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Archives of Orthopaedic and Trauma... Sep 2023We investigated the mid-term outcomes of supramalleolar osteotomies regarding "survivorship" [before ankle arthrodesis (AA) or total ankle replacement (TAR)],... (Review)
Review
INTRODUCTION
We investigated the mid-term outcomes of supramalleolar osteotomies regarding "survivorship" [before ankle arthrodesis (AA) or total ankle replacement (TAR)], complication rate and adjuvant procedures required.
MATERIAL AND METHODS
PubMed, Cochrane and Trip Medical Database were searched from January 01, 2000. Studies reporting on SMOs for ankle arthritis, in minimum of 20 patients aged 17 or older, followed for a minimum of two years, were included. Quality assessment was performed with the Modified Coleman Methodology Score (MCMS). A subgroup analysis of varus/valgus ankles was performed.
RESULTS
Sixteen studies met the inclusion criteria, with 866 SMOs in 851 patients. Mean age of patients was 53.6 (range 17-79) years, and mean follow-up was 49.1 (range 8-168) months. Of the arthritic ankles (646 ankles), 11.1% were classified as Takakura stage I, 24.0% as stage II, 59.9% as stage III and 5.0% as stage IV. The overall MCMS was 55.2 ± 9.6 (fair). Eleven studies (657 SMOs) reported on "survivorship" of SMO, before arthrodesis (2.7%), or total ankle replacement (TAR) (5.8%) was required. Patients required AA after an average of 44.6 (range 7-156) months, and TAR after 36.71 (range 7-152) months. Hardware removal was required in 1.9% and revision in 4.4% of 777 SMOs. Mean AOFAS score was 51.8 preoperatively, improving to 79.1 postoperatively. Mean VAS was 6.5 preoperatively and improved to 2.1 postoperatively. Complications were reported in 5.7% (44 out of 777 SMOs). Soft tissue procedures were performed in 41.0% (310 out of 756 SMOs), whereas concomitant osseous procedures were performed in 59.0% (446 out of 756 SMOs). SMOs performed for valgus ankles failed in 11.1% of patients, vs 5.6% in varus ankles (p < 0.05), with disparity between the different studies.
CONCLUSIONS
SMOs combined with adjuvant, osseous and soft tissue, procedures, were performed mostly for arthritic ankles of stage II and III, according to the Takakura classification and offered functional improvement with low complication rate. Approximately, 10% of SMOs failed and patients required AA or TAR, after an average of just over 4 years (50.5 months) after the index surgery. It is debatable whether varus and valgus ankles treated with SMO reveal different success rates.
Topics: Humans; Infant; Child, Preschool; Child; Ankle; Osteoarthritis; Treatment Outcome; Ankle Joint; Osteotomy; Retrospective Studies; Arthroplasty, Replacement, Ankle
PubMed: 37010603
DOI: 10.1007/s00402-023-04867-1 -
Foot and Ankle Clinics Mar 2020Complications following hallux valgus (HV) reconstruction will have an expected incidence of between 10% and 55% of cases. The more commonly reported complications... (Review)
Review
Complications following hallux valgus (HV) reconstruction will have an expected incidence of between 10% and 55% of cases. The more commonly reported complications include undercorrection/recurrence, overcorrection (hallux varus), transfer metatarsalgia, nonunion, malunion, avascular necrosis, arthritis, hardware removal, nerve injury, and ultimately patient dissatisfaction. The presence of arthritis will be an indication for fusion, whereas osteotomies will be the procedure of choice if the first metatarsophalangeal joint is healthy. Wide experience in primary HV surgery is advised before dealing with complex cases of failed HV surgery.
Topics: Hallux Valgus; Humans; Osteotomy
PubMed: 31997742
DOI: 10.1016/j.fcl.2019.10.011 -
Computers in Biology and Medicine Aug 2023Precision and safety are crucial in performing fibula osteotomy during mandibular reconstruction with free fibula flap (FFF). However, current clinical methods, such as...
Precision and safety are crucial in performing fibula osteotomy during mandibular reconstruction with free fibula flap (FFF). However, current clinical methods, such as template-guided osteotomy, have the potential to cause damage to fibular vessels. To address the challenge, this paper introduces the development of the surgical robot for fibula osteotomies in mandibular reconstruction surgery and propose an algorithm for sensor-aware hybrid force-motion control for safe osteotomy, which includes three parts: osteotomy motion modeling from surgeons' demonstrations, Dynamic-system-based admittance control and osteotomy sawed-through detection. As a result, the average linear variation of the osteotomized segments was 1.08±0.41mm, and the average angular variation was 1.32±0.65. The threshold of osteotomy sawed-through detection is 0.5 at which the average offset is 0.5mm. In conclusion, with the assistance of surgical robot for mandibular reconstruction, surgeons can perform fibula osteotomy precisely and safely.
