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Clinics in Sports Medicine Jul 2019Osteotomies around the knee for treating osteoarthritis or knee instability are currently well-established procedures. Success of these realignment procedures is based... (Review)
Review
Osteotomies around the knee for treating osteoarthritis or knee instability are currently well-established procedures. Success of these realignment procedures is based on the accuracy and the reliability of correction angles in the coronal and sagittal alignment. In this context of improving precision and adapting the correction to each patient, navigation is currently being widely used. The rationale for its use is based on understanding the advantages and limitations, technical principles, and potential pitfalls. This article describes these areas and the overall clinical outcomes of this system for knee osteotomies.
Topics: Humans; Knee Joint; Osteotomy; Surgery, Computer-Assisted; Tibia
PubMed: 31079774
DOI: 10.1016/j.csm.2019.02.009 -
Archives of Orthopaedic and Trauma... May 2022Eight hundred and fifty-eight consecutive osteotomies around the knee joint were analyzed retrospectively to detect intra- and early postoperative complications in a...
INTRODUCTION
Eight hundred and fifty-eight consecutive osteotomies around the knee joint were analyzed retrospectively to detect intra- and early postoperative complications in a period of 4 weeks postoperative. Indications for osteotomy were unilateral gonarthritis or torsional deformities resulting in femoropatellar instability or anterior knee pain.
MATERIALS AND METHODS
Etiology of deformity, technique and mode of correction and level of osteotomy were registered. Complications were detected and divided in minor complication (superficial wound infection, and deep-vein thrombosis) and major complication (compartment syndrome, deep infection, and vascular lesion).
RESULTS
Fifteen major (1.7%) and 17 minor complications (2.0%) were detected: 5 vascular lesions (0.58%), 4 compartment syndromes (0.47%) and 6 deep infections (0.70%), 14 superficial wound infections (1.6%) and 3 deep-vein thrombosis (0.35%). In posttraumatic osteotomies and continuous corrections, risk for a superficial wound infection was significantly higher and with osteoclasia risk for vascular lesion was higher compared to osteotomy with oscillating saw. No difference was found for anatomical level of osteotomy and for the other complications in terms of etiology of deformity, technique of osteotomy and mode of correction.
CONCLUSION
Osteotomy around the knee is a safe procedure in the treatment of unicompartmental gonarthritis in terms of intra- and postoperative complications. Major complications are rare. Pit falls for compartment syndromes (LCW and torsional corrections) have to kept in mind. There is no difference in frequency of complications between HTO and supracondylar osteotomies. Risk for superficial wound infection is higher in posttraumatic osteotomies and with continuous corrections. Osteoclasia contains a higher risk for vascular lesion compared to oscillating saw.
Topics: Compartment Syndromes; Humans; Knee Joint; Osteoarthritis, Knee; Osteotomy; Postoperative Complications; Retrospective Studies; Tibia; Venous Thrombosis; Wound Infection
PubMed: 33417020
DOI: 10.1007/s00402-020-03696-w -
American Journal of Veterinary Research Dec 2023To describe the use of patient-specific 3-D-printed osteotomy, reduction, and compression guides for tibial closing wedge osteotomy in small-breed dogs.
OBJECTIVE
To describe the use of patient-specific 3-D-printed osteotomy, reduction, and compression guides for tibial closing wedge osteotomy in small-breed dogs.
ANIMALS
6 dogs with unilateral tibial deformities.
METHODS
Six small-breed dogs with 1 or a combination of tibial deformities, including excessive tibial plateau angle, valgus, and torsion, were scheduled to undergo tibial closing wedge osteotomy using patient-specific 3-D-printed osteotomy, reduction, and compression guides. The location and orientation of the wedge osteotomy were determined based on CT data using computer-aided design software. After the tibial deformities were corrected, postoperative CT or radiographs were obtained to compare the achieved tibial limb angles with the planned angles. Clinical evaluation and radiographic follow-up were performed on all dogs.
