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PubMed1987

Long-term results of Marmor arthroplasty in varus osteoarthritic knees.

Twenty-one osteoarthritic knees with an average varus angulation of 13 degrees were followed up for 7-10 years after resurfacing with the Marmor compartmental knee arthroplasty. There were 14 unicompartmental and 7 bicompartmental replacements, a total of 28 implants. The knees were assessed clinically according to the Hospital for Special Surgery knee rating scale. At the latest follow-up, 19 of these cases were still excellent or good. None of the knees had been corrected by more than the tightness of the ligaments allowed, and a varus inclination of an average of 2 degrees remained after operation and at the latest follow-up. Radiolucency of more than 2 mm around the tibial component was found in 2 out of 28 of the cases, but this was not associated with pain or disability, nor was wire breakage, found in 6 out of 28, or positional changes of the tibial component, which were seen in five patients. It is concluded that the Marmor compartmental knee arthroplasty is still indicated in osteoarthritic varus knees.

Adult↗

PubMed1993

In vitro load transmission in the canine knee: the effect of medial meniscectomy and varus rotation.

The purpose of this study was to determine the in vitro load-transmission characteristics of the canine knee, paying particular attention to the positioning effect of the meniscus in the coronal plane. The intact joint was first loaded and then tested under two different loading conditions after a complete medial meniscectomy. The first set of test conditions attempted to simulate those used by previous investigators, by ignoring the spacer effect of the meniscus. The second set of tests were carried out following varus rotation of the joint (to account for the loss of the meniscal spacer) to assure initial contact in both tibiofemoral compartments at the start of test cycle. It is presumed that this varus realignment occurs during weight bearing following meniscectomy in vivo. As in previous studies, the joints experienced slightly larger displacements (although not statistically significant) and had lower stiffness values following medial meniscectomy than when intact. However, following varus realignment of the joint after meniscectomy, the displacement was markedly smaller (-35% to -49%; P < 0.01) and the structural stiffness was much greater (47-123%; P < 0.05) over the range of forces analyzed, compared with the intact joint. The ratio of dissipated to input energy was 42% for the intact joint, and increased following meniscectomy to 54% (P < 0.05) with realignment and 55% (P < 0.05) without realignment. Measured contact area decreased by 17% (P < 0.05) following meniscectomy alone, and by 12% (P < 0.05) following meniscectomy with realignment.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2003

Physiological coxa varus-genu valgus influences internal knee and ankle joint moments in females during crossover cutting.

This study evaluated the ankle and knee electromyographic, kinematic, and kinetic differences of 20 nonimpaired females with either neutral (group 1) or coxa varus-genu valgus (group 2) alignment during crossover cutting stance phase. Two-way mixed model ANOVA (group, session) assessed mean differences ( p<0.05) and correlation analysis further delineated relationships. During impact absorption, group 2 displayed earlier peak horizontal braking (anterior-posterior) ground reaction force timing, decreased and earlier peak internal knee extension moments (eccentric function), and earlier peak internal ankle dorsiflexion moment timing (eccentric function). During the pivot phase, group 2 displayed later and eccentrically-biased peak ankle plantar flexion moments, increased peak internal knee flexion moments (eccentric function), and later peak knee internal rotation timing. Correlation analysis revealed that during impact absorption, subjects with coxa varus-genu valgus alignment (group 2) displayed a stronger relationship between knee internal rotation velocity and peak internal ankle dorsiflexion moment onset timing ( r= -0.64 vs r = -0.26) and between peak horizontal braking ground reaction forces and peak internal ankle dorsiflexion moment onset timing ( r= 0.61 vs r= 0.24). During the pivot phase these subjects displayed a stronger relationship between peak horizontal braking ground reaction forces and peak internal ankle plantar flexion moment onset timing ( r= -0.63 vs r= -0.09) and between peak horizontal braking forces and peak internal ankle plantar flexion moments ( r= -0.72 vs r= -0.26). Group differences suggest that subjects with coxa varus-genu valgus frontal-plane alignment have an increased dependence on both ankle dorsiflexor and plantar flexor muscle group function during crossover cutting. Greater dependence on ankle muscle group function during the performance of a task that requires considerable 3D dynamic knee joint control suggests a greater need for frontal and transverse plane weight bearing tasks that facilitate eccentric ankle muscle group function to optimize injury prevention conditioning and post-surgical rehabilitation programs.

