Journal articles on the topic 'Mechanical lateral distal femoral angle'
To see the other types of publications on this topic, follow the link: Mechanical lateral distal femoral angle.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Mechanical lateral distal femoral angle.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Lusetti, Filippo, Andrea Bonardi, Chadi Eid, Anna De Bellesini, and Filippo Maria Martini. "Pelvic limb alignment measured by computed tomography in purebred English Bulldogs with medial patellar luxation." Veterinary and Comparative Orthopaedics and Traumatology 30, no. 03 (2017): 200–208. http://dx.doi.org/10.3415/vcot-16-07-0116.
Full textAbstract:
SummaryObjectives: The aim of the study was to describe the differences in pelvic limb alignment between healthy purebred English Bulldogs and those with medial patellar luxation through the measurement of femoral and tibial angles on computed tomography images in multiplanar reconstruction modality (MPRCT).Methods: Twenty-one purebred English Bulldogs were included and divided into two groups: one including healthy dogs (15 limbs) and the other including those with medial patellar luxation (24 limbs). Three different observers used MPR-CT to measure the following angles: anatomical lateral proximal femoral angle (aLPFA), anatomical lateral distal femoral angle (aLDFA), mechanical lateral proximal femoral angle (mLPFA), mechanical lateral distal femoral angle (mLDFA), angle of inclination of the femoral neck (AI), angle of anteversion (AA), mechanical medial proximal tibial angle (mMPTA), mechanical medial distal tibial angle (mMDTA), mechanical caudal distal tibial angle (mCdDTA), mechanical caudal proximal tibial angle (mCdPTA), and the tibial torsion angle (TTA). A Mann-Whitney U test was used to compare each variable in both groups.Results: The values for aLDFA and mLDFA in the medial patellar luxation population were significantly increased compared to healthy subjects (p <0.05). No significant differences were observed for the other variables.Clinical significance: In our population, an increased distal femoral varus was associated with medial patellar luxation. Our results could be useful to determine whether or not angular deformity of the femur is present and help determine the degree of correction necessary to restore alignment.ORCID iD:FMM: http://orcid.org/0000-0001-9615-2540
2
Palumbo Piccionello, Angela, Alberto Salvaggio, Antonella Volta, Fabiola Emiliozzi, Riccardo Botto, Fabrizio Dini, and Massimo Petazzoni. "Good Inter- and Intra-Observer Reliability for Assessment of Radiographic Femoral and Tibial Frontal and Sagittal Planes Joints Angles in Normal Cats." Veterinary and Comparative Orthopaedics and Traumatology 33, no. 05 (May 14, 2020): 308–15. http://dx.doi.org/10.1055/s-0040-1709694.
Full textAbstract:
Abstract Objective The aim of this study was to evaluate the inter- and intra-observer reliability of plain digital radiographs for assessing normal feline femoral and tibial joint reference angles in the sagittal and frontal planes. Study Design This was a cadaveric radiographic anatomical study. that involved 20 short-haired domestic adult cats. Materials and Methods Sagittal and frontal plane tibial and femoral joint angles of 40 limbs were measured twice by three observers with different levels of experience. Inter- and intraobserver reliability was determined by the intra-class correlation coefficient (ICC). An ICC > 0.75 was considered high correlation, 0.74 > ICC > 0.60 good correlation, 0.59 > ICC > 0.4 fair correlation and an ICC < 0.40 poor correlation. Results Mean ± standard deviation angles were anatomic lateral proximal femoral angle (aLPFA) 110.6 ± 3.6; anatomic lateral distal femoral angle (aLDFA) 91.9 ± 2.1; mechanical lateral proximal femoral angle; mLPFA (mLPFA) 107.3 ± 3.6; mechanical lateral distal femoral angle (mLDFA) 95.5 ± 1.7; femoral neck anteversion (FNA) 121.9 ± 4.1; anatomical caudal proximal femoral angle (aCPFA) 156.1 ± 3.9; anatomical caudal distal femoral angle (aCDFA) 101.4 ± 1.4; mechanical medial proximal tibial angle (mMPTA) 93.5 ± 1.2; mechanical medial distal tibial angle (mMDTA) 100.5 ± 2.3; mechanical cranial proximal tibial angle (mCrPTA) 113.1 ± 3.2; tibial plateau angle (TPA) 23.1 ± 3.2; mechanical cranial proximal tibial angle (mCrDTA) 86.7 ± 3.1.The intra-observer ICC indicated high correlation for 70% or more of the measurements. The inter-observer agreement among observers was high. These results show that the radiographic method for measuring femoral and tibial joint angles was good or high, except for FNA and mCrDTA. Conclusions This study provides some radiographic anatomical and mechanical joint angles of the femurs and tibias of normal domestic short-haired cats. We found good reliability for both intra- and interobserver measurements.
3
Cabassu, Julien. "Minimally Invasive Plate Osteosynthesis Using Fracture Reduction Under the Plate without Intraoperative Fluoroscopy to Stabilize Diaphyseal Fractures of the Tibia and Femur in Dogs and Cats." Veterinary and Comparative Orthopaedics and Traumatology 32, no. 06 (July 29, 2019): 475–82. http://dx.doi.org/10.1055/s-0039-1693413.
Full textAbstract:
Objective The aim of this study was to prospectively evaluate postoperative alignment when using fracture reduction under the plate (FRUP) during a minimally invasive plate osteosynthesis in tibial and femoral fractures, without intraoperative imaging, and report immediate postoperative complications. Materials and Methods After precise plate contouring and preoperative planning, FRUP was obtained with one cortical screw per fragment. Fractures were stabilized with a plate or plate rod. Tibial/femoral lengths, tibial plateau angles, mechanical medial proximal and distal tibial angles, anatomical lateral distal femoral angles, femoral curvatum and neck anteversion were evaluated on postoperative radiographs and contralateral bone. Tibial torsion was evaluated visually. Paired t-test were used to compare data. Immediate postoperative complications were recorded. Results Twenty-one tibial and 20 femoral fractures were stabilized (14 plate rod cases). Mean postoperative operated tibial length was 1.4% shorter (p = 0.001). Mean postoperative operated femoral length was 2% shorter (p = 0.04). Mean operated tibial plateau angle was 1.1° lower (p = 0.02). No difference in tibial torsion was noticed. No significant difference in mechanical medial proximal tibial angle, mechanical medial distal tibial angle, anatomical lateral distal femoral angle and femoral neck anteversion was observed. Mean operated femoral curvatum angle was 5.6° less (p = 0.01). Five cases (3 plate rod cases) required an immediate revision. Clinical Significance Minimally invasive plate osteosynthesis with FRUP leads to acceptable postoperative alignment. Correct pin placement should be evaluated.
4
Ucpunar, H., S. K. Tas, Y. Camurcu, H. Sofu, M. Mert, and A. I. Bayhan. "The effects of residual hip deformity on coronal alignment of the lower extremity in patients with unilateral slipped capital femoral epiphysis." Journal of Children's Orthopaedics 12, no. 6 (December 2018): 599–605. http://dx.doi.org/10.1302/1863-2548.12.180137.
Full textAbstract:
Purpose The aim of our explorative study was to compare the differences in the coronal alignments of the hip, knee and ankle on the slip side and non-slip sides in patients with slipped capital femoral epiphysis (SCFE). Methods The study group consisted of 28 patients. On the full-length standing radiographs, measurements of articulo-trochanteric distance (ATD), neck-shaft angle (NSA), femoral offset, hip-knee-ankle axis, femur-tibial angle, mechanical axis deviation ratio (MAD-r), anatomical medial proximal femoral angle (aMPFA), mechanical lateral proximal femoral angle (mLPFA), anatomical lateral distal femoral angle (aLDFA), mechanical lateral distal femoral angle (mLDFA), knee joint line congruency angle, mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), ankle joint line orientation angle (AJOA), and leg length discrepancy (LLD) were performed. The data from the slip side were compared with those from the non-slip side. Results At skeletal maturity, there were significant differences between the slip side and non-slip side in ATD (p <0.001), NSA (p <0.001), MAD-r (p <0.001), aMPFA (p <0.001), aLDFA (p = 0.03), mLDFA (p = 0.04), mLDTA (p = 0.02), AJOA (p <0.001) and LLD (p<0.001). Conclusion Residual deformity in the proximal femur after epiphyseal slip and premature epiphysiodesis could cause changes in the coronal alignment of the lower extremity. We can add lower extremity alignment examination to follow-up protocol to rule out secondary problems in patients with SCFE. Level of Evidence Level III, retrospective comparative study
5
Fonseca, R. L., A. R. Lobo-Jr, and M. I. S. Santana. "Measurements of femoral angles, femur length, and hip width in cat radiographs." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 69, no. 6 (November 2017): 1513–20. http://dx.doi.org/10.1590/1678-4162-9583.
Full textAbstract:
ABSTRACT Femoral angle, femur length, and hip width were measured in radiographs of 92 intact domestic cats, males and females of mixed breed from the Center for Zoonosis Control of the Federal District. The animals showed no trauma, orthopedic diseases or angular deformities and had closed physeal lines. Accordingly, we measured aLPFA (anatomical lateral proximal femoral angle, aLDFA (anatomical lateral distal femoral angle), mLPFA (mechanical lateral proximal femoral angle), mLDFA (mechanical lateral distal femoral angle), IA (femoral inclination angle), FL (femur length) and HW (hip width) using ventrodorsal radiographs, with both hindlimbs in a single exposure to an X-ray beam centered on the hip. The mean values of the variables were: mLPFA: 82.5±3.62°; aLPFA: 80.1±4.29°; mLDFA: 96.1±3.51° (males) and 97.3±2.05° (females); aLDFA: 94,3±3.43°; IA: 136.6±3.86°; FL: 12.9±0.55cm (males) and 13.4±0.66cm (females); and HW: 3.1cm±0.23 (males) and 3.5±0.26cm (females). These values will serve as a reference for the diagnosis of angular deformities and as support for planning corrective osteotomies in domestic cats.
6
Yasukawa, Shinji, Koji Tanegashima, Mamiko Seki, Kenji Teshima, Kazushi Asano, Tomohiro Nakayama, Kei Hayashi, and Kazuya Edamura. "Evaluation of bone deformities of the femur, tibia, and patella in Toy Poodles with medial patellar luxation using computed tomography." Veterinary and Comparative Orthopaedics and Traumatology 29, no. 01 (January 2016): 29–38. http://dx.doi.org/10.3415/vcot-15-05-0089.
Full textAbstract:
SummaryObjectives: To evaluate morphological parameters of the femur, tibia, and patella in Toy Poodles with medial patellar luxation (MPL) using three-dimensional (3D) computed tomography (CT) and to compare these parameters between radiography and CT.Methods: Thirty-five hindlimbs of Toy Poodles were divided into normal and grade 2 and 4 MPL groups. The anatomical and mechanical lateral proximal femoral angle, anatomical and mechanical lateral distal femoral angle (aLDFA, mLDFA), femoral varus angle (FVA), inclination of the femoral head angle, procurvation angle, anteversion angle (AA), frontal angle of the femoral neck, mechanical medial proximal or distal tibial angle, mechanical cranial proximal or distal tibial angle, tibial plateau angle, tibial torsion angle (TTA), Z angle, relative tibial tuberosity width, ratio of the medial distance of tibial tuberosity to the proximal tibial width (MDTT/PTW), patella size, and the patellar ligament length: patellar length (L:P) ratio were evaluated on radiography and 3D CT.Results: The aLDFA, mLDFA, FVA, and TTA were significantly larger and the AA, MDTT/ PTW, and patella were significantly smaller in the grade 4 MPL group. There were significant differences in many parameters between imaging tools, and CT was considered less susceptible to potential artefacts and rotational deformities.Clinical significance: Toy Poodles with grade 4 MPL had significant femoral varus deformity, medial displacement of the tibial tuberosity, internal torsion of the proximal tibia, and hypoplasia of the patella.
7
Soparat, C., C. Wangdee, S. Chuthatep, and M. Kalpravidh. "Radiographic measurement for femoral varus in Pomeranian dogs with and without medial patellar luxation." Veterinary and Comparative Orthopaedics and Traumatology 25, no. 03 (2012): 197–201. http://dx.doi.org/10.3415/vcot-11-04-0057.
Full textAbstract:
SummaryObjectives: To measure radiographically the inclination angle (ICA), femoral varus angle (FVA), anatomical lateral distal femoral angle (aLDFA), and mechanical lateral distal femoral angle (mLDFA) in Pomeranian dogs with and without medial patellar luxation (MPL).Materials and methods: Stifles of 34 Pomeranian dogs were graded and allocated into three groups: normal, grades I-II MPL, and grade III MPL. Angle values were measured from craniocaudal radiographs of the hindlimbs by each of the three examiners on three separate occasions.Results: Each of the three groups consisted of 15 stifles. Means ± SD for the ICA, FVA, aLDFA and mLDFA in the normal stifles were 136.46 ± 7.12°, 5.85 ± 3.18°, 95.21 ± 3.48° and 99.46 ± 4°, respectively. No significant differences (p >0.05) in the measured values for the ICA between groups were observed. The FVA, aLDFA and mLDFA values in grade III MPL group were significantly (p <0.05) greater than those in the other two groups. Significant differences in the three angles between the normal and grades I-II MPL groups were not observed.Clinical significance: Significant change of distal femoral varus exists in Pomeranian dogs with grade III MPL.
