at final follow-up proved significantly better in the group in whom a greater amount of varus was fixed.

Adolescent↗

PubMed2001

[Scarf osteotomy of hallux valgus in children and adolescents].

PURPOSE OF THE STUDY: The aim of this study was to analyze the results of surgical treatment of hallux valgus using scarf osteotomy in children and adolescents. MATERIAL AND METHOD: Twelve children and adolescents (19 feet) operated on with scarf osteotomy were reviewed retrospectively with a mean follow-up of 15 months. Clinical and radiographic results were assessed. RESULTS: We obtained 10 good results (asymptomatic cases), 9 poor with residual symptoms such as pain or cosmetic problems. Two populations could be identified considering the metatarsus varus and distal metatarsal angle. Those with metatarsus varus >/= 10 degrees or normal distal metatarsal angle had good results. Those without metatarsus varus had poor results. There was no disturbance of growth. DISCUSSION: Scarf osteotomy can be used in children without risk of hindering growth. Nevertheless, good results can be achieved only in cases of true metatarsus varus and normal distal metatarsal angle. In other cases, a different osteotomy of the first metatarsal would be preferable.

Adolescent↗

PubMedDate not supplied

A fresh appraisal of tibial osteotomy for osteoarthritis of the knee.

A retrospective study was performed on 189 arthritic knees treated by tibial osteotomy at the Nuffield Orthopaedic Centre, Oxford, England to determine the quality of the results. The objective results were deduced from a numerical system of grading of pain, function, and movement, for 132 osteoarthritic knees. No statistical difference was found between high and low tibial osteotomies. Varus and male knees fared better than valgus and female knees. The result was significant only for the male varus group. Correction of the angular deformity had a profound influence on the results for varus but not for valgus knees. A joint tilt increase usually occurred and was associated with increased subluxation and instability in valgus knees but decreased or unchanged subluxation in varus knees. This was held to be an important cause of failure to achieve good results in valgus knees, and appeared to be an irremedial fault of tibial osteotomy.

Adult↗

PubMed2003

[Medial wedged proximal tibial osteotomy for treating osteoarthritis of knee].

OBJECTIVE: To assess the efficacy of medial wedged proximal tibial osteotomy for treating knee osteoarthritis with varus deformity. METHODS: From July 1996 to September 1999, 19 patients with knee osteoarthritis accompanied by varus deformity were treated by medial wedged proximal tibial osteotomy combined with internal fixation. Full-length anterior-posterior radiographs were taken preoperatively, 8 weeks and 2 years postoperatively. The parameters including the femorotibial angle, the tibial angle, the femoral angle, the femoral condyle-tibial plateau angle, and the medial joint space, were measured from these radiographs. The function of knee was evaluated according to the 100-point rating scale standard of knee. RESULTS: The mean postoperative score had been significantly improved from 48.6 +/- 16.6 points to 81.7 +/- 14.8 points after 2 years of operation. The medial joint space had been increased from 2.2 +/- 1.6 mm to 4.9 +/- 1.5 mm and the femoral condyle-tibial angle had been decreased from 7.4 degrees +/- 3.1 degrees to 1.7 degrees +/- 3.1 degrees. There were complications in 3 cases: 2 cases of superficial wound infections and 1 case of intra-articular fracture. There were no delayed union and recurrence of varus deformity. CONCLUSION: Medial wedged proximal tibial osteotomy combined with internal fixation provides an efficacious approach to treat knee osteoarthritis with varus deformity.

Adult↗

PubMed2005

Assessment of femoral component migration in total hip arthroplasty: digital measurements compared to RSA.

The aim of this study was to determine the accuracy of the software system "Düsseldorf Migration Analysis - Femoral Component Analysis" (DMA-FCA) in measuring stem migration in total hip arthroplasty (THA) on digitised anteroposterior radiographs of the pelvis. Bony and implant landmarks on two consecutive radiographs were used for measurements of subsidence and varus-valgus tilt. The accuracy of the method was determined by reference to radiostereometric measurements (RSA). Using specific comparability limits, comparability analysis of radiographs with respect to femoral positioning is possible with DMA. DMA-FCA and RSA measurements were performed after cementless THR in a population of 60 patients aged 38 to 69 years. With a Cronbach's alpha-index of 0.89 and 0.99 for subsidence and 0.90 and 0.98 for classic varus-valgus-tilt, the intraobserver and interobserver reliability for the DMA-FCA-method was calculated as good. Using RSA as reference method, the accuracy of DMA-FCA was calculated to be 2.51 mm for subsidence and 2.49 degrees for varus-valgus-tilt (95% confidence interval). Without comparison to RSA, DMA measured 1.94 mm for subsidence and 2.35 degrees for varus-valgus-tilt. Based on a comparison with RSA, our results show lower accuracy for DMA-FCA than for EBRA-FCA, but DMA-FCA is easier to use in everyday clinical practice. It is hoped that the use of digital measuring methods such as DMA will become standard for long-term observation and will be integrated into clinical routine in the context of quality assurance of THR.

Adult↗