Adolescent↗

PubMed2006

High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis.

In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39-76) years. For the clinical evaluation of the patients Hospital of Special Surgery (HSS) score, American Knee Society and Oxford knee scores, and for the radiological assessment mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), femorotibial angle and Insall-Salvati index were basically taken into consideration. Our patients were followed up for an average of 34 (range 18-60) months. In the last assessments of our cases, mean improvements detected in HSS scores, Oxford knee scores, knee and functional scores of Knee Society were 26.72, 19.18, 49.9, and 30 points, respectively. The radiological examinations revealed that their mechanical axes on the average passed 5.09 mm laterally achieving an average of 6.5 degrees genu valgum, and a mean Insall-Salvati index of 1.09. As complications, superficial wound infection in two patients (3%), implant infections in one patient (1.5%), deep vein thrombosis in two patients (3%), peroperative lateral tibial plateau fracture in one patient (1.5%), and postoperative lateral tibial plateau fracture due to a falling down were encountered. According to the results obtained, postoperative pain resolves promptly and a significant degree of improvement of knee functions of the patients are achieved. Therefore, we believe that high tibial osteotomy with a Puddu plate is a valuable alternative to total knee arthroplasty in cases with varus gonarthrosis. Although early results are satisfactory, long-term follow-up studies are required especially in the middle aged and elderly patient populations.

Adult↗

PubMed1999

Gait analysis following varus osteotomy of the femur for hip osteoarthritis.

The purpose of this study was to evaluate differences in the gait patterns of healthy and osteoarthritic hips, and changes in these patterns after intertrochanteric varus osteotomy of the femur, in relation to the strength of the muscles around the hip joint. We measured the strength ratio of hip abductor muscles, temporal and distance factors, and pelvic movement, and carried out dynamic electromyography (EMG) in 24 women who underwent unilateral varus osteotomy of the femur for hip osteoarthritis (OA), 30 non-surgically-treated women with hip OA, and 54 healthy women. The stance phase time was shorter and the strength ratio of hip abductor muscles was lower in the operated patients than these values in the other two groups, changes in pelvic obliquity and tilt were smaller, and changes in the percent maximum voluntary contraction of the gluteus medius and tensor fascia latae muscles were greater than these values in the healthy subjects. 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 the decreased stance phase time and increased performance of the hip abductor muscles achieved after this procedure.

Adult↗

PubMed2002

Coordination of the anterior and posterior cruciate ligaments in constraining the varus-valgus and internal-external rotatory instability of the knee.

Tension along both cruciate ligaments was measured simultaneously under various loading conditions, and the interaction of these ligaments as constraints on knee instability was analyzed. Six fresh cadaveric knees were used. The attachments for both cruciate ligaments were detached from the femur and reattached to their original positions using metal plates equipped with 12 strain gauges. Each knee was moved under various loading conditions, and changes in tension along the cruciate ligaments were recorded simultaneously using the output of the strain gauges. Under varus torque, tension along the anterior cruciate ligament increased near full extension whereas that along the posterior cruciate ligament increased near 90 degrees of flexion. Similar results were obtained under valgus torque. Under internal rotatory torque, a pattern similar to that under varus torque was also observed. Under external rotatory torque, no remarkable changes in tension were observed along either cruciate ligament. Thus, we conclude that both the anterior cruciate ligament and the posterior cruciate ligament cooperate to control varus-valgus and internal rotatory instabilities of the knee, and that the constraining function is transferred from the anterior cruciate ligament to the posterior cruciate ligament as the knee joint is flexed.

Adult↗

PubMed1995

Tardy ulnar nerve palsy caused by cubitus varus deformity.

Fifteen patients with tardy ulnar nerve palsy caused by cubitus varus deformity were studied. All patients had a history of previous fracture of the humerus during childhood. The mean interval between fracture and onset of symptoms was 15 years. The severity of the palsy was classified as McGowan's grade I in 12 patients, grade II in 2 patients, and grade III in 1 patient. The mean carrying angle was -2 degrees before surgery. X-ray films showed a shallow ulnar nerve groove, a dysplastic humeral trochlea, medial shift of the ulna, and deformity of the medial epicondyle. The ulnar nerve was explored in all but one patient. Operative findings suggested that the main cause of the palsy was compression by a fibrous band running between the two heads of flexor carpi ulnaris. Surgical steps included release of the fibrous band in 14 patients with anterior subcutaneous transposition of the ulnar nerve in 5 of those patients. A corrective osteotomy was done in 11 patients who requested correction of the varus deformity. Traumatic cubitus varus deformity should be recognized as another cause of cubital tunnel syndrome.