8
Maderbacher, Günther, Jan Matussek, Felix Greimel, Joachim Grifka, Jens Schaumburger, Clemens Baier, and Armin Keshmiri. "Lower Limb Malrotation Is Regularly Present in Long-Leg Radiographs Resulting in Significant Measurement Errors." Journal of Knee Surgery 34, no. 01 (July 29, 2019): 108–14. http://dx.doi.org/10.1055/s-0039-1693668.
Full textAbstract:
AbstractWeight-bearing long-leg radiographs are commonly used in orthopaedic surgery. Measured parameters, however, change when radiographs are conducted in different rotational positions of the leg. It was hypothesized that rotational errors are regularly present in long-leg radiographs resulting in wrong measurements. In 100 consecutive long-leg radiographs conducted according to the method of Paley, rotation was assessed by fibular overlap. Angular parameters in radiographs (mechanical lateral proximal femoral angle (mLPFA), mechanical lateral distal femoral angle (mLDFA), angle between the anatomical and mechanical femoral axis (AMA), mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), and the mechanical femoral and tibial axis (mFA–mTA) were measured and deviations related to malrotation calculated. An average internal rotation of 8 degrees was found in lower limbs showing a range between 29 degrees of internal and 22 degrees of external rotation. As a result, mean differences before and after rotational correction for measured parameters (mLPFA, mLDFA, AMA, mMPTA, mLDTA, mFA–mTA) ranged between 0.4 and 1.7 degrees (−2.1; 5.6 95% confidence interval [CI]). In conclusion, malrotation of lower limbs is regularly present in long-leg radiographs. As all measured parameters are influenced by malrotation, correct lower limb rotation needs to be verified.
9
Mathew, Smitha E., Todd A. Milbrandt, and Megan L. Young. "Lateral Opening Wedge Osteotomy of the Distal Femur for Genu Valgum." Journal of the Pediatric Orthopaedic Society of North America 4, no. 3 (August 1, 2022): 1–11. http://dx.doi.org/10.55275/jposna-2022-0033.
Full textAbstract:
Genu valgum is a risk factor for patellofemoral maltracking and recurrent instability and may cause mechanical overload of the lateral compartment leading to early arthritic changes in some patients. In skeletally mature adolescents, a varus-producing distal femoral osteotomy will correct the valgus malalignment when the femur contributes to the overall lower extremity deformity. The goal of a distal femoral osteotomy is to correct the lateral distal femur joint angle and restore a neutral mechanical axis through the center of the knee joint. We aim to discuss the indications and contraindications, pros and cons, preoperative planning, osteotomy options, surgical techniques, and postoperative protocol for a distal femur corrective osteotomy.
10
Suvarly, Prettysia, Nyoman Aditya Sindunata, Rio Aditya, Rusli Muljadi, and John Butarbutar. "Femoral Shaft Bowing Angle in The Coronal Plane Affects Distal Femoral Valgus Cutting Angle: A Radiographic Study." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl5 (May 1, 2020): 2325967120S0004. http://dx.doi.org/10.1177/2325967120s00047.
Full textAbstract:
Postoperative limb alignment is important for successful total knee arthroplasty (TKA). Femoral shaft bowing angle (FBA) in coronal plane may influence distal femoral valgus cutting angle (DFVCA) and 5±2º may not perpendicular to mechanical axis. Methods: Sixty-six lower extremity long film x-ray of osteoarthritic knees were collected and analyzed with IntstaRISPACS (digital radiography software). The correlation and linear regression between FBA and DFVCAwere measured using SPSS 24. Results: Our study shows a strong correlation between FBA and DFVCA. Lateral FBA tends to present with DFVCA outside 7º as shown in linear regression test, vice versa. Conclusion: Since DFVCA is influenced by FBA, we recommend preoperative femoral x-ray in all knee replacement candidates. References: Rezende FC, Carneiro M. Is it safe the empirical distal femoral resection angle of 5° to 6°of valgus in the Brazilian geriatric population? Rev Bras Orthop. 2013; 48(5): 421-6. Kim CW, Lee CR. Effects of femoral lateral bowing on coronal alignment and component position after total knee arthroplasty: a comparison of conventional and navigation-assisted surgery. Knee Surg Relat Res. 2018 Mar; 30(1): 64–73. Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin et al. Femoral shaft bowing in the carinal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):1936-42
11
Wang, Zhibing, Xingwang Cheng, Yuan Zhang, Xia Zhang, and Yue Zhou. "Restoration of Constitutional Alignment in TKA with a Novel Osteotomy Technique." Journal of Knee Surgery 33, no. 02 (January 16, 2019): 190–99. http://dx.doi.org/10.1055/s-0038-1677508.
Full textAbstract:
AbstractMany studies have shown that restoration of the preoperative constitutional varus may lead to a normal knee status in total knee arthroplasty (TKA). It is also known that coronal femoral lateral bowing contributes to constitutional varus of the femoral shaft, and bilateral femoral lateral bowing (BFLB) can decelerate medial knee osteoarthritis progression. In this sense, the BFLB should be reserved in TKA. To date, no study has yet reported the technique to reserve BFLB in TKA. Our study showed that the proximal and distal femur had no significant geometric difference between patients with varus knees and BFLB (> 5°) and volunteers with healthy knees and straight femoral shaft. So, the virtual center of femoral head fell on the distal femoral mechanical axis (DMA) after accurate correction of the bowing, indicating that the DMA should be the femoral original constitutional mechanical axis (CA). Subsequently, the distal femoral osteotomy was performed perpendicular to DMA in TKA, and the postoperative angle formed by DMA and tibial mechanical axis (TMA) was measured to assess whether CA was restored successfully. In this study, the gap balance was achieved without medial collateral ligaments release, and the patient's CA was successfully restored (range of DMA–TMA angle 178.2°–179.9°). This study provides a novel technique to restore preoperative CA in patients with varus knees and BFLB. It is found that the distal femur should be cut perpendicular to DMA, so the lower limb alignment and soft tissue strains can be restored to the preoperative state, and the knees would be stable and in a natural status after TKA.
12
Brown, Matthew L., Julie C. McCauley, Guilherme C. Gracitelli, and William D. Bugbee. "Osteochondritis Dissecans Lesion Location Is Highly Concordant With Mechanical Axis Deviation." American Journal of Sports Medicine 48, no. 4 (March 2020): 871–75. http://dx.doi.org/10.1177/0363546520905567.
Full textAbstract:
Background: The cause of osteochondritis dissecans (OCD) is unknown. Purpose: To determine if mechanical axis deviation correlates with OCD lesion location in the knee, if degree of mechanical axis deviation correlates with size of OCD lesion, and if the deformity was primarily in the distal femur or proximal tibia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We identified 61 knees that underwent osteochondral allograft (OCA) transplantation for femoral condyle OCD lesions and used preoperative lower extremity alignment radiographs to measure lower extremity mechanical axis, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and hip-knee-ankle angle. Lesion location and area were retrieved from operative records. Results: The location of the OCD lesion was the medial femoral condyle (MFC) for 37 knees and lateral femoral condyle (LFC) for 24 knees. Among knees with MFC lesions, alignment was varus in 25 (68%). Conversely, knees with LFC lesions had valgus alignment in 16 (67%). The mLFDA was significantly more valgus in the LFC group. mMPTA was not different between MFC and LFC groups. There was no significant correlation between degree of mechanical axis deviation and lesion size. Conclusion: In this cohort, two-thirds of patients with symptomatic OCD lesions had associated mechanical axis deviation. Lesion location correlated with mechanical axis deviation (LFC lesions were associated with a deformity in the distal femur). Degree of deformity was not correlated with lesion size. Mechanical axis deviation may play a role in OCD pathogenesis. These data do not allow analysis of the role of mechanical axis deviation in causation or prognosis of OCD lesions, but surgeons treating OCD should be aware of this common association.
13
Winanto, Iman Dwi, and Yoyos Dias Ismiarto. "Mechanical Lateral Distal Femoral Angle (MLDFA), Medial Proximal Tibia Angle (MPTA), and Mechanical Axis Deviation (MAD) Value in Young Adults in North Sumatera." Cermin Dunia Kedokteran 49, no. 4 (April 1, 2022): 184. http://dx.doi.org/10.55175/cdk.v49i4.1817.
Full textAbstract:
<p>Introduction. Reference value to determine the angle of lower extremity is only based on clinical measurement and radiological assessment, which is limited to tibiofemoral angle (TFA). Although this examination can estimate the lower extremity angle, it is not satisfactory for a comprehensive analysis. Material and Method. A descriptive study in RSUP Haji Adam Malik Hospital in August - September 2019 to measure mechanical lateral distal femoral angle (MLDFA), medial proximal tibia angle (MPTA), and mechanical axis deviation (MAD). Results. Thirty nine subjects were included in this study. The mean age was 26.77±4,65 years old (range: 22 to 39 years); 69,2% were male (n = 27) and 30,8% were female (n = 12). The average mechanical lateral distal femoral angle (MLDFA) was 87,93o ±2,16o . The average medial proximal tibia angle (MPTA) was 86,28o ±2,26o . The average mechanical axis deviation (MAD) was 1.56±1,48 mm. Our results of MLDFA and MPTA measurement, but not in MAD, are consistent with study conducted by Farr, et al. Conclusion. Our MLDFA, MPTA, but not MAD measurement results are similar to studies involving Caucasian population.</p><p>Pendahuluan. Nilai acuan sudut pada ekstremitas bawah hanya berdasarkan pemeriksaan klinis dan radiologis, yang terbatas pada sudut tibiofemoral. Pemeriksaan sudut tibiofemoral (STF) tunggal tidak cukup untuk analisis komprehensif ekstremitas bawah. Bahan dan Cara. Penelitian deskriptif di RSUP Haji Adam Malik pada bulan Agustus – September 2019 untuk mengukur sudut mekanik lateral distal femur (SMLDF), sudut medial proksimal tibia (SMPT), dan deviasi aksis mekanik (DAM). Hasil. Sejumlah 39 subjek diteliti. Usia rata-rata 26,77 ± 4,65 tahun (22 - 39 tahun); 69,2% pria (n = 27) dan 30,8% wanita (n = 12). Nilai rata-rata sudut mekanik lateral distal femur (SMLDF) adalah 87,93º ± 2,16º. Nilai rata-rata sudut medial proksimal tibia (SMPT) adalah 86,28º ± 2,26º. Nilai rata–rata deviasi aksis mekanik (DAM) adalah 1.56 ± 1,48 mm. Pada penelitian ini, hasil pengukuran SMLDF dan SMPT sesuai hasil penelitian Farr, et al, tetapi hasil pengukuran DAM tidak sesuai. Simpulan. Nilai SMLDF dan SMPT pada penelitian ini tidak berbeda dengan penelitian pada populasi Kaukasia</p><p> </p>
14
Nha, Kyung Wook, Yoonwon Ha, Seungmin Oh, Vivek P. Nikumbha, Sae Kwang Kwon, Woo-Jin Shin, Byung Hoon Lee, and Keun Bae Hong. "Surgical Treatment With Closing-Wedge Distal Femoral Osteotomy for Recurrent Patellar Dislocation With Genu Valgum." American Journal of Sports Medicine 46, no. 7 (April 24, 2018): 1632–40. http://dx.doi.org/10.1177/0363546518765479.
Full textAbstract:
Background: Closing-wedge distal femoral osteotomy (CWDFO)—combined with medial reefing and lateral release, if necessary— has been used to treat recurrent patellar dislocation (RPD) with genu valgum. Purpose: To evaluate the clinical and radiologic outcomes of surgical treatment with CWDFO for treatment of RPD with genu valgum. Study Design: Case series; Level of evidence, 4. Methods: Fourteen consecutive patients (23 knees) with RPD and genu valgum were treated with CWDFO. Patients with a minimum 2-year follow-up period were eligible for this study. Patients with prior failed surgery were also eligible. Radiographic evaluation was performed with mechanical femorotibial and lateral distal femoral angle. The radiographic parameters presenting patellar positions and pathologic abnormalities associated with RPD were evaluated. Chondral lesion changes in second-look arthroscopic examination were examined, and clinical outcomes (eg, occurrence of redislocation, range of motion, and clinical scores) were assessed pre- and postoperatively at a minimum of 2 years. Results: At a mean follow-up of 30.7 months (range, 25-62 months), the mean mechanical femorotibial and mechanical lateral distal femoral angles changed significantly from valgus 5° (range, 2°-11°) to varus 3° (2°-11°; P < .001) and from 83° (range, 78°-86°) to 89° (84°-92°; P < .001), respectively. The mean patellar congruence angle improved from 40° lateral (range, 20°-53° lateral) to 4° medial (23° medial to 21° lateral; P < .001), as did the lateral patellofemoral angle from 26° (range, 8°-62°) to 9° (0°-15°; P < .001). Computed tomography scans showed that the mean distance of patellar lateral shift decreased from 13.5 mm (range, 4-22 mm) to 2.0 mm (–4 to 5 mm; P < .001). The mean tibial tubercle to trochlear groove distance significantly decreased from 20.4 to 13.5 mm ( P < .001), while the Caton-Deschamps ratio did not change significantly after surgery ( P = .984). Chondral lesions of the patella and trochlear groove significantly improved or were maintained. None of the patients experienced subluxation or redislocation after surgery. Patellar instability symptoms also improved, as validated by radiographic and other clinical outcomes. Conclusion: CWDFO combined with medial reefing and lateral release successfully treated RPD with genu valgum for a minimum follow-up of 2 years, with improved patellar alignment and stability.