RESULTS
Guides were successfully positioned at each specific location, and osteotomies were performed without radiation exposure or observer assistance in all dogs. Tibial deformities were corrected with angular errors of 1.8 ± 1.4°, 2.3 ± 2.1°, and 2.6 ± 1.3° in the sagittal, frontal, and transverse planes, respectively. Mild complications resolved within 1 month in 3 dogs, and revision surgery was not required. Five dogs improved to the normal gait (mean, 14.8 ± 6.6 weeks), and 1 dog recovered a satisfactory gait 24 weeks after surgery. All limbs healed 14 ± 4.7 weeks after surgery.
CLINICAL RELEVANCE
Patient-specific 3-D-printed osteotomy, reduction, and compression guides can provide effective assistance allowing accurate correction of tibial deformities. Their use yields good clinical outcomes in small-breed dogs.
Topics: Humans; Dogs; Animals; Tibia; Radiography; Osteotomy; Extremities
PubMed: 38041942
DOI: 10.2460/ajvr.23.06.0146 -
The Bone & Joint Journal Sep 2022The aims of this study were to characterize the incidence and risk factors associated with stress fractures following periacetabular osteotomy, and to determine their...
AIMS
The aims of this study were to characterize the incidence and risk factors associated with stress fractures following periacetabular osteotomy, and to determine their effect on osteotomy union.
METHODS
We retrospectively reviewed all periacetabular osteotomies (PAOs) performed for developmental dysplasia of the hip (DDH) at one institution over a six-year period between 2012 and 2017. Perioperative factors were recorded, and included demographic and surgical data. Postoperatively, patients were followed for a minimum of one year with anteroposterior and false profile radiographs of the pelvis to monitor for evidence of stress fracture and union of osteotomies. We characterized the incidence and locations of stress fractures, and used univariate and multivariable analysis to identify factors predictive of stress fracture and the association of stress fracture on osteotomy union.
RESULTS
A total of 331 patients underwent PAO during the study period with 56 (15.4%) stress fractures: 46 fractures of the retroacetabular posterior column, five cases of ischiopubic stress fracture, and five cases of concurrent ischiopubic and retroacetabular stress fractures. Overall, 86% (48/56) healed without intervention. Univariate analysis revealed that stress fractures occurred more frequently in females (p = 0.040), older patients (mean age 27.6 years (SD 8.4) vs 23.8 (SD 9.0); p = 0.003), and most often with the use of the broad Mast chisel (28.5%; p < 0.001). Multivariable analysis revealed that increasing age (odds ratio (OR) 1.04; 95% CI 1.01 to 1.07; p = 0.028) and use of the broad Mast chisel (OR 5.1 (95% CI 1.3 to 19.0) compared to narrow Ganz chisel; p = 0.038) and surgeon (p = 0.043) were associated with increased risk of stress fracture. Patients with stress fractures were less likely to have healed osteotomies after one-year follow-up (76% vs 96%; p < 0.001).
CONCLUSION
Stress fracture of the posterior column may be an under-recognized complication following PAO, and the rate may be influenced by surgical technique. Consideration should be given to using a narrow chisel during the ischial cut to reduce the risk of stress propagation through the posterior column.Cite this article: 2022;104-B(9):1017-1024.
Topics: Acetabulum; Adult; Female; Fractures, Stress; Hip Dislocation; Hip Joint; Humans; Incidence; Osteotomy; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 36047021
DOI: 10.1302/0301-620X.104B9.BJJ-2021-1391.R3 -
Open Veterinary Journal 2022Numerous cementless total hip replacement (THR) systems are available for application in dogs and one of the potential differences among these systems is the technique...
BACKGROUND
Numerous cementless total hip replacement (THR) systems are available for application in dogs and one of the potential differences among these systems is the technique for performing a femoral osteotomy and the amount of bone preserved in the calcar region. However, no quantitative comparison of osteotomy level has been performed for canine THRs to date.
AIMS
To develop and validate a method for quantifying the level of the osteotomy at its most distomedial aspect in conjunction with canine THR and to compare osteotomy level between multiple different THRs.