Adolescent↗

PubMed1999

Correction of varus deformity with tibial flip autograft technique in total knee arthroplasty.

A simple method of autogenous bone grafting is described for correction of varus deformity during total knee arthroplasty. This technique uses a wedge of bone resected from the proximal tibia, which is flipped to augment the medial compartment. It is recommended in osteoarthritic knees with 15 degrees to 20 degrees of varus angular deformity resulting from peripheral rim tibial defects involving the medial compartment. This method corrects varus deformity, preserves bone stock, and creates a stable platform for seating of tibial components without the need for internal fixation.

Aged↗

PubMedDate not supplied

Valgus osteotomy of the humeral neck: a technique for the treatment of humerus varus.

Proximal humerus varus is defined by both its radiographic and clinical characteristics. Clinically significant humerus varus has a proximal humeral neck-shaft angle less than 140 degrees and causes limited active abduction or forward flexion as a result of impingement of the greater tuberosity on the acromion. Weakness of the shoulder girdle is often present as well. The condition may be congenital, developmental, idiopathic, or posttraumatic in origin. Previous treatments for humerus varus have included acromionectomy and wedge osteotomy with placement of the extremity in a shoulder spica cast. This article describes a technique for treatment involving valgus osteotomy of the humeral neck and tension-band fixation. Correction of the deformity allows markedly improved function of the extremity with significant increases in active and passive abduction, forward flexion, and internal rotation.

Adolescent↗

PubMed2004

Remodeling of the proximal femur after varus osteotomy in children with cerebral palsy.

The purpose of this study was to determine and measure the factors that affect the remodeling of the proximal femur after varus osteotomy in children with spastic cerebral palsy (CP). Seventy-five varus proximal osteotomies were performed on 44 children (26 females, 18 males) for hip dysplasia. Thirty-nine patients had spastic CP and five had spastic diplegia; 35 patients used a wheelchair for mobility and nine could walk. Mean age at time of surgery was 8 years (SD 4 years), range 2 years 6 months to 15 years. Preoperative, immediate postoperative, and follow-up (0 to 6 months, 6 months to <1 year, 1 year to <2 years, 2 years to <4 years, 4 years to <6 years, and 6 years to <8 years) radiographs were reviewed. Neck-shaft angles were measured. Correlations to examine the relationship between age at time of surgery and ambulatory status with postoperative changes in neck-shaft angles were reviewed. Remodeling of the proximal femur does occur after varus osteotomy as long as the physes of the proximal femur show growth potential. Remodeling was quite variable between patients: children younger than 4 years old at the time of surgery remodeled more than children who were older than 4 years. Ambulatory status has little effect on the magnitude of remodeling. This study reinforces the need to follow these patients with periodic hip radiographs until completion of growth.

Adolescent↗

PubMedDate not supplied

[Knee instability and varus malangulation - Simultaneous cruciate ligament reconstruction and osteotomy (Indication, planning and operative technique, results)].

AIM: Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability in varus malangulated knees. We present the indication, planning of the osteotomy as well as the operative technique and the results of our patients with simultaneous osteotomy and cruciate ligament reconstruction. MATERIALS/METHODS: From 4/96 until 12/00 58 patients ( 33 years) received simultaneous osteotomy (r = 57 correcting valgus, r = 1 varus malalignement) and cruciate ligament plasty (e = 49 ACL, n = 7 PCL, n = 2 ACL & PCL which routinely was performed in the arthroscopic technique after completion of the osteotomy (closed-wedge technique). Average correction angle of the osteotomy was 7 (4 - 10) degrees with a mean malalignement of 5 (0 - 10) degrees. 13 patients underwent additional cartilage surgery (osteochondral autograft transplantation, autologous chondrocyte transplantation, microfracturing), 2 patients received an implanted Collagen Meniscus (CMI) at the same time. RESULTS: Preoperatively the Lysholm score was 66 (35 - 81) points and increased to 81 (74 - 95), 87 (79 - 99) and 93 (88 - 99) points at 3, 6, and 12 months after surgery, respectively. Subjectively all patients reported an improvement of preoperative swelling, pain and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications were noted in 4 patients. CONCLUSIONS: Unstable varus malangulated knees can be sufficiently treated by osteotomy and cruciate ligament plasty at the same time, suggesting that unicompartimental decompression and treatment of instability is a causal and cost effective therapy delaying the progression of osteoarthritis and minimising clinical symptoms. Performing both operations in one procedure facilitates early rehabilitation and return of these patients to the activities of daily living and sports.