15
Adams, Robert, Shane Andrews, Charlie Tewson, Mieghan Bruce, and Karen Perry. "Impact of femoral varus on complications and outcome associated with corrective surgery for medial patellar luxation." Veterinary and Comparative Orthopaedics and Traumatology 30, no. 04 (2017): 288–98. http://dx.doi.org/10.3415/vcot-16-09-0132.
Full textAbstract:
SummaryObjectives: To evaluate the association of femoral varus with postoperative complications and outcome following standard corrective surgery for medial patellar luxation (MPL) without distal femoral osteotomy (DFO) in dogs.Methods: In a retrospective study spanning a 12 year period, 87 stifles with MPL that were treated by standard surgical techniques were included. Inclination angle (ICA), femoral varus angle (FVA), anatomical lateral distal femoral angle (aLDFA), and mechanical lateral distal femoral angle (mLDFA) were measured. Postoperative complications were noted and outcome evaluated. Associations between potential risk factors and both complication rate and outcome were assessed.Results: Postoperative complications occurred in 19 stifles, five of which were major. There was no evidence of an association between FVA (p = 0.41) or aLDFA (p = 0.38) and any complication. There was also no evidence of an association between FVA (p = 0.31) or aLDFA (p = 0.38) and any major complication. Dogs with a larger aLDFA had increased odds of a poorer outcome (p = 0.01) as did dogs that suffered a major complication (p = 0.0001).Clinical significance: Based on radiographic measurements, there is no evidence of an association between FVA and the incidence of postoperative complications following standard MPL correction. Traditional surgical techniques appear to be appropriate for most cases of MPL and further work is required to better define selection criteria for including DFO in the treatment of these cases.
16
Sappey-Marinier, Elliot, Stephen M. Howell, Alexander J. Nedopil, and Maury L. Hull. "The Trochlear Groove of a Femoral Component Designed for Kinematic Alignment Is Lateral to the Quadriceps Line of Force and Better Laterally Covers the Anterior Femoral Resection Than a Mechanical Alignment Design." Journal of Personalized Medicine 12, no. 10 (October 16, 2022): 1724. http://dx.doi.org/10.3390/jpm12101724.
Full textAbstract:
Background: A concern about kinematically aligned (KA) total knee arthroplasty (TKA) is that it relies on femoral components designed for mechanical alignment (MAd-FC) that could affect patellar tracking, in part, because of a trochlear groove orientation that is typically 6° from vertical. KA sets the femoral component coincident to the patient’s pre-arthritic distal and posterior femoral joint lines and restores the Q-angle, which varies widely. Relative to KA and the native knee, aligning the femoral component with MA changes most distal joint lines and Q-angles, and rotates the posterior joint line externally laterally covering the anterior femoral resection. Whether switching from a MAd- to a KAd-FC with a wider trochlear groove orientation of 20.5° from vertical results in radiographic measures known to promote patellar tracking is unknown. The primary aim was to determine whether a KAd-FC sets the trochlear groove lateral to the quadriceps line of force (QLF), better laterally covers the anterior femoral resection, and reduces lateral patella tilt relative to a MAd-FC. The secondary objective was to determine at six weeks whether the KAd-FC resulted in a higher complication rate, less knee extension and flexion, and lower clinical outcomes. Methods: Between April 2019 and July 2022, two surgeons performed sequential bilateral unrestricted caliper-verified KA TKA with manual instruments on thirty-six patients with a KAd- and MAd-FC in opposite knees. An observer measured the angle between a line best-fit to the deepest valley of the trochlea and a line representing the QLF that indicated the patient’s Q-angle. When the trochlear groove was lateral or medial relative to the QLF, the angle is denoted + or −, and the femoral component included or excluded the patient’s Q-angle, respectively. Software measured the lateral undercoverage of the anterior femoral resection on a Computed Tomography (CT) scan, and the patella tilt angle (PTA) on a skyline radiograph. Complications, knee extension and flexion measurements, Oxford Knee Score, KOOS Jr, and Forgotten Joint Score were recorded pre- and post-operatively (at 6 weeks). A paired Student’s T-test determined the difference between the KA TKAs with a KAd-FC and MAd-FC with a significance set at p < 0.05. Results: The final analysis included thirty-five patients. The 20.5° trochlear groove of the KAd-FC was lateral to the QLF in 100% (15 ± 3°) of TKAs, which was greater than the 69% (1 ± 3°) lateral to the QLF with the 6° trochlear groove of the MAd-FC (p < 0.001). The KAd-FC’s 2 ± 1.9 mm lateral undercoverage of the anterior femoral resection was less than the 4.4 ± 1.5 mm for the MAd-FC (p < 0.001). The PTA, complication rate, knee extension and flexion, and clinical outcome measures did not differ between component designs. Conclusions: The KA TKA with a KAd-FC resulted in a trochlear groove lateral to the QLF that included the Q-angle in all patients, and negligible lateral undercoverage of the anterior femoral resection. These newly described radiographic parameters could be helpful when investigating femoral components designed for KA with the intent of promoting patellofemoral kinematics.
17
Fürmetz, Julian, Jan Sass, Jalil Jalali, Nikolaus Degen, Wolfgang Böcker, and Peter Thaller. "3D-ANALYSIS OF LOWER LIMB ANATOMY: NORMAL VALUES FOR JOINT ANGLES AND ALIGNMENT." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl4 (May 1, 2020): 2325967120S0029. http://dx.doi.org/10.1177/2325967120s00295.
Full textAbstract:
Aims and Objectives: The analysis of lower limb anatomy is mandatory in deformity surgery and total knee replacement. Standard values for joint angles and alignment are only available for 2D images using long standing and lateral radiographs. In contrast, 3D bone models realistically represent the anatomy and are independent of position and projection. Using a self-developed, standardised and validated protocol for 3D analysis of lower limb geometry, standard values for specific joint angles and axes can be obtained in a young cohort for the first time. Materials and Methods: After power and sample size analysis, 60 thin-slice CTs of the entire leg were analysed (30 patients, 13 f, 17 m; age = 33.8 [18-50 years]). After segmentation all 24 relevant bony landmarks were set using our standardised analysis method. Results of joint angles and mechanical axis deviation are calculated automatically. Mean values are stated with standard deviations to describe a possible reference range. Results: The mean neck-shaft angle (NSA) was 133±10° and the mean medial proximal femoral angle (MPFA) 85±9°. Around the knee joint, the mean mechanical lateral distal femoral angle (mLDFA) was 87±4° and the medial proximal tibial angle (MPTA) 88±5°. Medial and lateral slope averaged 12±7° and 9±8°. The deviation of the frontal mechanical leg axis from the knee joint center (MAD frontal) was 7±15mm and the mechanical femoro-tibial angle (HKA) 175±6°. Women showed a smaller mLDFA than men (86.4° vs. 87.8°, p<0.05) and a larger joint line convergence angle (JLCA 2.5° vs. 1.4°, p<0.01) representing a more valgiform anatomy. Conclusion: The standardised 3D analysis enabled reference ranges for the relevant joint angles and axes to be defined on the 3D bone model for the first time. The results redefine reference ranges for 3D measurements similar to existing 2D measurements on long standing radiographs. The systematic analysis of the complex 3D anatomy results in a multitude of new questions and possibilities in preoperative planning.
18
Kariksiz, Mesut, and Ozgur Karakoyun. "Acute correction of distal femoral deformities by retrograde femoral nail using preoperative planning." Journal of Orthopaedic Surgery 30, no. 3 (September 2022): 102255362211435. http://dx.doi.org/10.1177/10225536221143552.
Full textAbstract:
Purpose This study presents the technique and results of acute correction of distal femoral deformities using retrograde femoral nailing based on preoperative planning without using a fixator. Methods Twenty-eight patients (34 limbs: 22 left-sided, 12 right-sided, mean age = 36 years) undergoing distal femoral deformity correction with retrograde femoral nailing between 2013 and 2020 were examined retrospectively. The osteotomy line, block screw location and number were identified by detailed preoperative planning. Osteotomy was performed using the percutaneous multiple drill method, and the retrograde femoral nail was placed. Results The average follow-up period was 62.7 months (range: 13–84 months). Postoperatively, the mean mechanical axis deviation was corrected to 6.8 mm (range: 0–8 mm) and the mean mechanical lateral distal femoral angle to 87.42° (range: 84–90°). The Association for the Study an Application of the Method of Ilizarov (ASAMI) score was excellent for all patients. None of the patients had fracture, infection, implant failure, or non-union. Conclusion Distal femoral deformities can be corrected acutely, without applying external fixators, with good preoperative planning and using the retrograde femoral nail. This technique is safe and effective, with a low complication rate.
19
Hattori, Yosuke, Nobuyuki Asai, Shotaro Mori, Ken Ikuta, Yusuke Kazama, Yusuke Iesaki, Shimpei Takahashi, Atsushi Kaneko, and Tomotaro Sato. "Femoral Valgus Correction Angle for the Intramedullary Alignment Rod Is Strongly Associated with Femoral Lateral Bowing in Japanese Patients with Varus Knee Osteoarthritis Undergoing Total Knee Arthroplasty." Advances in Orthopedics 2022 (August 16, 2022): 1–7. http://dx.doi.org/10.1155/2022/7223534.
Full textAbstract:
Background. This study aimed to investigate factors, such as differences in femoral shape, that could affect the femoral valgus correction angle (VCA) for the intramedullary alignment rod (IM rod) by using a three-dimensional (3D) measurement system in patients with varus knee osteoarthritis undergoing total knee arthroplasty (TKA). Methods. A total of 305 knees in 233 Japanese patients with varus knee osteoarthritis who underwent primary TKA by using Jig Engaged 3D Pre-Operative Planning Software for the TKA operation support system was examined. We retrospectively analysed factors, such as the shape of the proximal, middle, and distal femur in the coronal plane, all of which could affect the VCA for the IM rod, by multiple linear regression analyses. Results. The VCA for the IM rod was 5.9° ± 1.6° (range: 1.7° to 10.7°), and the femoral lateral bowing angle (FBA) was 3.5° ± 3.2°. Major factors independently associated with the VCA for the IM rod were the FBA (β: 0.75), femoral offset (β: 0.38), and the medial angle between the mechanical femoral axis and the line that connects the distal margins of the medial and lateral femoral condyles (β: −0.16). The model was created by stepwise multiple linear regression (F = 266.6, p < 0.001 , and estimated effect size = 4.4) explained 85% of the variance in the VCA for the IM rod (R2 = 0.85). Conclusions. The VCA for the IM rod was most strongly associated with femoral lateral bowing in patients with varus knee osteoarthritis undergoing TKA. Our findings suggest that preoperatively measuring the VCA for the IM rod in patients with femoral lateral bowing by using a 3D measurement system could be useful for accurate coronal alignment of the femoral component in TKA.
20
Chien, Ruei-Shyuan, Cheng-Pang Yang, Chun-Ran Chaung, Chin-Shan Ho, and Yi-Sheng Chan. "Functional and Radiographic Results of Arthroscopy-Assisted Lateral Open-Wedge Distal Femur Osteotomy for Lateral Compartment Osteoarthritis with Valgus Knee." Journal of Clinical Medicine 12, no. 1 (December 26, 2022): 176. http://dx.doi.org/10.3390/jcm12010176.
Full textAbstract:
Treating lower extremity malalignment-related knee osteoarthritis, especially valgus alignment, is a challenge. A high revision rate was observed with patients who underwent unicompartmental knee arthroplasty, so distal femur osteotomy has regained its popularity. This research aimed to evaluate the radiographic and functional outcomes of arthroscopy-assisted lateral open-wedge distal femur osteotomy (LOWDFO) for patients with lateral compartment osteoarthritis and valgus knees with a minimum follow-up of 2 years. Our study retrospectively included isolated lateral osteoarthritis (Outerbridge grade 3 and grade 4) of the knee related to valgus alignment and a young age (<65 y/o) with the demand for a high-impact activity event. Preoperative and postoperative radiographic and functional outcomes were evaluated. Significant pre-operative and postoperative mechanical correction was observed with mechanical axis deviation (preop/postop: −28.77 ± 12.98/−9.45 ± 7.36, p < 0.001), hip-knee angle (preop/postop: 7.64 ± 3.62/2.68 ± 2.04, p < 0.001), and mechanical lateral distal femoral angle (mLDFA, preop/postop: 10.9 ± 4.14/5.66 ± 3.71, p < 0.001). The International Knee Documentation Committee (IKDC) score also showed improvement after the operation (preop/postop: 57.36 ± 11.98/79.02 ± 4.58, p = 0.002). In conclusion, lateral open-wedge distal femur osteotomy is effective in treating patients with lateral compartment osteoarthritis and valgus knees with a low complication rate and excellent outcome.