METHODS
Immediate post-operative cranial-caudal or caudal-cranial radiographs of 33 dogs treated with 17 Helica and 17 BFX THR were assessed and osteotomy level was quantified using a novel radiographic assessment by 3 independent observers. Correlation among observers was quantified using a Spearman rank order correlation. Osteotomy location was subsequently quantified for an additional 10 Zurich THRs. The osteotomy level for each THR was subsequently compared between Helica, BFX, and Zurich THRs using one-way non-parametric Mann-Whitney rank sum tests and significance set at < 0.05.
RESULTS
-values assessing correlation between observers were 0.87, 0.72, and 0.60. Osteotomy location was significantly more proximal in conjunction with the Helica (0.75 ± 0.22) versus the BFX (0.97 ± 0.13; < 0.001) and Zurich (1.1 ± 0.15; < 0.001) femoral prostheses. Osteotomy location was also significantly more proximal with the BFX prosthesis in comparison to the Zurich THR ( < 0.05).
CONCLUSION
The strong correlations among three different observers indicate that the technique for measuring the location of the distomedial aspect of the osteotomy was acceptably precise. The osteotomies made in conjunction with the short-stemmed Helica implants were significantly more proximal than those made with both of the long-stemmed (BFX and Zurich) femoral prostheses. The distomedial aspect of the osteotomy with the BFX system was significantly more proximal than that with the Zurich THR, indicating that between these two long-stemmed systems the osteotomy level is unique.
Topics: Dogs; Animals; Arthroplasty, Replacement, Hip; Dog Diseases; Osteotomy; Radiography; Postoperative Period
PubMed: 36650855
DOI: 10.5455/OVJ.2022.v12.i6.25 -
Journal of Neuroradiology = Journal de... Jan 2022Orthognathic surgery is the standard procedure to correct congenital, developmental, or acquired dentofacial deformities. The maxillomandibular relationship corrected by... (Review)
Review
Orthognathic surgery is the standard procedure to correct congenital, developmental, or acquired dentofacial deformities. The maxillomandibular relationship corrected by orthognathic surgery can improve facial esthetics, masticatory function, articulation, and breathing. The most common types of osteotomies include the combination of Le Fort I osteotomy, bilateral sagittal split mandibular ramus osteotomy, and genioplasty. High-resolution low-dose computed tomography is useful for evaluating the facial skeleton and soft tissues after surgery as well as for depicting a variety of possible complications. This article reviews the postoperative imaging findings of the most common orthognathic surgeries and their potential complications on multidetector-row computed tomography.
Topics: Humans; Orthognathic Surgery; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Radiologists; Tomography, X-Ray Computed
PubMed: 33864896
DOI: 10.1016/j.neurad.2021.04.033 -
L' Orthodontie Francaise Sep 2022Orthognathic surgery aims to treat facial dysmorphoses related to an anomaly of the maxillomandibular complex. This surgical treatment is most often performed in...
INTRODUCTION
Orthognathic surgery aims to treat facial dysmorphoses related to an anomaly of the maxillomandibular complex. This surgical treatment is most often performed in parallel with orthodontic treatment for functional and aesthetic purposes. In order to provide more efficient management and obtain a better stability of result, simple procedures must be added to orthognathic surgery to treat chronic nasal obstruction (CNO).
MATERIALS AND METHODS
The authors describe the techniques for surgical correction of CNO during orthodontic-surgical treatment and illustrate with some clinical cases.
CONCLUSIONS
Restoration of nasal ventilation should be an objective of orthodontic-surgical treatment. CNO treatment can be performed at the same time as a maxillomandibular osteotomy.
Topics: Esthetics, Dental; Humans; Nasal Obstruction; Nasal Septum; Orthognathic Surgery; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Treatment Outcome
PubMed: 36217583
DOI: 10.1684/orthodfr.2022.90 -
International Orthopaedics Sep 2023Although flatfoot is a widespread human condition, historical medical texts and ancient illustrations on this deformity are extremely rare. Nowadays, doubts regarding... (Review)
Review
PURPOSE
Although flatfoot is a widespread human condition, historical medical texts and ancient illustrations on this deformity are extremely rare. Nowadays, doubts regarding its management remain unsolved. This historical review aims to identify the presence of pes planus since the prehistoric era and examine the treatments proposed over the centuries up to the present.