Adolescent↗

PubMedDate not supplied

[Comparison of roentgenological, macroscopic and histological degree of degeneration in varus gonarthrosis].

In 20 cases of varus gonarthrosis the degree of severity of osteoarthrosis was assessed preoperatively, intraoperatively and postoperatively for the medial and lateral compartments, respectively. The preoperative assessment was carried out on the basis of x-ray taken in an anterior-posterior and lateral view, whereas the intraoperative assessment was based on the recognizable macroscopic alteration of the femur and tibia. Following implantation of a total knee prosthesis, the resected osteocartilogical samples were assessed from a histological point of view. In the case of varus gonarthrosis there is a distinct difference in the degree of degeneration in the medial and lateral compartments. This difference becomes less noticeable if the assessment is carried out intraoperatively. The histological analysis shows that there are certainly differences between the compartments from a quantitative point of view but a late stage of osteoarthrosis was discernible both medially and laterally. From a histological point of view the radiological concept of the so-called "unicompartmental varus gonarthrosis" cannot be supported. In both compartments the osteoarthrotic process is more uniform than is to be expected.

Aged↗

PubMedDate not supplied

Single-strand reconstruction of the lateral ulnar collateral ligament restores varus and posterolateral rotatory stability of the elbow.

Because of a lack of biomechanical studies of lateral elbow ligament reconstruction in the literature, the initial stability afforded by 3 different techniques of lateral ulnar collateral ligament reconstruction was evaluated in 8 cadaveric elbows. The arm was mounted in a testing apparatus, and passive flexion was performed with the arm in varus and valgus orientations. A pivot shift test was performed with the arm in the vertical orientation. An electromagnetic tracking device was used to quantify motion pathways. After intact testing, each specimen underwent sectioning of the radial collateral and lateral ulnar collateral ligaments from the lateral epicondyle. Reconstruction of the lateral ulnar collateral ligament was performed in a randomized sequence, consisting of proximal single-strand, distal single-strand, and double-strand tendon grafts. Division of the radial collateral and lateral ulnar collateral ligaments from the lateral epicondyle caused a significant decrease in rotational stability when the pivot shift test was being performed (P <.0001). Varus-valgus stability also decreased after transection of the radial collateral and lateral ulnar collateral ligaments (P <.0001). Reconstruction of the lateral ulnar collateral ligament restored elbow stability to that of the intact state. There was no significant difference in stability between the single- and double-strand repair techniques (P >.05). This study demonstrates that both single- and double-strand reconstructions restore varus and posterolateral elbow stability and may be considered appropriate reconstructive procedures in patients with symptomatic insufficiency of the lateral ligaments of the elbow.

Aged↗

PubMedDate not supplied

The effect of varus stress on the moving rabbit knee joint.

Unicompartmental osteoarthritis was produced by applying varus stress to moving rabbit knee joints. Degenerative changes were confined to the medial tibial and the medial femoral articular surfaces. Within the range of varus stress used, duration appears to be more important than magnitude of varus stress in determining the severity of cartilage damage. The calcified zone remained histologically unchanged despite advanced changes in the noncalcified zone superficial to the tidemark. Intrachondral degenerative cysts were frequently found in the basilar layers of the noncalcified cartilage adjacent to the tidemark where shear stresses were likely to be highest and diffusible nutrients least available. Highly cellular cartilaginous tissue was noted in the subchondral marrow spaces in the specimens with advanced cartilage degeneration. These areas appeared to be continuous with the overlying degenerated cartilage through gaps in the calcified cartilage. Subchondral bone did not show remarkable trabecular thickening despite advanced degenerative changes in the articular cartilage.

Animals↗

PubMed2000

Dome corrective osteotomy for cubitus varus deformity.