21
Toliopoulos, Panagiota, Marc-Andre LeBlanc, Jonathan Hutt, Martin Lavigne, Francois Desmeules, and Pascal-Andre Vendittoli. "Anatomic Versus Mechanically Aligned Total Knee Arthroplasty for Unicompartmental Knee Arthroplasty Revision." Open Orthopaedics Journal 10, no. 1 (July 28, 2016): 357–63. http://dx.doi.org/10.2174/1874325001610010357.
Full textAbstract:
Objectives:The purpose of this study was to compare the intra-operative benefits and the clinical outcomes from kinematic or mechanical alignment for total knee arthroplasty (TKA) in patients undergoing revision of failed unicompartmental kneel arthroplasty (UKA) to TKA.Methods:Ten revisions were performed with a kinematic alignment technique and 11 with a mechanical alignment. Measurements of the hip-knee-ankle angle (HKA), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) were performed using long-leg radiographs. The need for augments, stems, and constrained inserts was compared between groups. Clinical outcomes were compared using the WOMAC score along with maximum distance walked as well as knee range of motion obtained prior to discharge. All data was obtained by a retrospective review of patient files.Results:The kinematic group required less augments, stems, and constrained inserts than the mechanical group and thinner polyethylene bearings. There were significant differences in the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) between the two groups (p<0.05). The mean WOMAC score obtained at discharge was better in the kinematic group as was mean knee flexion. At last follow up of 34 months for the kinematic group and 58 months for the mechanical group, no orthopedic complications or reoperations were recorded.Conclusion:Although this study has a small patient cohort, our results suggest that kinematic alignment for TKA after UKA revision is an attractive method. Further studies are warranted.
22
Phetkaew, Thitaporn, Marissak Kalpravidh, Rampaipat Penchome, and Chalika Wangdee. "A Comparison of Angular Values of the Pelvic Limb with Normal and Medial Patellar Luxation Stifles in Chihuahua Dogs Using Radiography and Computed Tomography." Veterinary and Comparative Orthopaedics and Traumatology 31, no. 02 (February 2018): 114–23. http://dx.doi.org/10.3415/vcot-17-05-0067.
Full textAbstract:
Objective This article aimed to determine and compare the angular values of the pelvic limb in normal and medial patellar luxation (MPL) stifles in Chihuahuas using radiography and computed tomographic (CT) scan, to identify the relationship between pelvic limb angles and severity of MPL. In addition, radiographic and CT images were compared to determine the more suitable method of limb deformity assessment. Methods Sixty hindlimbs of Chihuahuas were divided into normal and grade 1, 2, 3 and 4 MPL groups. The pelvic limb angles in frontal and sagittal planes were evaluated on radiography and CT scan. Femoral and tibial torsion angles (FTA and TTA) were evaluated only by CT scan. All angles were compared among normal and MPL stifles and between radiography and CT scan. Results Based on the CT scan, the mechanical lateral distal femoral angle (mLDFA), anatomical caudal proximal femoral angle (aCdPFA), and TTA were related to the severity of MPL. The mLDFA and TTA were significantly increased (p < 0.05) in grade 4 MPL, while the aCdPFA was significantly decreased in grade 2, 3 and 4 MPL groups. There were significant differences of many angles between radiography and CT scan. Clinical Significance The angles related to MPL in Chihuahuas are aLDFA, mLDFA, aCdPFA and TTA. Radiography had some limitations for evaluating pelvic limb angles. The caudocranial radiograph is recommended for the assessment of the distal femoral angles, while the craniocaudal radiograph is for the tibial angles.
23
Kanto, Ryo, Hiroshi Nakayama, and Shinichi Yoshiya. "Distal Femoral Varus Osteotomy for the Valgus Knee after Distal Femoral Growth Plate Fractures in Children: A Case Report." Case Reports in Orthopedics 2019 (December 23, 2019): 1–5. http://dx.doi.org/10.1155/2019/2091932.
Full textAbstract:
An 18-year-old male suffered a valgus injury to the right knee due to a fall during a bigfoot race he took part in when he was 15 years old. He visited a different hospital at the age of 15. No obvious ligament injury or fracture was noted on MRI and physical examination. However, he gradually became aware of the valgus deformity of the right knee. Finally, he could not take part in a sports activity because of right knee pain. X-ray images at the age of 18 at an initial visit to our department showed severe valgus deformity with mechanical lateral distal femoral angle (mLDFA) of 71 degrees in contrast to left mLDFA which was 87 degrees. We performed a biplane-cut distal femoral varus osteotomy (DFO). Postoperative X-ray images showed an improvement of 86 degrees in mLDFA. Bony fusion was achieved six months after surgery, and he could play several sports activity.
24
Ševčík, Karol, Marián Hluchý, Marieta Ševčíková, Michal Domaniža, and Valent Ledecký. "Inter- and Intra-Observer Variations in Radiographic Evaluation of Pelvic Limbs in Yorkshire Terriers with Cranial Cruciate Ligament Rupture and Patellar Luxation." Veterinary Sciences 9, no. 4 (April 10, 2022): 179. http://dx.doi.org/10.3390/vetsci9040179.
Full textAbstract:
The main aims of the study were to describe bone alignment differences in Yorkshire Terriers (YT) with cranial cruciate ligament rupture (CCLR), patellar luxation (PL), or with a combination of both (CCLR + PL); to verify the theory of increased strain on cranial cruciate ligament (CrCL) due to PL as a predisposing factor; and to evaluate intra- and inter-observer variability of the protocols developed for measurement of femoral and tibial alignment in Yorkshire Terriers. Fifty-five hindlimbs of YT were divided into four groups: Control, CCLR, PL, and CCLR + PL. Thirty parameters were radiographically evaluated including hip joint, femoral, tibial, and intercondylar fossa (ICF) parameters. Three observers evaluated all parameters on two separate occasions with a twelve-week interval between measurements. Significant differences in conjunction with CCLR and PL theories between groups were noticed in: Norberg angle (NA), quadriceps angle (Qa), anatomic lateral distal femoral angle (aLDFA), femoral varus (FVA), mechanical cranial proximal tibial angle (mCrPTA), mechanical caudal proximal tibial angle (mCdPTA), tibial plateau angle (TPA), distal tibial axis/proximal tibial axis angle (DPA). Some interesting findings are the similarity of values between Control and CCLR vs. CCLR + PL and PL groups in Na, Qa, aLDFA; between CCLR + PL and PL in FVA and a significantly lower age of dogs in CCLR + PL compared to CCLR group. Based on our results, we can conclude that YT with different clinical findings have differing bone morphology. Moreover, these findings may support PL as a predisposing factor for CCLR in small breeds. Measurements in which excellent inter- observer agreement was achieved may be used for surgical planning or for further discussions.
25
Eberbach, Helge, Julian Mehl, Matthias J. Feucht, Gerrit Bode, Norbert P. Südkamp, and Philipp Niemeyer. "Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity." American Journal of Sports Medicine 45, no. 4 (December 21, 2016): 909–14. http://dx.doi.org/10.1177/0363546516676266.
Full textAbstract:
Background: Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. Purpose: The purposes of this study were (1) to analyze the coronal geometry of patients with valgus malalignment and identify the location of the underlying deformity and (2) to investigate the proportion of cases that require realignment osteotomy at the tibia, the femur, or both locations to avoid an oblique joint line. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The analysis included 420 standing full-leg radiographs of patients with valgus malalignment (mechanical femorotibial angle [mFTA], ≥4°). A systematic analysis of the coronal leg geometry was performed including the mFTA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). The localization of the deformity was determined according to the malalignment test described by Paley, and patients were assigned to 1 of 4 groups: femoral-based valgus deformity, tibial-based valgus deformity, femoral- and tibial-based valgus deformity, or intra-articular/ligamentary–based valgus deformity. Subsequently, the ideal osteotomy site was identified with the goal of a postoperative change of the joint line of two different maximum values, ±2° and ±4°, from its physiological varus position of 3°. Results: Measurements of the coronal alignment revealed a mean (±SD) mFTA of 7.4° ± 4.3° (range, 4°-28.2°). The mean mLDFA and mean mMPTA were 84.8° ± 2.4° and 90.9° ± 2.6°, respectively. The mean JLCA was 1.2° ± 3.1°. The majority (41.0%) of valgus deformities were tibial based, 23.6% were femoral based, 26.9% were femoral and tibial based, and 8.6% were intra-articular/ligamentary based. To achieve a straight-leg axis and an anatomic postoperative joint line with a tolerance of ±4°, the ideal site of a corrective osteotomy was tibial in 55.2% of cases and femoral in 19.5% of cases. A double-level osteotomy would be necessary in 25.2% of cases. With a tolerance of ±2°, the ideal osteotomy site was the proximal tibia in 41.0% of cases and the distal femur in 13.6% of cases; a double-level osteotomy would be necessary in 45.5% of cases. Conclusion: In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.
26
Valčić, Vanja, Maša Jakovljević, Jovan Varda, and Miloš Mališ. "Morphometric parameters of the distal end of the femur and their influence on the knee joint." Medicinski podmladak 73, no. 2 (2022): 34–39. http://dx.doi.org/10.5937/mp73-33432.
Full textAbstract:
Introduction: The femur is a long pair of bones and it consists of the proximal, distal end and body. The distal end carries the medial and lateral condyle (condylus medialis et lateralis), the intercondylar fossa and line (linea et fossa intercondylaris), and together with the patella (patella) and tibia (tibia) forms the knee joint. This study considers the effects of certain parameters on the femurs on the knee joint, and in addition to the fact that anthropometrically important parameters also represent important clinical indications during operations on the knee joint, that can become necessary due to the consequences of various diseases or environmental factors. Aim: Study of morphometric parameters of the distal end of the femur which are of exceptional importance in orthopedic surgery of the hip joint when planning osteocorrective interventions. Material and methods: At the Institute for Anatomy "Niko Miljanić" in Belgrade in 2020, a number of 47 femurs were measured, out of which 22 were right and 25 were left. Shaft length, lateral distal femoral angle (LDFA), mechanical lateral distal femoral angle (mLDFA) were measured, and for all measurements an orthopedic digital goniometer accurate to two decimal places was used. Results: A total of 47 femurs with an average shaft length of 40.0 ± 2.69 were processed. The shortest specimen was 34.8 cm while the longest was 45.7 cm. The mean LDFA was 81.36 ± 2.95 degrees, the minimum was 81.8 degrees while the maximum was 89.9 degrees. The average mLDFA was 87.69 ± 2.99 degrees, while the maximum and minimum were 94.6 and 81.8 degrees, respectively. Conclusion: Thirteen measured femurs fell under the definition of either genu varum or genu valgum. Four right and three left femurs are defined as varum, while two right and four left are defined as valgum. Additional analysis is necessary to determine the clinical implications of these parameters.
27
Qiao, Yi, Junjie Xu, Xiuyuan Zhang, Zipeng Ye, Chenliang Wu, Caiqi Xu, Song Zhao, and Jinzhong Zhao. "Correlation of Tibial Torsion With Lower Limb Alignment and Femoral Anteversion in Patients With Patellar Instability." Orthopaedic Journal of Sports Medicine 10, no. 12 (December 1, 2022): 232596712211414. http://dx.doi.org/10.1177/23259671221141484.
Full textAbstract:
Background: Alignment and rotation of the lower extremities have been suggested to be predisposing pathologic factors for patellar instability. Purpose: To elucidate the relationship between the lower limb alignment and lower extremity rotation in patients with patellar instability. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 83 patients with patellar instability. Computed tomography scans and standing full-leg radiographs were used to measure the tibial tuberosity–trochlear groove (TT-TG) distance, mechanical femorotibial angle (mFTA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), femoral torsion, and tibial torsion of the different segments. The relationships between femoral torsion, tibial torsion of the different segments, and the mFTA, mLDFA, and mMPTA were evaluated. The levels of tibial torsion and femoral torsion in patients with varus, normal, or valgus alignment were compared with 1-way analysis of variance and chi-square test. Results: The total tibial torsion was significantly associated with total femoral anteversion ( r = 0.329; P = .002) and mFTA ( r = –0.304; P = .005). There were no significant correlations between mFTA and TT-TG distance or femoral anteversion. Compared with patients with valgus malalignment, patients with varus malalignment tended to have higher tibial torsion. Conclusion: Tibial torsion was associated with leg axis alignment and femoral anteversion in patients with patellar instability. Patients with patellar instability, especially those with concurrent leg axis deformities, should undergo further radiological imaging so that tibial torsion can be assessed and a diagnosis of torsion deformity made early in the treatment pathway and the proper surgical plan formulated.
28
Palmer, Jonathan S., Luke D. Jones, A. Paul Monk, Michael Nevitt, John Lynch, David J. Beard, M. K. Javaid, and Andrew J. Price. "Varus alignment of the proximal tibia is associated with structural progression in early to moderate varus osteoarthritis of the knee." Knee Surgery, Sports Traumatology, Arthroscopy 28, no. 10 (January 21, 2020): 3279–86. http://dx.doi.org/10.1007/s00167-019-05840-5.
