The biomechanical rationale for osteotomy and the pathogenesis of degenerative arthrosis accompanying malalignment has been delineated well. Malalignment of the limb results in added stress on damaged articular cartilage and causes further loss of articular cartilage that subsequently exacerbates the limb malalignment. A downward spiral of progressive deformity and additional loss of articular cartilage occurs over time. Osteotomy can be used to realign the limb, reduce stress on the articular cartilage at risk and share the load with the opposite compartment of the knee. In appropriately selected patients osteotomy is a reliable operation to improve pain and function. Over the past two decades osteotomy has been viewed largely as a temporizing measure to buy time for patients before they ultimately have a total knee arthroplasty. In this role, osteotomy has largely been accepted as successful. Substantial improvements in pain and function have been documented and seem to hold up well over a 7- to 10-year period after the osteotomy. Medial opening wedge osteotomy has recently gained in popularity in the United States after a long period of use in Europe. Potential advantages of the medial opening wedge technique include the ability to easily adjust the degree of correction intra-operatively, the ability to correct deformities in the sagittal plane as well as the coronal plane, the need to make only one bone cut, and avoiding the tibiofibular joint. The downsides of the opening wedge technique include the need for bone graft to fill the created defect, a potentially higher rate of non-union or delayed union, and a longer period of restricted weight bearing after the procedure.
The biomechanical rationale for osteotomy and the pathogenesis of degenerative arthrosis accompanying malalignment has been delineated well. Malalignment of the limb results in added stress on damaged articular cartilage and causes further loss of articular cartilage that subsequently exacerbates the limb malalignment. A downward spiral of progressive deformity and additional loss of articular cartilage occurs over time. Osteotomy can be used to realign the limb, reduce stress on the articular cartilage at risk and share the load with the opposite compartment of the knee. In appropriately selected patients osteotomy is a reliable operation to improve pain and function. Over the past two decades osteotomy has been viewed largely as a temporizing measure to buy time for patients before they ultimately have a total knee arthroplasty. In this role, osteotomy has largely been accepted as successful. Substantial improvements in pain and function have been documented and seem to hold up well over a 7 to 10 year period after the osteotomy. Medial opening wedge osteotomy has recently gained in popularity in the United States after a long period of use in Europe. Potential advantages of the medial opening wedge technique include the ability to easily adjust the degree of correction intraoperatively, the ability to correct deformities in the sagittal plane as well as the coronal plane, the need to make only one bone cut, and avoiding the tibiofibular joint. The downsides of the opening wedge technique include the need for bone graft to fill the created defect, a potentially higher rate of non-union or delayed union, and a longer period of restricted weight bearing after the procedure.
Aim. Arthroscopic interventions have revolutionized the treatment of joint pathologies. The appropriate diagnostics and treatment are required for infections after ligament reconstructions using non-resorbable material such as tendon grafts, anchors, and sutures, prone to biofilm formation. The infection rate is around 1% for knee and shoulder, while up to 4% for Achilles tendon reconstructions. Despite high number of these procedures worldwide, there is limited evidence about the best treatment protocol. Our study aimed to provide a general protocol for the treatment of small implants for soft tissue reconstruction. Method. Between 2019 and 2023, we treated 48 infections of ligament, meniscus, and tendon reconstructions out of 7291 related procedures performed in the same time period. Early infection (<30 days) were treated with an arthroscopic debridement and implant retention (DAIR), except Achilles tendons had open DAIR, while those with delayed or chronic infection (>30 days) were treated with extensive debridement and lavage combined with one-stage exchange (OSE) or implant removal. During surgery, at least 5 microbiological s and samples for histopathology were obtained. The removed material was sonicated. After surgery, all patients were one week on iv. antibiotics, followed by oral antibiofilm antibiotics for 6 weeks including rifampicin and/or a quinolone. All patients were followed for at least 1 year. Failure was defined as the need for additional revision surgery after finished iv. antibiotic treatment. Results. Among 48 patients, 38 were early and 10 were late acute or chronic infections. The incidence of infection for our cohort was 0.7%. We observed 27 infections after ligament reconstruction of the knee, 15 of the shoulder, 5 of the ankle, and 1 infection of the elbow joint. 40 patients were treated with DAIR, 5 with OSE, and 3 with implant removal. We had 11 C. acnes, 10 S. aureus, 6 S. epidermidis, 2 P. aeruginosa, 2 S. lugdunensis, 10 mixed flora, and 3 culture-negative infections. 12 patients received antibiotics before surgery, and all culture-negative infections were related to this subgroup. We observed 2 failures, both in a combination of
Introduction. Aneurysmal bone cysts commonly found in lower limbs are locally aggressive masses that can lead to bony erosion, instability and fractures. This has major implications in the lower limbs especially in paediatric patients, with potential growth disturbance and deformity. In this case series we describe radical aneurysmal bone cyst resection and lower limb reconstruction using cable transport and syndesmosis preservation. Materials & Methods. Case 1 - A 12-year-old boy presented with a two-week history of atraumatic right ankle pain. An X-ray demonstrated a distal tibia metaphyseal cyst confirmed on biopsy as an aneurysmal bone cyst. The cyst expanded on interval X-rays from 5.5cm to 8.5cm in 9 weeks. A wide-margin en-bloc resection was performed leaving a 13.8cm tibial defect. A cable transport hexapod frame and a
Introduction. Distal femoral and