Between 1994 and 1998, 15 patients had corrective dome-shaped osteotomy of the humerus for posttraumatic cubitus varus deformity. Thirteen patients had surgery before puberty and two patients had surgery after puberty. In the prepuberty group, all the osteotomies were done by a posterior approach with triceps muscle splitting, and cross pins were used to fix the osteotomy. In the postpuberty group, the osteotomies were done by a posterior approach with olecranon osteotomy, and reconstructive plates were used for fixation. The average followup was 2 years and 4 months. Preoperative carrying angle ranged from 19 degrees to 31 degrees varus (average, 26.2 degrees) and postoperative carrying angle ranged from 7 degrees to 15 degrees valgus (average, 10.7 degrees). No loss of correction was observed and all osteotomies united. The preoperative and postoperative differences of the lateral condylar prominence index ranged from -67% to +6% (average, -30.1%). After reviewing these cases, a dome-shaped osteotomy was found to have the following advantages for correction of cubitus varus deformity: the osteotomy site is more stable than a lateral closing wedge osteotomy for maintaining the correction obtained; the domed osteotomy avoids having the lateral condyle becoming prominent; and the posterior scar is more cosmetically acceptable than the lateral scar in the lateral closing wedge osteotomy.

Child↗

PubMed2004

Recurrent varus angulation after high tibial osteotomy: an anatomic analysis.

Recurrent varus deformity and an associated lateral instability are a common and perplexing concern after high tibial osteotomy. An anatomic study using fresh cadaver specimens was done to delineate the cause of this complication. A closing wedge osteotomy was done on four cadaveric knees, which then were subjected to a small varus load to simulate the adduction moment experienced by the knee during normal gait. The osteotomy was progressively closed in 5 degree increments and the angular alignment of the knee was measured with each incremental change. Experimental results identified postosteotomy angular corrections to be 50%, or less, of the predicted value. As the osteotomy was closed progressively the lateral joint space increased concomitantly, creating an effective lateral instability and negating much of the angular correction afforded by the osteotomy. At osteotomy angles greater than 10 degrees the lateral collateral ligament was rendered nonfunctional with the lateral capsule and the anterior cruciate ligament assuming the primary function of stabilizing the lateral side of the knee. As commonly done, a closing wedge valgus tibial osteotomy does not alter the lateral collateral tension, which allows the knee to swing back toward native alignment when subjected to a varus load.

Humans↗

PubMedDate not supplied

Treatment of posttraumatic cubitus varus in the pediatric population with humeral osteotomy and external fixation.

Cubitus varus may occur after supracondylar humerus fractures. Poor fixation, however, complicates operative treatment of cubitus varus. We discuss the use of external fixation in the treatment of cubitus varus. Five patients had humeral osteotomies with external fixation. The preoperative humeroulnar angle (HUA) averaged -24.2 degrees. The immediate postoperative HUA averaged 12 degrees, and the final angle averaged 13 degrees. Duration of external fixation averaged 8.9 weeks. Complications were one transient radial neurapraxia, one superficial pin infection, and one keloid. No loss of correction or motion occurred with external fixation; we recommend external fixation as safe and effective.

Adolescent↗

PubMed1995

Analysis of tardy ulnar nerve palsy associated with cubitus varus deformity after a supracondylar fracture of the humerus: a report of four cases.

Four cases of tardy ulnar nerve palsy associated with a cubitus varus deformity of the elbow secondary to a supracondylar fracture of the humerus are presented. All patients had surgical management of their ulnar nerve palsy. In two patients, the ulnar nerve was entrapped by scar tissue at the abnormal position and the nerve developed a sharp V-shaped kink when the elbow was flexed. In one patient, the ulnar nerve displaced anteriorly with elbow flexion and spontaneously reduced into the ulnar nerve groove with elbow extension. In one patient, the ulnar nerve remained in the ulnar nerve groove; however, it was entrapped by fibrous bands arising from the flexor carpi ulnaris. It is speculated that malunion resulting in cubitus varus deformity will alter the anatomy at the elbow and that this can have a direct effect on the position and instability of the ulnar nerve. Incongruity of the elbow joint due to cubitus varus deformity also may cause osteoarthritis changes. As a result, ulnar neuropathy may develop from irritation to the ulnar nerve from the posttraumatic osteoarthritic changes at the elbow joint.

Adolescent↗