Full textAbstract:
Abstract Purpose Lower limb malalignment is a strong predictor of progression in knee osteoarthritis. The purpose of this study is to identify the individual alignment variables that predict progression in early to moderate osteoarthritis of the knee. Method A longitudinal cohort study using data from the Osteoarthritis Initiative. In total, 955 individuals (1329 knees) with early to moderate osteoarthritis (Kellgren-Lawrence grade 1, 2 or 3) were identified. All subjects had full-limb radiographs analysed using the Osteotomy module within Medicad® Classic (Hectec GMBH) to give a series of individual alignment variables relevant to the coronal alignment of the lower limb. Logistic regression models, with generalised estimating equations were used to identify which of these individual alignment variables predict symptom worsening (WOMAC score > 9 points) and or structural progression (joint space narrowing progression in the medial compartment > 0.7mm) over 24 months. Results Individual alignment variable were associated with both valgus and varus alignment (mechanical Lateral Distal Femoral Angle, Medial Proximal Tibial Angle and mechanical Lateral Distal Tibial Angle). Only the Medial Proximal Tibial Angle was significantly associated with structural progression and none of the variables was associated with symptom progression. The odds of joint space narrowing progression in the medial compartment occurring at 24 months increased by 21% for every one degree decrease (more varus) in Medial Proximal Tibial Angle (p < 0.001) Conclusions Our results suggest that the risk of structural progression in the medial compartment is associated with greater varus alignment of the proximal tibia. Level of evidence Level III, retrospective cohort study.
29
Irmak, Rafet, Ahsen Irmak, and Gökhan Biçer. "Quadriceps Muscle Mechanical Simulator for Training of Vastus Medialis Obliquus and Vastus Lateralis Obliquus Mechanical Properties." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0016. http://dx.doi.org/10.1177/2325967114s00166.
Full textAbstract:
Objectives: In classical anatomy quadriceps muscle has four heads. Clinical studies have demostrated 6 heads of this muscle. These heads were demostrated seperately not only by their functional properties,but also by innervation and kinesiological properties. In our previous study we have developed and demostrated electrophysiological properties of vastus medialis obliquus by an electronic patient simulator. The purpose of this study is to develop a mechanical simulator which can be used to demostrate mechanical properties of 6 heads of quadriceps muscle and the screw home mechanism. Methods: Quadriceps femoris muscle has 6 heads: rectus femoris, vastus intermedius, vastus medialis obliquus, vastus medialis longus, vastus lateralis obliquus and vastus lateralis longus. The fundamental mechanical properties of each head is seperated by insersio and angle of pull. Main design principle was to demostrate all heads with insersio and angle of pull properties. Second design principle was to demostrate the screw-home mechanism which is the result of difference in articular surfaces of medial and lateral of condyles of femur. Results: Final design of the simulator consists of three planes for demostration of angle of pull and pulling forces (patellar plane, proximal and distal planes) of each heads. On each plane channels were graved as origo and insersio for demostration of angle of pull. Distal plane was movable for demostration of pulling forces in different angels of knee flexion and extention. Also proximal plane was adjustable to demostrate different sitting and standing positions. Srew home mechanism was demostrated by specially designed hingle mechanism. Left and right side hingle mechanisms have different radii as femoral condyles and this difference can cause rotation in terminal extension as in the screw home mechanism. Conclusion: Vastus medialis obliquus, vastus lateralis obliquus and screw-home mechanism have clinical significance. We were not able to find any study which deals with training of screw home mechanism and vastus medialis obliqus and wastus lateralis obliquus muscles in the literature. The purpose of this study was to develop a simulator which can demostrate mechanical properties of vastus medialis obliquus and vastus lateralis muscles and screw home mechanism. As a result a traning simulator with stated properties was developed. In this simulator force measurement is acheived with analog dynamometers and future studies may focus on improvement of this simulator with digital force measurement.
30
Danino, B., R. Rödl, J. E. Herzenberg, L. Shabtai, F. Grill, U. Narayanan, E. Segev, and S. Wientroub. "Growth modulation in idiopathic angular knee deformities: is it predictable?" Journal of Children's Orthopaedics 13, no. 3 (June 2019): 318–23. http://dx.doi.org/10.1302/1863-2548.13.190033.
Full textAbstract:
Purpose To evaluate the temporal and spatial sequence of events following temporal hemiepiphysiodesis in idiopathic knee varus/valgus. Methods This is a retrospective multicentre study on 372 physes in 206 patients. The average rate of correction (ROC) was calculated; univariate and multivariate analysis were performed. Results In all, 92% of the femoral physes were followed for more than one year/reached skeletal maturity. Of those, 93% were corrected to a mechanical lateral distal femoral angle (mLDFA) of 85° to 89°; 2% did not, while 5% were over-corrected. A total of 92% of the tibial physes were followed for more than one year/reached skeletal maturity. Of those, 92% were corrected to a mechanical medial proximal tibial angle (mMPTA) of 85° to 89°; 2% did not, while 6% were over-corrected. Factors significantly influencing success and ROC were age, direction and magnitude of deformity. Femoral ROC was significantly faster than tibial ROC: 0.85° versus 0.78°/month, respectively (p = 0.05). Femoral valgus ROC was significantly faster than varus ROC: 0.90° versus 0.77°/month, respectively (p = 0.04). A constant was derived to calculate the amount of correction. Significant correlation was found between calculated and actual mLDFA in valgus deformity during the first year (r = 0.58 to 0.87, p < 0.01). Calculated mLDFA of varus deformity did not correlate with actual mLDFA. Significant correlation was found when calculating mMPTA correction in all deformities. Conclusions Femur corrects faster than tibia; valgus femoral deformities are corrected faster than varus. Valgus correction in the distal femur/proximal tibia as well as varus correction in the tibia in idiopathic patients is highly predictable. The constant derived is the first tool which enables predicting and monitoring amount of correction in hemiepiphysiodesis when correcting angular deformities around the knee. Level of Evidence IV
31
Palatnik, Yevgeniy, and S. Robert Rozbruch. "Femoral Reconstruction Using External Fixation." Advances in Orthopedics 2011 (2011): 1–10. http://dx.doi.org/10.4061/2011/967186.
Full textAbstract:
Background. The use of an external fixator for the purpose of distraction osteogenesis has been applied to a wide range of orthopedic problems caused by such diverse etiologies as congenital disease, metabolic conditions, infections, traumatic injuries, and congenital short stature. The purpose of this study was to analyze our experience of utilizing this method in patients undergoing a variety of orthopedic procedures of the femur.Methods. We retrospectively reviewed our experience of using external fixation for femoral reconstruction. Three subgroups were defined based on the primary reconstruction goal lengthening, deformity correction, and repair of nonunion/bone defect. Factors such as leg length discrepancy (LLD), limb alignment, and external fixation time and complications were evaluated for the entire group and the 3 subgroups.Results. There was substantial improvement in the overall LLD, femoral length discrepancy, and limb alignment as measured by mechanical axis deviation (MAD) and lateral distal femoral angle (LDFA) for the entire group as well as the subgroups.Conclusions. The Ilizarov external fixator allows for decreased surgical exposure and preservation of blood supply to bone, avoidance of bone grafting and internal fixation, and simultaneous lengthening and deformity correction, making it a very useful technique for femoral reconstruction.
32
Pandya, Nirav K., Christina Allen, Emily Monroe, and Caitlin Chambers. "PARTIAL TRANSPHYSEAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: CLINICAL, FUNCTIONAL, AND RADIOGRAPHIC OUTCOMES." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (March 1, 2019): 2325967119S0008. http://dx.doi.org/10.1177/2325967119s00081.
Full textAbstract:
BACKGROUND Partial transphyseal anterior cruciate ligament (ACL) reconstruction is a technique utilized in the skeletally immature population. The femoral tunnel is placed in the distal femoral epiphysis whereas the tibial tunnel is placed in a transphyseal fashion medial to the tibial tubercle. This technique was introduced in an effort to lessen insult to the distal femoral physis of skeletally immature adolescents while also avoiding the technical difficulty of placing an intra-epiphyseal tunnel in the proximal tibia which at times can be non-anatomic. There is limited literature examining this technique. In this study we analyzed the concurrent surgical procedures, re-operation and graft failure rates, and radiographic outcomes in adolescents undergoing partial transphyseal ACL reconstruction. METHODS Consecutive patients undergoing partial transphyseal ACL reconstruction by the two senior authors (NP and CA) were retrospectively reviewed. Inclusion criteria consisted of patients with symptomatic ACL rupture with open distal femoral physes and at least two years of growth remaining by chronologic and physiologic age as determined by growth and pubertal history. All patients received hamstring autograft. Femoral tunnels were drilled in an intra-epiphyseal location utilizing small angle guides under fluoroscopic guidance. Transphyseal tibial tunnels were drilled in standard fashion with a tip-aiming guide while minimizing thermal damage from slow reaming, avoiding horizontal tunnel placement, and using extraphyseal graft fixation to lessen insult to the proximal tibial physis. Radiographic outcomes including bilateral limb length (LL) and alignment as judged by mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), and medial proximal tibial angle (MPTA) were measured on long standing anterior-to-posterior (AP) view radiographs. Growth disturbance was defined as = 1 cm leg length discrepancy, = 1 cm difference in MAD, or 5-degree difference in mLDFA or MPTA as compared to the non-operative side and MAD/mLDFA/MPTA outside of established range of normal values. Clinical outcomes including graft failure and need for repeat operation were recorded at each follow-up visit. Operative extremity alignment measurements were compared to non-operative extremity measurements utilizing a paired students t-test. RESULTS Twenty-four patients with average follow up of 31.5 ± 17.1 months met inclusion criteria for this study. Five female and 19 male patients were enrolled consisting of 13 left and 11 right knees. Average age at time of surgery was 12.3 ± 0.9 years (10.1-13.8 years). The average ACL graft size was 7.8 mm ± 0.5 mm (6-9 mm). Ten patients (41.7%) had concurrent meniscal surgery, with seven (29.2%) undergoing partial lateral meniscectomy, two (8.3%) lateral meniscus repairs, and one patient (4.2%) with medial and lateral meniscal repairs. Six patients (25.0%) required re-operation at an average of 29.2 ± 17.3 months (1.5-49.5 months) for removal of hardware (n=3), revision ACL reconstruction (n=2), and meniscus surgery (n=1). Two patients had ACL graft failure (8.3%) during sporting activity and underwent revision ACL reconstruction at 19.7 months and 49.5 months post-operatively. There were no contralateral ACL tears. As shown in Table 1, comparison of the mean alignment and limb length measurements between all patients’ operative to nonoperative extremity revealed no significant difference in femur length, MAD, MLDFA, or MPTA. There was a small but statistically significant difference in operative versus non-operative tibia length (390.2 cm versus 392.4 cm, p=0.0004) and limb length (880.9 cm versus 884.0 cm, p=0.02). In analyzing individual patients’ limb length or alignment differences, five patients (20.8%) were identified with a growth disturbance. One patient had isolated shortening of the operative extremity, two with significant lateral deviation of the MAD, and two with both shortening and lateral MAD translation. No patients had significant side-to-side difference in mLDFA or MPTA. Femoral shortening accounted for the majority of the limb length discrepancy in two of the three patients with significant limb length discrepancy. All patients returned to sport. CONCLUSIONS / SIGNIFICANCE Partial transphyseal ACL reconstruction has a 25.0% re-operation rate, most often for hardware removal, and an 8.3% graft failure rate. Overall, approximately 20% of patients undergoing partial transphyseal ACL reconstruction had a growth disturbance but none required surgical intervention for these disturbances. While the partial transphyseal technique spares the distal femoral physis, femur-dominant limb length discrepancy can still occur. Drilling and graft placement across the tibial physis appears to be safe. Further studies are needed to directly compare the radiographic, functional, and clinical outcomes of partial transphyseal ACL reconstruction with transphyseal and all-epiphyseal techniques in the pediatric population. [Table: see text]
33
Song, Suk Kyoon, Cheol Hwan Ryu, and Won-Kee Choi. "Advantages of the experience of navigation when starting manual total knee arthroplasty." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949902090339. http://dx.doi.org/10.1177/2309499020903395.
Full textAbstract:
Purpose: To evaluate how the accuracy of coronal-plane bone cutting and operative time may be affected by the experience of navigated total knee replacement (TKR) in starters of manual TKR. Methods: We analyzed 30 cases of navigated TKR performed in the early years (group 1), 30 consecutive cases of navigated TKR performed after experiencing more than 100 cases of navigated TKR (group 2), and the initial 30 consecutive cases of manual TKR (group 3). Postoperative mechanical hip-knee-ankle (mHKA) angle, mechanical medial proximal tibial angle (mMPTA), and mechanical lateral distal femoral angle (mLDFA) were measured. Bone cutting was aimed at mHKA angle of 0°, mMPTA of 90°, and mLDFA of 90°. We have set the tolerance of absolute value of errors in mHKA angle, mMPTA and mLDFA as 0 ± 3°. Comparative analysis of tourniquet times have been performed. Results: Postoperative absolute error values of mHKA angle, mMPTA, and mLDFA were 2.78 ± 3.53°, 1.06 ± 1.91°, and 1.44 ± 1.90° in group 1; 1.18 ± 1.32°, 1.20 ± 1.49°, and 0.98 ± 1.09° in group 2; and 2.11 ± 2.49°, 1.35 ± 0.62°, and 1.92 ± 2.85° in group 3. Tourniquet times were 67.50 ± 21.50 min in group 1, while group 2 and group 3 showed tourniquet times of 51.87 ± 12.00 and 52.00 ± 15.00 min, respectively. Conclusion: In starters of manual TKR, previous experience of performing navigated TKR may help the error values during femoral and tibial bone cutting to fall within the values similar to the median error value of navigated TKR. It may also help to reduce the operative time of manual TKR similar to the operative time of and experienced surgeon with over 100 cases of navigated TKR.