High tibial osteotomy is an efficient treatment for medial compartment osteoarthritis of the knee; its used for middle aged patients with high activity levels and can delay the need for total arthroplasty. The results of total knee arthroplasty after failed high tibial osteotomy are controversies; several authors reported inferior outcomes, but others have concluded that tibial osteotomy doesn't bias following total arthroplasty. The aim of this study was to evaluate the results of failed high tibial osteotomy subsequently converted to total knee arthroplasty and compare the results to group of patients underwere primary arthroplasty; the authors evaluate some of technical problems that a previous high tibial osteotomy can generate, like scar tissue, patellar tendon shortening and changes of proximal tibial anatomy. Methods. 50 total knee arthroplasty performed after a previous closed wedge osteotomy were matched with 50 patients operated with a primary knee prosthesis for osteoarthritis. The time from a
Introduction. Snapping hip syndrome is a common condition affecting 10% of the population. It is due to the advance of the iliotibial band (ITB) over the greater trochanter during lower limb movements and often associated with hip overuse, such as in athletic activities. Management is commonly conservative with physiotherapy or can be surgical to release the ITB. Here we carry out a systematic review into published surgical management and present a case report on an overlooked cause of paediatric snapping hip syndrome. Materials & Methods. A systematic review looking at published surgical management of snapping hip was performed according to PRISMA guidelines. PubMed, MEDLINE, EMBASE, CINAHL and the Cochrane Library databases were searched for “((Snapping hip OR Iliotibial band syndrome OR ITB syndrome) AND (Management OR treatment))”. Adult and paediatric published studies were included as few results were found on paediatric snapping hip alone. Results. 1548 studies were screened by 2 independent reviewers. 8 studies were included with a total of 134 cases, with an age range of 14–71 years. Surgical management ranged from arthroscopic, open or ultrasound guided release of the ITB, as well as gluteal muscle releases. Common outcome measures showed statistically significant improvement pre- and post-operatively in visual analogue pain score (VAPS) and the Harris Hip Score (HHS). VAPS improved from an average of 6.77 to 0.3 (t-test p value <0.0001) and the HHS improved from an average of 62.6 to 89.4 (t-test p value <0.0001). Conclusions. Although good surgical outcomes have been reported, no study has reported on the effect of rotational profile of the lower limbs and snapping hip syndrome. We present the case of a 13-year-old female with snapping hip syndrome and trochanteric pain. Ultrasound confirmed external snapping hip with normal soft tissue morphology and radiographs confirmed no structural abnormalities. Following extensive physiotherapy and little improvement, she presented again aged 17 with concurrent anterior knee pain, patella mal-tracking and an asymmetrical out-toeing gait. CT rotational profile showed 2° of femoral neck retroversion and excessive external tibial torsion of 52°. Consequently, during her gait cycle, in order to correct her increased foot progression angle, the hip has to internally rotate approximately 35–40°, putting the greater trochanter in an anterolateral position in stance phase. This causes the ITB to snap over her abnormally positioned greater trochanter. Therefore, to correct rotational limb alignment, a
Background:. Tibia Vara (Blount's disease) is characterized by a growth disturbance of the posteromedial proximal tibial physis. This results in the typically complex tibial deformity of varus, procurvatum and internal tibial torsion. Knee instability is due to medial tibial joint depression and lateral ligament complex attenuation. Femoral angular and rotational deformity are associated features. Obesity often complicates management. Langenskiöld observed six stages of the disorder on X-ray (stage 6 not occurring before 9 years) and obtained good results with
Introduction. Although the “learning curve” in surgical procedures is well recognized, little data exists documenting the accuracy of surgeons in performing individual steps of orthopedic procedures. In this study we have used a validated computer-based training system to measure variations instrument placement and alignment in TKA, specifically those relating to tibial preparation. Methods. Eleven trainees (surgical students, residents and fellows) were recruited to perform a series of 43 knee replacement procedures in a computerized training center. After initial instruction, each trainee performed a series of four TKA procedures in cadavers (n=2) and bone replicas (n=2) using a contemporary TKA instrument set and the assistance of an experienced surgical instructor. The Computerized Bioskills system was utilized to monitor the placement and orientation of the
Blount's disease is by far common cause of significant genu varum in paediatric age group. The deformity can range from simple varus deformity to significant varus, shortening of tibia and internal torsion of tibia, depending up on type and stage of Blount's disease. Several studies have shown excellent correction with the use of circular frame. The trend has moved from Ilizarov circular frame to Taylor Spatial Frame. The most accepted method of achieving correction of all components is by performing
The Repicci modification of the Marmor unicompartmental arthroplasty (UKA) has provided a minimally invasive alternative to
As an alternative to external fixators, intramedullary lengthening nails (ILNs) can be employed for distraction osteogenesis. While previous studies have demonstrated that typical complications of external devices, such as soft-tissue tethering, and pin site infection can be avoided with ILNs, there is a lack of studies that exclusively investigated tibial distraction osteogenesis with motorized ILNs inserted via an antegrade approach. A total of 58 patients (median age 17 years (interquartile range (IQR) 15 to 21)) treated by unilateral tibial distraction osteogenesis for a median leg length discrepancy of 41 mm (IQR 34 to 53), and nine patients with disproportionate short stature treated by bilateral simultaneous tibial distraction osteogenesis, with magnetically controlled motorized ILNs inserted via an antegrade approach, were retrospectively analyzed. The median follow-up was 37 months (IQR 30 to 51). Outcome measurements were accuracy, precision, reliability, bone healing, complications, and patient-reported outcome assessed by the Limb Deformity-Scoliosis Research Society Score (LD-SRS-30).Aims
Methods