METHOD
For this propose, we performed an extensive electronic search of the relevant literature, complemented by a manual search of additional sources from archaeological to artistic, literary, historical, and scientific accounts, describing flatfoot and its treatment in different eras.
RESULTS
Flatfoot accompanied the evolutionary timeline of human species: from Lucy Australopithecus to Homo Sapiens. It was described among various diseases suffered by Tutankhamun (1343-1324 B.C.), while the first anatomical description dates to Emperor Trajan (53-117 A.D.) and the medical studies of Galen (129-201 A.D.). It was also represented in the anatomical drawings of Leonardo da Vinci (1452-1519) and Girolamo Fabrici d'Acquapendente (1533-1619). Historically, the conservative treatment by insoles was the only one proposed until the nineteenth century. Since then, the most popular surgical procedures performed for correction have been osteotomies, arthrodesis, arthrorisis, and tendon lengthening and transfer.
CONCLUSION
During the centuries, conservative therapeutic strategies have not radically changed in their substance, while operative ones have become the protagonists during the twentieth century up to the present. Nevertheless, after more than 2000 years of history, there is no consensus regarding the best indication for the flatfoot and if it really needs to be treated.
Topics: Humans; Arthrodesis; Flatfoot; Osteotomy; Tendon Transfer
PubMed: 37222816
DOI: 10.1007/s00264-023-05837-3 -
Seminars in Musculoskeletal Radiology Jun 2022Total hip arthroplasty and hip preservation surgeries have substantially increased over the past few decades. Musculoskeletal imaging and interventions are cornerstones... (Review)
Review
Total hip arthroplasty and hip preservation surgeries have substantially increased over the past few decades. Musculoskeletal imaging and interventions are cornerstones of comprehensive postoperative care and surveillance in patients undergoing established and more recently introduced hip surgeries. Hence the radiologist's role continues to evolve and expand. A strong understanding of hip joint anatomy and biomechanics, surgical procedures, expected normal postoperative imaging appearances, and postoperative complications ensures accurate imaging interpretation, intervention, and optimal patient care. This article presents surgical principles and procedural details pertinent to postoperative imaging evaluation strategies after common hip surgeries, such as radiography, ultrasonography, computed tomography, and magnetic resonance imaging. We review and illustrate the expected postoperative imaging appearances and complications following chondrolabral repair, acetabuloplasty, osteochondroplasty, periacetabular osteotomy, realigning and derotational femoral osteotomies, and hip arthroplasty.
Topics: Arthroplasty, Replacement, Hip; Hip Joint; Humans; Osteotomy; Postoperative Period; Radionuclide Imaging
PubMed: 35654093
DOI: 10.1055/s-0041-1740996 -
The Journal of Craniofacial Surgery Oct 2023In orthognathic surgery, it is well known that maxillary osteotomies and displacements sometimes affect auditory function. Thus, this study examined the relationship...
BACKGROUND
In orthognathic surgery, it is well known that maxillary osteotomies and displacements sometimes affect auditory function. Thus, this study examined the relationship between the direction of maxillary displacement and postoperative otalgia.
METHODS
Twenty consecutive patients underwent Le Fort I maxillary osteotomy using advancement, impaction, setback, or a combination of these procedures. The direction of movement and incidence of otalgia were investigated. Patients provided informed consent preoperatively, and postoperative reassurance was prudent.
RESULTS
Pure-tone average evaluation based on horizontal or vertical movements did not show significant differences, although vertical movements resulted in fewer changes in the hearing threshold. Specifically, no significant changes were observed in the hearing thresholds of patients after surgery. No significant difference was also observed between horizontal and vertical movements in the tympanometry results. Negative changes were found in the results of the Eustachian tube dysfunction test in vertical movements, which returned to preoperative values in the final test.
CONCLUSIONS
The risk of minor changes in hearing function is probable during the first week after orthognathic surgery; however, these negative changes either completely disappear or remain negligible.
Topics: Humans; Orthognathic Surgery; Orthognathic Surgical Procedures; Earache; Incidence; Maxilla; Acoustic Impedance Tests; Osteotomy, Le Fort; Cephalometry; Retrospective Studies
PubMed: 37589962
DOI: 10.1097/SCS.0000000000009609