34
Pornrattanamaneewong, Chaturong, Pakpoom Ruangsomboon, Rapeepat Narkbunnam, and Keerati Chareancholvanich. "Medial Closing-Wedge Distal Femoral Varus Osteotomy via Lateral Approach: The Modified Technique for Treating Valgus Osteoarthritic Knee as Case Series." Siriraj Medical Journal 74, no. 11 (November 1, 2022): 747–53. http://dx.doi.org/10.33192/smj.2022.88.
Full textAbstract:
Objective: The medial closing-wedge distal femoral varus osteotomy (MCW-DFVO) was an excellent operation for painful valgus lateral unicompartmental osteoarthritic (OA) knee, especially in the young patient. Originally, it requires a medial approach that has more precarious. On top of that, releasing of the iliotibial band that is the deforming force needs added incision. Therefore, this study aims to describe the modified surgical technique of MCW-DFVO that uses a lateral approach and lateral plating to treat the valgus OA knee. Additionally, we also reveal the outcomes of our technique as the case series.
Materials and Methods: Ten patients (12 knees) who underwent MCW-DFVO via a lateral approach were retrospectively reviewed. The inclusion criteria were age 18-60 years, isolated lateral compartmental OA knee (Kellgren-Lawrence grade 3-4), no significant patellofemoral pain, and range of motion (ROM) > 90 degrees. We excluded the inflammatory joint disease, unstable knee (femorotibial joint subluxation > 1 cm), and prior surgical procedure. Demographic data, pre- and postoperative ROM, radiographic outcomes, complications, and survivorship were recorded.
Results: The mean age, body mass index, and preoperative ROM were 55.3 ± 4.0 years, 25.4 ± 3.7 kg/m2 and 113.3 ± 11.5 degrees, respectively. The preoperative mechanical femorotibial angle was 162.3 ± 4.8 degrees, and the final post-operative alignment was 182.3 ± 2.6 degrees. Overall mean operative time of this technique was 92.5 ± 26.7 minutes. During the mean follow-up period of 8.3 ± 3.1 years, all osteotomy were united and the final postoperative ROM was decreased to 108.8 ± 11.7 degrees. One knee required plate removal due to hardware irritation, and another knee required subsequent total knee arthroplasty at 1 and 8.5 years after MCW-DFVO, respectively. The survivorship of this technique was 91.7% at the mean survival time of 13.8 years (95% confidence interval, 11.9 – 15.7 years).
Conclusion: This study proposed the modified surgical technique of MCW-DFVO via a lateral approach. This technique provided the excellent correction angle, union rate and survivorship.
35
Rosso, Federica, Roberto Rossi, Antonino Cantivalli, Carola Pilone, and Davide Edoardo Bonasia. "Joint Line Obliquity Does Not Affect the Outcomes of Opening Wedge High Tibial Osteotomy at an Average 10-Year Follow-up." American Journal of Sports Medicine 50, no. 2 (December 2, 2021): 461–70. http://dx.doi.org/10.1177/03635465211059811.
Full textAbstract:
Background: A significant number of high tibial osteotomies (HTOs) result in an overcorrected tibia and subsequent excessive lateral joint line obliquity (JLO). The correlation between excessive JLO and poor outcomes is controversial. Purpose: To evaluate the prognostic factors (including a pathological postoperative JLO) related with the outcomes of opening wedge HTO at 10 years of follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing HTO between 2004 and 2017 for medial osteoarthritis and with a postoperative hip-knee-ankle angle between 176° and 185° were included. Clinical evaluation included Knee Society Score (KSS; knee score and function score), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale for pain. Several mechanical and anatomic angles were measured pre- and postoperatively on long-leg weightbearing radiographs. Abnormal JLO was defined as a Mikulicz–joint line angle (MJL) ≥94° or a mechanical medial proximal tibial angle (mMPTA) ≥95°. Regression analysis was performed to evaluate the association between independent variables and each outcome. A Kaplan-Meier cumulative survival analysis was performed. Results: A total of 92 knees in 76 patients were included. The mean age of the patients was 53.5 years (SD, 9.7 years), and the mean follow-up was 129.4 months (SD, 44.4 months). Increased JLO was associated with a significant preoperative varus deformity (small preoperative hip-knee-ankle angle), increased mechanical lateral distal femoral angle, increased joint line congruency angle, and increased knee-ankle joint angle. Male sex was associated with better WOMAC scores ( P = .0277), and increased body mass index (BMI) was associated with inferior WOMAC scores ( P = .0024). A good preoperative range of motion was associated with better knee score ( P = .0399) and function score ( P = .0366) on the KSS. An increased BMI was associated with inferior KSS function scores ( P = .0317). MJL ≥94° and mMPTA ≥95° were not associated with inferior WOMAC or KSS outcomes. With indication to total knee arthroplasty as an endpoint, Kaplan-Meier analysis showed a survival rate of 98.7% at 5 years, 95.5% at 10 years, and 92.7% at 12 years. Conclusion: Increased lateral JLO (MJL ≥94° or mMPTA ≥95°) was not correlated with the clinical outcomes of opening wedge HTO at 10 years of follow-up.
36
Imhoff, Florian B., Knut Beitzel, Philip Zakko, Elifho Obopilwe, Andreas Voss, Bastian Scheiderer, Daichi Morikawa, Augustus D. Mazzocca, Robert A. Arciero, and Andreas B. Imhoff. "Derotational Osteotomy of the Distal Femur for the Treatment of Patellofemoral Instability Simultaneously Leads to the Correction of Frontal Alignment: A Laboratory Cadaveric Study." Orthopaedic Journal of Sports Medicine 6, no. 6 (June 1, 2018): 232596711877566. http://dx.doi.org/10.1177/2325967118775664.
Full textAbstract:
Background: Derotational osteotomy of the distal femur allows the anatomic treatment of patellofemoral maltracking due to increased femoral antetorsion. However, such rotational osteotomy procedures have a high potential of intended/unintended changes of frontal alignment. Purpose/Hypothesis: The purpose of this study was to perform derotational osteotomy of the distal femur and to demonstrate the utility of a novel trigonometric approach to address 3-dimensional (3D) changes on 2-dimensional imaging (axial computed tomography [CT] and frontal-plane radiography). The hypothesis was that 1-step single-cut osteotomy can simultaneously correct torsion and frontal alignment based on preoperatively calculated cutting angles. Study Design: Controlled laboratory study. Methods: Eight human cadaveric whole legs (4 lower limb torsos) underwent derotational osteotomy of the distal femur of 20°. A straight leg axis, determined as a mechanical femorotibial angle (mFTA) of 0°, was chosen as a goal for postoperative frontal alignment. The inclination of the cutting angle from the lateral view was calculated individually for each cadaveric leg and was represented by a simple 3D-printed cutting guide for surgery. Specimens underwent CT for the measurement of torsion, while the frontal leg axis was determined on an upright radiograph preoperatively and postoperatively. Preoperative and postoperative angles were compared with the mathematical prediction model. Results: The preoperative mFTA ranged from –3.9° (valgus) to +3.4° (varus) (mean, –0.2° ± 2.6°). A postoperative mean mFTA of 0.37° ± 0.69° (95% CI, –0.22° to 0.95°) was achieved ( P = .01). Derotation showed a mean of 19.1° ± 2.1° (95% CI, 17.3°-20.8°). The oblique cutting plane for the correction of valgus legs showed a mean of 5.9° ± 6.8° and, for the correction of varus legs, a mean of –10.0° ± 4.5° projected on the perpendicular plane to the virtual anatomic shaft axis from the sagittal view. Conclusion: Single-cut distal femoral osteotomy can be performed to simultaneously address rotational as well as frontal alignment using a preoperatively defined oblique cut, as determined by the presented reproducible calculation model. Clinical Relevance: This study adds important knowledge to the technique of derotational osteotomy. This approach provides an individual, oblique single cut for the correction of torsion and frontal axis within a clinically insignificant margin. Simplified tables for calculation and a surgical reference make this model reproducible and safe.
37
Schmale, G. A., A. F. Bayomy, A. O. O’Brien, and V. Bompadre. "The reliability of full-length lower limb radiographic alignment measurements in skeletally immature youth." Journal of Children's Orthopaedics 13, no. 1 (February 2019): 67–72. http://dx.doi.org/10.1302/1863-2548.13.180087.
Full textAbstract:
Purpose Reliable radiographic measurement techniques are important for investigating limb alignments prior to and following paediatric anterior cruciate ligament (ACL) reconstruction. We investigated the inter- and intraobserver reliability of alignment measurements from lower extremity anteroposterior and lateral radiographs of adolescents having undergone transphyseal ACL reconstruction Methods A total of 15 of 90 patients who had undergone transphyseal ACL reconstruction were randomly selected for alignment measurements of radiographs of operative and nonoperative limbs. Radiographs were de-identified, randomized to three varying sequences and made available in electronic format to three blinded investigators: a junior orthopaedic resident, a senior orthopaedic resident and a paediatric orthopaedic attending. Coronal measurements comprised the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and mechanical axis deviation (MAD), measured from standing teleoroentgenograms of the lower extremities. Tibial slope was measured on lateral knee radiographs of operative limbs. The intra-class correlation coefficient (ICC) was calculated for each of the three coronal measures and for tibial slope. Results Intraobserver reliability was excellent across all measures (ICC > 0.75) except for tibial slope in one investigator’s measurements (good or ICC = 0.68 for the operative limbs) and mLDFA in another investigator’s measurements (fair or ICC = 0.49 for the operative limbs, and poor ICC = 0.27 for the nonoperative limbs). Interobserver reliability was excellent across all investigators for all measurements for operative and nonoperative limbs. Conclusions Radiographic measurements of lower extremity alignment may be reliably measured on teleoroentgenograms in a subset of youth who underwent transphyseal ACL reconstruction. Level of Evidence III
38
Sano, Hirotaka, Norikazu Yamada, and Shingo Maeda. "MECHANICAL STRESS MAY CAUSE THE TEAR OF THE LABRUM IN ACETABULAR DYSPLASIA." Journal of Musculoskeletal Research 08, no. 01 (March 2004): 35–41. http://dx.doi.org/10.1142/s021895770400120x.
Full textAbstract:
In the current study, using the arthrogram, we developed two-dimensional finite element (FE) models of the human hip joint. To clarify the relationship between the stress distribution and the degree of acetabular dysplasia, three FE models were established and analyzed. The models varied only in the degree of the bony covering of the femoral head; i.e. the center-edge (CE) angle=20, 10, 0 degrees. An edge load (x=0 N, y=600 N) was then applied on the distal border of the femur to simulate the bearing of the body weight. In the CE=20 degree model, no definite stress concentration was seen at the site of the labrum. On the other hand, the stress concentration was seen from the attachment of the labrum to the superior aspect of the acetabulum in the CE=0 degree model. The site of stress concentration clearly corresponded to the lesions where the acetabular rim pathologies were seen in the clinical practice. Moreover, we found that the Von Mises stress increases dramatically with decreasing the CE angle at the attachment of the labrum. In the dysplastic hip, the mechanical stress increases significantly at the supero-lateral aspect of the acetabulum, which eventually leads to the tearing or detachment of the labrum.
39
Bartolomei, Christopher, Jon Miles, Grant Dornan, Travis Turnbull, Rachel Frank, Armando Vidal, and Simon Lee. "Poster 216: The Effects of Lateral Opening Wedge Distal Femoral Osteotomy on Meniscus Allograft Transplantation: A Biomechanical Evaluation." Orthopaedic Journal of Sports Medicine 10, no. 7_suppl5 (July 1, 2022): 2325967121S0077. http://dx.doi.org/10.1177/2325967121s00777.