Topics: Mandibular Reconstruction; Robotics; Robotic Surgical Procedures; Fibula; Bone Transplantation; Osteotomy
PubMed: 37263153
DOI: 10.1016/j.compbiomed.2023.107040 -
Orthopaedics & Traumatology, Surgery &... Nov 2021the hinge plays a fundamental role in the support and consolidation of a high tibial osteotomy. The objective of this work was to analyse the influence of the end zone...
INTRODUCTION
the hinge plays a fundamental role in the support and consolidation of a high tibial osteotomy. The objective of this work was to analyse the influence of the end zone of the osteotomy cut and its orientation in relation to the articular joint line (JL) on the risk of hinge fracture.
HYPOTHESIS
a specific orientation and end zone of the osteotomy cut can be utilised to decrease the risk of hinge fracture.
MATERIAL AND METHOD
a finite element (FE) model was used to reproduce the proximal portion of the tibia and the proximal tibiofibular joint with transverse isotropic elastic bone properties. A 1.27mm thick, complete, anteroposterior saw cut was made with a U-shaped saw blade. Five proximal and lateral tibial zones were used according to Nakamura et al corresponding to the end zones of the osteotomy cut. Three angulations of the cut relative to the JL were defined: 10°, 15°, 20°. The tests consisted of simulating 15 possible situations (3 angulations for each of the 5 end zones) on this model. These simulations made it possible to identify the existence of a local stress concentration (von Mises, in MPa) at the level of the hinge, corresponding to the main judgment criterion.
RESULTS
If we consider only the end zones of the osteotomy cut, regardless of its angulation with respect to the JL, the zone which presents, on average, the lowest local stress concentration is the AM zone (40.3MPa). If we consider only the angulation of the osteotomy cut, with respect to the JL, regardless of the end zone of the cut, the angulation that locally concentrates, on average, the least stress is an angulation at 10° (147.7MPa). Finally, it is important to define the best end zone of the osteotomy cut for each angulation value in relation to the JL: for an angulation of 10°, the end zone must be in AM (38MPa), but also for an angulation of 15° (45MPa), and for an angulation of 20° (38MPa).
DISCUSSION-CONCLUSION
With the inherent caveats of the experimental conditions, the hypothesis is confirmed. An end zone of the osteotomy cut exists (AM) and an orientation (10°) that induces the lowest local stress concentration and therefore the least likely to induce lateral hinge fracture. However, the orientation of the osteotomy cut is also a matter of surgical habit, especially regarding complementary osteotomy of the tibial tuberosity that some may want to avoid. Thus, it is equally important to know the best end zone associated with a given angulation of the cut in relation to the JL, which according to these results is the AM zone for each angulation. This information helps guide the operator in their surgical practices according to their habits.
LEVEL OF EVIDENCE
V, expert opinion.
Topics: Finite Element Analysis; Fractures, Bone; Humans; Knee Joint; Osteotomy; Tibia
PubMed: 34343697
DOI: 10.1016/j.otsr.2021.103031 -
Journal of Orthopaedic Surgery (Hong... 2022In medial open-wedge high tibial osteotomy (HTO) hinge axis and osteotomy plane influence the resulting anatomy, but accurate angular quantifications using...
In medial open-wedge high tibial osteotomy (HTO) hinge axis and osteotomy plane influence the resulting anatomy, but accurate angular quantifications using 3D-planning-simulations are lacking. The objectives of this study were developing a standardized and validated 3D-planning method of an HTO and to perform several simulated realignments to explain unintended anatomy changes. The cutting direction of the main osteotomy was defined parallel to the medial tibial slope and the hinge axis 1.5 cm distal to the lateral plateau. For interobserver testing, this 3D planning was performed on 13 digital models of human tibiae by two observers. In addition, four different hinge axis positions and five differently inclined osteotomy planes each were simulated. The osteotomy direction ranged from medial 0°-30° anteromedial, while the tilt of the osteotomy plane compared to the tibial plateau was -10° to +10°. All anatomic angular changes were calculated using 3D analysis. Multiple HTO plannings by two medical investigators using standardized procedures showed only minimal differences. In the 3D-simulation, each 10° rotation of the hinge axis resulted in a 1.7° significant increase in slope. Tilting the osteotomy plane by 10° resulted in significant torsional changes of 2°, in addition to minor but significant changes in the medial proximal tibial angle (MPTA). Standardized 3D-planning of the HTO can be performed with high reliability using two-observer planning. 3D-simulations suggest that control of the osteotomy plane is highly relevant to avoid unintended changes in the resulting anatomy, but this can be a helpful tool to modify specific angles in different pathologies in the HTO.