Full textAbstract:
Objectives: Lateral meniscus deficiency with valgus malalignment increases the risk and rate of lateral compartment osteoarthritis. Lateral meniscus allograft transplantation (LMAT) with concomitant varus-producing lateral opening wedge distal femoral osteotomy (LOWDFO) is an available option to treat this pathology. No biomechanical data currently exists evaluating the effect on joint forces with these combined procedures. The purpose of this study is to evaluate the effects of LMAT with concomitant varus-producing LOWDFO on lateral and medial compartment biomechanics. We hypothesize that LMAT restores lateral compartment biomechanics back to native intact forces, varus-producing LOWDFO improves lateral compartment forces following LMAT, and medial compartment forces change to a lesser degree in response to mechanical varus. Methods: Ten human cadaveric knees underwent varus-producing LOWDFO and were placed in an external fixator. Anatomic alignment was standardized for each knee and utilized as a proxy for mechanical alignment. Thin film Tekscan pressure sensors were placed sub-meniscal and specimens were loaded on a biaxial dynamic testing machine to 800N within a custom designed apparatus, with loading angles between 9° valgus and 6° varus of mechanical alignment. Testing conditions included the intact meniscus, lateral meniscus deficiency, and LMAT. Statistical analysis was performed by creating two-factor random-intercepts linear mixed-effects models to compare peak pressure and contact area among the three experimental meniscus conditions. Results: Isolated varus-producing LOWDFO to 6° varus in the setting of meniscus deficiency was unable to restore joint forces to the level of the intact meniscus in neutral alignment (Mean Contact Pressure: 175%, Peak Pressure 135%, Contact Area -41%, P>0.05). LMAT restored mean contact and peak pressures, with no significant differences compared to the intact meniscus (P<0.05). LMAT resulted in significantly lower contact areas from 9° valgus to 0° (P>0.05), but this was restored to intact state at 3° and 6° varus (P<0.05). Within the lateral compartment following LMAT, every additional 1° of DFO correction contributes to a decreased in mean contact pressure of 5.6% (-0.0479 N/mm2)(Figure 1), a decrease in peak pressure of 5.9% (-0.154 N/mm2)(Figure 2), and a decrease in contact area of 1.4% (6.99 mm2)(Figure 3), as compared to forces in neutral alignment. Within the medial compartment following LMAT, every additional 1° of DFO correction contributes to an increase in mean contact pressure of 7.3% (+0.034 N/mm2), an increase in peak pressure of 12.6% (+0.160 N/mm2), and an increase in contact area of 4.3% (20.53 mm2), as compared to forces in neutral alignment. However, baseline forces in the medial compartment are significantly lower at baseline compared to lateral compartment forces (P>0.05). Conclusions: This is the first biomechanical study evaluating the effects of concomitant LMAT and varus-producing LOWDFO. Isolated varus-producing LOWDFO is inadequate to restore forces in the meniscus deficient knee. LMAT restores near normal forces, and concomitant LOWDFO improves the lateral compartment biomechanical profile. Although to a smaller magnitude, force changes in the medial compartment are significant with varus-producing LOWDFO. Unloading to 0° following LMAT may be ideal. Overall, this study provides tools to for the surgeon to individualize alignment correction for each patient to optimize outcomes. [Figure: see text][Figure: see text][Figure: see text]
40
Tian, Gengshuang, Lishan Wang, Linzhou Liu, Yali Zhang, Lixiong Zuo, and Jianpeng Li. "Kinematic alignment versus mechanical alignment in total knee arthroplasty: An up-to-date meta-analysis." Journal of Orthopaedic Surgery 30, no. 3 (September 2022): 102255362211259. http://dx.doi.org/10.1177/10225536221125952.
Full textAbstract:
Purpose The purpose of this meta-analysis was to compare the efficacy and imaging parameters of kinematic alignment (KA) and mechanical alignment (MA) in total knee arthroplasty (TKA) and to evaluate whether patients undergoing KA-TKA benefited more than those undergoing MA-TKA. Methods Studies comparing the efficacy of KA-TKA and MA-TKA were included after searching and screening in the database, including PubMed, Embase, Web of Science and Cochrane Database Library. A total of 1420 patients were enrolled in the study, with 736 MA-TKA and 738 KA-TKA. The primary outcomes were postoperative knee function scores including KSS series, WOMAC, KOOS and OKS. Secondary outcomes included the operative time, the length of hospital stay, knee extension/flexion angle, and some imaging parameters. The risk of bias for included studies was assessed using the Cochrane Collaborative risk-of-bias assessment tool or the Newcastle-Ottawa Scale(NOS). Results Sixteen studies were included in this meta-analysis (11 randomized controlled studies and 5 cohort studies). Primary outcomes: Knee Society score (KSS, MD = 8.36, 95% Cl: 0.83–15.90) and combined KSS (MD = 15.24, 95% CI: 5.41–25.07) were higher in KA-TKA than in MA-TKA, and other functional scores were not statistically significant in KA-TKA and MA-TKA, including knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), Knee Function score (KFS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes: KA-TKA resulted in smaller medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) compared to MA-TKA. For other outcome measures, KA-TKA showed similar results compared to MA-TKA, including hip-knee-ankle (HKA) angle, extension/flexion angle, tibial component slope angle, joint line orientation angle (JLOA), the operation time, the length of hospital stay and ligament release rate. Conclusions In our analysis results, patients undergoing KA-TKA benefit as much as patients undergoing MA-TKA. KA may be a viable reference in total knee replacement.
41
Liu, Kuei-Yu, Kuan-Wen Wu, Chia-Che Lee, Sheng-Chieh Lin, Ken N. Kuo, and Ting-Ming Wang. "Tibial Lengthening along Submuscular Plate with Simultaneous Acute Tibial Deformity Correction by High-Energy Osteotomy: A Comparative Study." Journal of Clinical Medicine 11, no. 18 (September 18, 2022): 5478. http://dx.doi.org/10.3390/jcm11185478.
Full textAbstract:
Submuscular plating and osteotomy using power saw have shown the benefits in certain situations of limb lengthening. However, no previous studies combining both procedures have been conducted for acute tibial deformity correction and limb lengthening. Nineteen cases were enrolled in this study. Ten patients received tibial lengthening with acute knee angular deformity correction using high-energy osteotomy (Group 1), and nine patients received tibial lengthening only with osteotomy using multiple drills and osteotome (Group 2). Radiographic parameters retrieved before and after the operation included leg-length discrepancy, tibial length, length gained, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD). There were significant differences between groups in terms of external fixator index (EFI) (p = 0.013) and healing index (HI) (p = 0.014), but no significance in the length gained (p = 0.356). The latest postoperative mLDFA (p = 0.315), MPTA (p = 0.497), and MAD (p = 0.211) of Group 1 were not distinguishable from Group 2. The functional outcomes were excellent, and there were no permanent complications. Despite showing a longer healing time, this alternative lengthening procedure which combines fixator-assisted plate lengthening in the tibia with simultaneous surgical intervention of acute tibial deformity correction using an oscillating saw is appropriate for patients with leg-length discrepancy and angular deformity of the tibia.
42
Harrer, Jörg, Max Schenke, Christoph Lutter, Jörg Dickschas, Matthias Feucht, and Thomas Tischer. "Double-Level Osteotomy in Severe Varus Malalignment to Optimize Knee Joint Restoration." Video Journal of Sports Medicine 1, no. 6 (November 2021): 263502542110466. http://dx.doi.org/10.1177/26350254211046632.
Full textAbstract:
Background: Lower extremity alignment-correcting procedures for unicompartmental osteoarthritis are experiencing a rapid rise. Medial open-wedge high tibial osteotomy (MOW-HTO) thereby represents the most common technique among osteotomies but is limited in cases of severe malalignment. Some cases make a double-level osteotomy necessary. Indications: If planning of malalignment correction using a MOW-HTO results in a mechanical medial proximal tibial angle (mMPTA) of more than 93° (causing an oblique joint line), double-level osteotomy is indicated to avoid nonphysiological knee kinematics. Technique Description: After clinical examination and detailed analysis of malalignment (full-weight-bearing long-leg radiograph: hip-knee-angle [HKA], mMPTA, mechanical lateral distal femoral angle [mLDFA], joint line convergence angle [JLCA]), as well as individualized planning of the correction, the surgical procedure starts with an arthroscopy to evaluate the cartilage conditions and eventually treat intraarticular pathologies. Then, the femoral supracondylar correction is performed (closed wedge, biplanar osteotomy [ to increase bony healing]) according to the presurgical planning by resecting the osteotomy wedge with the measured length. K-wires are placed to check the correction. An angle-stable plate is used for osteosynthesis. The wedge taken out will be used as bone stock for the MOW-HTO afterward. The biplanar open-wedge tibial osteotomy is then performed subsequently using a medial tibial approach and an angle-stable plate. Opening of the osteotomy is then performed and double checked with intraoperative fluoroscopy using an alignment rod. Postoperative partial weight bearing for 6 weeks is recommended. Results: In recent literature, only few publications report on results of double-level osteotomies. Babis et al reports that it is a valuable procedure for patients with large varus deformity. Nakayama et al noted a significant improvement in patient-registered clinical outcomes in early postoperative evaluation of 20 patients. Schröter et al reports on 37 knees and findings include good clinical results, despite progressive osteoarthritis. Discussion/Conclusion: In cases of severe malalignment, adequate axis correction may require a double-level osteotomy. Exact preoperative planning is essential. Results reported in recent publications are promising. By splitting 1 large correction into 2 smaller ones, complications like hinge fracture and delayed bone healing are lowered.
43
Eltayeby, H. H., C. A. Iobst, and J. E. Herzenberg. "Hemiepiphysiodesis using tension band plates: does the initial screw angle influence the rate of correction?" Journal of Children's Orthopaedics 13, no. 1 (February 2019): 62–66. http://dx.doi.org/10.1302/1863-2548.13.180086.
Full textAbstract:
Purpose When using tension band plates for angular deformity correction, the literature is unclear regarding the most effective screw insertion angle to use. This study evaluates the correlation between initial screw angle and the average rate of correction during hemiepiphysiodesis using tension band plates Methods This retrospective study includes 35 patients (47 physes) with genu valgum deformity (17 idiopathic and 18 fibular hemimelia) who underwent insertion of Eight-Plates between 2010 and 2015. Initial screw angle was determined from the intraoperative fluoroscopic images. Radiographs were obtained within three months of surgery, and follow-up films were obtained every three to six months. Change in mechanical lateral distal femoral angle, medial proximal tibial angle and screw angle was obtained from each follow-up radiograph. Initial screw angle was correlated with the average rate of correction during the entire treatment period. The average rate of angular correction during first and last follow-up periods was also compared. Results The relationship between the initial screw angle and the mean rate of angular correction was not statistically significant (p = 0.2). The rate of angular correction during the first follow-up period (mean of 4.7 months) was 0.86° per month compared with 0.71° per month during the last follow-up period (mean of 5.1 months). Conclusion Application of a tension band plate with a divergence angle ranging from 0° to 30° results in similar rates of angular correction. For surgeons inserting screw-plate tension band devices, there does not seem to be any necessity to make the screws parallel or divergent. We recommend that screw placement be anatomically correct, i.e. not impinging on the physis, rather than favouring any particular divergence angle. Level of evidence IV
44
Wong, Kin Weng, Chung Da Wu, Chi-Sheng Chien, Cheng-Wei Lee, Tai-Hua Yang, and Chun-Li Lin. "Patient-Specific 3-Dimensional Printing Titanium Implant Biomechanical Evaluation for Complex Distal Femoral Open Fracture Reconstruction with Segmental Large Bone Defect: A Nonlinear Finite Element Analysis." Applied Sciences 10, no. 12 (June 14, 2020): 4098. http://dx.doi.org/10.3390/app10124098.
Full textAbstract:
This study proposes a novel titanium 3D printing patient-specific implant: a lightweight structure with enough biomechanical strength for a distal femur fracture with segmental large defect using nonlinear finite element (FE) analysis. CT scanning images were processed to identify the size and shape of a large bone defect in the right distal femur of a young patient. A novel titanium implant was designed with a proximal cylinder tube for increasing mechanical stability, proximal/distal shells for increasing bone ingrowth contact areas, and lattice mesh at the outer surface to provide space for morselized cancellous bone grafting. The implant was fixed by transverse screws at the proximal/distal host bone. A pre-contoured locking plate was applied at the lateral site to secure the whole construct. A FE model with nonlinear contact element implant-bone interfaces was constructed to perform simulations for three clinical stages under single leg standing load conditions. The three stages were the initial postoperative period, fracture healing, and post fracture healing and locking plate removal. The results showed that the maximum implant von Mises stress reached 1318 MPa at the sharp angles of the outer mesh structure, exceeding the titanium destruction value (1000 MPa) and requiring round mesh angles to decrease the stress in the initial postoperative period. Bone stress values were found decreasing all the way from the postoperative period to fracture healing and locking plate removal. The overall construct deformation value reached 4.8 mm in the postoperative period, 2.5 mm with fracture healing assisted by the locking plate, and 2.1 mm after locking plate removal. The strain value at the proximal/distal implant-bone interfaces were valuable in inducing bone grafting in the initial postoperative period. The proposed patient-specific 3D printed implant is biomechanically stable for treating distal femoral fractures with large defect. It provides excellent lightweight structure, proximal/distal bone ingrowth contact areas, and implant rounded outer lattice mesh for morselized cancellous bone grafting.
45
Teulières, Maxime, Tristan Langlais, Jérôme Sales de Gauzy, Jan Duedal Rölfing, and Franck Accadbled. "Bone Lengthening with a Motorized Intramedullary Nail in 34 Patients with Posttraumatic Limb Length Discrepancies." Journal of Clinical Medicine 10, no. 11 (May 28, 2021): 2393. http://dx.doi.org/10.3390/jcm10112393.
Full textAbstract:
The Fitbone® motorized nail system has been used to correct limb length discrepancies (LLD) for several years. This study focuses on its application in posttraumatic limb lengthening surgery, its outcome and challenges. Materials and methods: A prospective, single center study was conducted between 2010 and 2019 in patients treated with motorized lengthening nails. The inclusion criteria were symptomatic LLD of 20 mm or more. An imaging analysis was done using TraumaCad® software (Brainlab AG, Munich, Germany) to compare frontal alignment angles and limb length discrepancy (LLD) on preoperative and latest follow-up radiographs of the lower limbs. Results: Thirty-four patients were included with a mean age of 28.8 ± 9.7 years, a mean follow-up of 27.8 ± 13 months and a mean hospital stay of 4.4 ± 1.7 days. The mean LLD was 44 ± 18 mm in 29 femoral and 32 ± 8 mm in 4 tibial cases, which was reduced to less than 10 mm in 25/34 (74%) patients. The mean healing index was 84.6 ± 62.5 days/cm for femurs and 92 ± 38.6 days/cm for tibias. The mean time to resume full weight-bearing without walking aids was 226 days ± 133. There was no significant difference between preoperative and final follow-up alignment angles and range of motion. The mechanical lateral distal femoral angle (mLDFA) was corrected in the subgroup of 10 LLD patients with varus deformity of the femur (preoperative 95.7° (±5.0) vs. postoperative 91.5° (±3.4), p = 0.008). According to Paley’s classification, there were 14 problems, 10 obstacles and 2 complications. Discussion: Six instances of locking screw pull out, often requiring reoperation, raise the question of whether a more systematic use of blocking screws that provide greater stability might be indicated. Lack of compliance can lead to poor outcomes, patient selection in posttraumatic LLD patients is therefore important. Conclusion: Limb lengthening with a motorized lengthening nail for posttraumatic LLD is a relatively safe and reliable procedure. Full patient compliance is crucial. In-depth knowledge of lengthening and deformity correction techniques is essential to prevent and manage complications.
46
Park, Jun-Gu, Seong-Il Bin, Jong-Min Kim, and Bum-Sik Lee. "Using the Lower Limb Adduction Angle to Predict Postoperative Knee Joint-Line Obliquity After Open-Wedge High Tibial Osteotomy." Orthopaedic Journal of Sports Medicine 9, no. 5 (May 1, 2021): 232596712110039. http://dx.doi.org/10.1177/23259671211003991.
Full textAbstract:
Background: Knee joint-line orientation is altered after open-wedge high tibial osteotomy (OWHTO), and excessive joint-line obliquity (JLO) can adversely affect outcomes. Little is known regarding preoperative prediction of postoperative knee JLO. Purpose/Hypothesis: The purpose of this study was to assess the correlation between the amount of lower limb adduction and changes in knee JLO after OWHTO. The hypothesis was that postoperative knee JLO could be predicted using the amount of lower limb adduction after OWHTO. Study Design: Case series; Level of evidence, 4. Methods: The records of 67 patients (77 knees) who underwent OWHTO for medial compartment osteoarthritis were retrospectively reviewed. The mechanical hip-knee-ankle (HKA) axis, lateral distal femoral angle, medial proximal tibial angle (MPTA), knee JLO, ankle JLO, and joint-line convergence angle were measured on standing whole-leg plain radiographs preoperatively and at 1 year postoperatively. The limb adduction angle was defined as the angle between the native weightbearing line (WBL) and the planned WBL on preoperative standing whole-leg plain radiographs. The predicted knee JLO was calculated as the sum of the preoperative knee JLO and the limb adduction angle. Multivariable linear regression analysis was used to identify the preoperative radiologic factors associated with the postoperative knee JLO. The agreement between postoperative and predicted values was determined using intraclass correlation coefficients (ICCs). Results: The estimated limb adduction angle was 4.2° ± 1.3°, and the predicted knee JLO was 4.9° ± 3.0°. The actual postoperative knee JLO was 4.5° ± 2.4°, which was a significant increase from 0.7° ± 2.4° preoperatively ( P < .001). Excellent agreement was found between the predicted knee JLO and postoperative knee JLO (ICC = 0.928; P < .001). Limb adduction angle and changes in preoperative MPTA were significantly associated with changes in knee JLO ( P < .001). On multivariable linear regression analysis, preoperative knee JLO and limb adduction angle were significantly associated with postoperative knee JLO ( P < .001; R 2 = 0.83). Conclusion: Changes in knee JLO after OWHTO were associated with adduction of the lower limb after OWHTO. During preoperative planning, postoperative knee JLO can be predicted as the sum of the preoperative knee JLO and the limb adduction angle between the preoperative WBL and planned WBL.
47
Firer, Ponky, and Brad Gelbart. "Balancing of total knee arthroplasty by bone cuts achieves accurately balanced soft tissues without the need for soft tissue releases." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 3, no. 5 (August 16, 2018): 263–68. http://dx.doi.org/10.1136/jisakos-2018-000217.
Full textAbstract:
IntroductionPatient satisfaction, after mechanically aligned Total Knee Arthroplasty (TKA) is only 80%-85%. There is an inabilty to consistently get perfect soft tissue balance with this technique. It is postulated that soft tissue balance within 2° can be achieved by the boney cuts (Bone Balancing) without soft tissue releases, accepting whatever coronal mechanical alignment (CMA) this produces; that the alignment produced would be similar to natural (constitutional) alignment and that balanced knees would improve patient satisfaction.MethodsWe report on 914 consecutive TKAs using Bone Balancing: the femoral rotation for the flexion gap; the distal femoral cut and valgus angle for the extension gap are adjusted to give equal gap sizes with soft tissue balanced within 2° of medio-lateral laxity. Long leg X-rays were used to measure post-operative coronal alignment. Satisfaction beyond 1 year post operation was assessed by an independent researcher, using a question on satisfaction and a VAS score.Results782(85.5%) TKAs with satisfactory x-rays were available at 2-7 years follow up. Their CMA had a similar distribution profile to reported natural alignment studies. Of these, 672 (86%) had a CMA of 0°±3° (’aligned' group). Overall patient satisfaction was 92.8%, with satisfied patients having a mean (range) VAS score of 9.53 (7.3-10.0) and the dissatisfied patients 3.78 (0.0-6.3) (p<0.0001). There was no difference in satisfaction between ’aligned' knees (92.7%) and those ’outliers', whose CMA was >±3° (93.6%) (p=0.853). All balance measurements were within 3° with 92.2% being ≤2°. Gap size difference between extension and 90° flexion was ≤2mm in 98.7% of cases. Midflexion (45° flexion) balance was within 3° in all cases and the gap size difference was ≤2mm in 89%.ConclusionBalancing by bone cuts is able to achieve accurately balanced soft tissues without the need for soft tissue releases. The coronal alignment profile produced matches that of the normal population. This technique improves satisfaction compared to the literature for mechanically aligned TKAs. Acurate and measured soft tissue balancing needs further consideration in TKAs.Level of EvidenceLevel IV.
48
MacDessi, Samuel J., William Griffiths-Jones, Ian A. Harris, Johan Bellemans, and Darren B. Chen. "The arithmetic HKA (aHKA) predicts the constitutional alignment of the arthritic knee compared to the normal contralateral knee." Bone & Joint Open 1, no. 7 (July 2020): 339–45. http://dx.doi.org/10.1302/2046-3758.17.bjo-2020-0037.r1.
Full textAbstract:
Aims An algorithm to determine the constitutional alignment of the lower limb once arthritic deformity has occurred would be of value when undertaking kinematically aligned total knee arthroplasty (TKA). The purpose of this study was to determine if the arithmetic hip-knee-ankle angle (aHKA) algorithm could estimate the constitutional alignment of the lower limb following development of significant arthritis. Methods A matched-pairs radiological study was undertaken comparing the aHKA of an osteoarthritic knee (aHKA-OA) with the mechanical HKA of the contralateral normal knee (mHKA-N). Patients with Grade 3 or 4 Kellgren-Lawrence tibiofemoral osteoarthritis in an arthritic knee undergoing TKA and Grade 0 or 1 osteoarthritis in the contralateral normal knee were included. The aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA) measured on standing long leg radiographs. The primary outcome was the mean of the paired differences in the aHKA-OA and mHKA-N. Secondary outcomes included comparison of sex-based differences and capacity of the aHKA to determine the constitutional alignment based on degree of deformity. Results A total of 51 radiographs met the inclusion criteria. There was no significant difference between aHKA-OA and mHKA-N, with a mean angular difference of −0.4° (95% SE −0.8° to 0.1°; p = 0.16). There was no significant sex-based difference when comparing aHKA-OA and mHKA-N (mean difference 0.8°; p = 0.11). Knees with deformities of more than 8° had a greater mean difference between aHKA-OA and mHKA-N (1.3°) than those with lesser deformities (-0.1°; p = 0.009). Conclusion This study supports the arithmetic HKA algorithm for prediction of the constitutional alignment once arthritis has developed. The algorithm has similar accuracy between sexes and greater accuracy with lesser degrees of deformity. Cite this article: Bone Joint Open 2020;1-7:339–345.
49
MacDessi, Samuel J., William Griffiths-Jones, Ian A. Harris, Johan Bellemans, and Darren B. Chen. "The arithmetic HKA (aHKA) predicts the constitutional alignment of the arthritic knee compared to the normal contralateral knee." Bone & Joint Open 1, no. 7 (July 1, 2020): 339–45. http://dx.doi.org/10.1302/2633-1462.17.bjo-2020-0037.r1.
Full textAbstract:
Aims An algorithm to determine the constitutional alignment of the lower limb once arthritic deformity has occurred would be of value when undertaking kinematically aligned total knee arthroplasty (TKA). The purpose of this study was to determine if the arithmetic hip-knee-ankle angle (aHKA) algorithm could estimate the constitutional alignment of the lower limb following development of significant arthritis. Methods A matched-pairs radiological study was undertaken comparing the aHKA of an osteoarthritic knee (aHKA-OA) with the mechanical HKA of the contralateral normal knee (mHKA-N). Patients with Grade 3 or 4 Kellgren-Lawrence tibiofemoral osteoarthritis in an arthritic knee undergoing TKA and Grade 0 or 1 osteoarthritis in the contralateral normal knee were included. The aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA) measured on standing long leg radiographs. The primary outcome was the mean of the paired differences in the aHKA-OA and mHKA-N. Secondary outcomes included comparison of sex-based differences and capacity of the aHKA to determine the constitutional alignment based on degree of deformity. Results A total of 51 radiographs met the inclusion criteria. There was no significant difference between aHKA-OA and mHKA-N, with a mean angular difference of −0.4° (95% SE −0.8° to 0.1°; p = 0.16). There was no significant sex-based difference when comparing aHKA-OA and mHKA-N (mean difference 0.8°; p = 0.11). Knees with deformities of more than 8° had a greater mean difference between aHKA-OA and mHKA-N (1.3°) than those with lesser deformities (-0.1°; p = 0.009). Conclusion This study supports the arithmetic HKA algorithm for prediction of the constitutional alignment once arthritis has developed. The algorithm has similar accuracy between sexes and greater accuracy with lesser degrees of deformity. Cite this article: Bone Joint Open 2020;1-7:339–345.
50
Wang, Peizhao, Xiao Wang, Xiaotao Shi, and Honglue Tan. "Evaluation of Accuracy of Preoperative Planning of the Femurofibular Angle in Open-Wedge High Tibial Osteotomy for Mild Medial Knee Osteoarthritis." BioMed Research International 2021 (February 18, 2021): 1–8. http://dx.doi.org/10.1155/2021/8813300.
Full textAbstract:
Objective. The purpose of this study was to evaluate the usefulness of preoperative planning of the femurofibular angle (FFA) in medial open-wedge high tibial osteotomy (OWHTO) for mild medial knee osteoarthritis. Methods. Thirty-two patients (32 knees) with mild medial knee OA were retrospectively reviewed. The patients underwent preoperative planning of the FFA for OWHTO. For preoperative planning, a full-length weight-bearing X-ray photograph of the lower limb was opened within Adobe Photoshop Software, and a targeted corrective mechanical axis line of the lower limb and its intersecting point at the lateral tibial plateau surface was drawn using rectangle selection and filling tools. A frame, which encircled the tibia and fibula, was created around the predicted osteotomy plane and then rotated until the ankle center was on the targeted mechanical axis line. Subsequently, a distal femoral condyle line and a proximal fibula axis line were drawn, and the angle between the two lines was measured and defined as the femurofibular angle (FFA). During biplane OWHTO, the preoperatively determined FFA was used to complete the correction of the mechanical axis. During follow-up, the postoperative mechanical weight-bearing line (WBL) of the lower limb, the mechanical femorotibial angle (mFTA), and the FFA were measured and compared with the preoperatively determined values. Results. The mechanical WBL shifted from a preoperative value of 25.36 ± 5.02 % to a postoperative value of 56.19 ± 0.10 % from the medial border along the mediolateral width of the tibial plateau, and it was 56.57 ± 0.08 % at the final follow-up ( P < 0.01 ). The preoperatively determined value was 56.25%, and no significant difference was found compared with postoperative week-one and final follow-up values ( P > 0.05 ). The mFTA was corrected from a preoperative varus of 4.02 ± 0.63 ° to a postoperative week-one valgus of 2.37 ± 0.28 ° , and it had a valgus of 2.48 ± 0.39 ° at the final follow-up ( P < 0.01 ). No significant difference in the valgus was found compared with the postoperative week-one, final follow-up and preoperatively determined valgus of 2.34 ± 0.26 ° ( P > 0.05 ). The postoperative week-one and final follow-up FFAs were 90.34 ± 1.53 ° and 90.33 ± 1.52 ° , respectively, and no significant difference was found compared with the preoperatively determined value of 90.12 ± 1.72 ° and the intraoperative setting value of 90.25 ± 1.67 ° ( P > 0.05 ). All corrected values were within the acceptable range of preoperative planning. Conclusion. Preoperative planning of the FFA may be useful in OWHTO for patients with mild medial knee OA. Satisfactory correction of the postoperative targeted mechanical axis line of the lower limb can be obtained.