Topics: Humans; Knee Joint; Osteoarthritis, Knee; Osteotomy; Prostheses and Implants; Reproducibility of Results; Rotation; Tibia
PubMed: 35694778
DOI: 10.1177/10225536221101699 -
Arthroscopy : the Journal of... Jun 2022Knee osteotomy is a valuable treatment option for younger knee osteoarthritis patients. Improved surgical techniques, including double-level osteotomies to address...
Editorial Commentary: Timely Surgery, Optimizing Perioperative Care, and Prospective Data Collection Are Next Steps to Improving Return to Sport and Work Outcomes After Knee Osteotomy.
Knee osteotomy is a valuable treatment option for younger knee osteoarthritis patients. Improved surgical techniques, including double-level osteotomies to address femoral and tibial malalignment, have led to reappreciation of this joint-sparing alternative to knee arthroplasty. Yet, postoperative ability to resume sport and work at the desired level needs further improvement. We believe that timely surgery, optimized perioperative care, including evidence-based advice for resumption of activities, and prospective data collection are interesting next steps in this process.
Topics: Data Collection; Humans; Knee Joint; Osteoarthritis, Knee; Osteotomy; Perioperative Care; Return to Sport; Tibia
PubMed: 35660187
DOI: 10.1016/j.arthro.2022.01.027 -
Oral and Maxillofacial Surgery Clinics... Nov 2019Virtual surgical planning provides the ability to visualize the patient anatomy and pathologic condition, establish pertinent reference points, and simulate osteotomies... (Review)
Review
Virtual surgical planning provides the ability to visualize the patient anatomy and pathologic condition, establish pertinent reference points, and simulate osteotomies and reconstruction design in advance of the surgery. Virtual surgical planning is also an ideal environment for improved communication between the patient and the surgical team.
Topics: Computer Simulation; Computer-Aided Design; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Osteotomy; Patient Care Planning; Plastic Surgery Procedures; Surgery, Computer-Assisted; Surgery, Oral
PubMed: 31477430
DOI: 10.1016/j.coms.2019.07.011 -
Foot and Ankle Clinics Dec 2023Supramalleolar osteotomy enables correction of the ankle varus deformity and is associated with improvement of pain and function in the short term and long term. Despite... (Review)
Review
Supramalleolar osteotomy enables correction of the ankle varus deformity and is associated with improvement of pain and function in the short term and long term. Despite these beneficial results, the amount of surgical correction is challenging to titrate and the procedure remains technically demanding. Most supramalleolar osteotomies are currently planned preoperatively on 2-dimensional weight-bearing radiographs and executed peroperatively using free-hand techniques. This article encompasses 3-dimensional planning and printing techniques based on weight-bearing computed tomography images and patient-specific instruments to correct ankle varus deformities.
Topics: Humans; Talipes Cavus; Foot Deformities; Ankle Joint; Ankle; Osteotomy
PubMed: 37863539
DOI: 10.1016/j.fcl.2023.06.002 -
Journal of Orthopaedics and... Nov 2023The development of the Bernese periacetabular osteotomy (PAO) is based on a structured approach starting with an analysis of the preexisting procedures to improve the... (Review)
Review
The development of the Bernese periacetabular osteotomy (PAO) is based on a structured approach starting with an analysis of the preexisting procedures to improve the coverage of the femoral head and was followed by a list of additional goals and improvements. Cadaveric dissections with a detailed description of the vascular supply of acetabulum and periacetabular bone set the stage for an intrapelvic approach, which offered the largest acetabular correction possible combined with safe intracapsular access. The final composition of osteotomies required the development of several instruments and cutting devices before the feasibility could be tested on a series of cadaveric hips.While the sequence of the osteotomies remained largely unchanged over time (except for the pubic and ischial osteotomies), several propositions for an easier/less invasive approach have been discussed; some made it into standard practice. Efforts were undertaken to optimize the learning curve and minimize failures using video-clips, hands-on courses, fellowships, publications, and ongoing mentoring programs. In retrospect, with almost 40 years of experience, such efforts have promoted a worldwide adoption of the Bernese periacetabular osteotomy.
Topics: Humans; Acetabulum; Hip Joint; Hip Dislocation, Congenital; Osteotomy; Cadaver; Retrospective Studies; Treatment Outcome
PubMed: 37917385
DOI: 10.1186/s10195-023-00734-2 -
International Orthopaedics Jun 2024Spinal osteotomies are often essential in the treatment of congenital scoliosis. Risk factors for bleeding in these patients needing extracavitatory approaches,...
PURPOSE
Spinal osteotomies are often essential in the treatment of congenital scoliosis. Risk factors for bleeding in these patients needing extracavitatory approaches, especially hidden blood loss, are sparsely investigated. We aimed to investigate the bleeding characteristics and hidden blood loss in paediatric patients undergoing spinal osteotomies for congenital scoliosis.
METHODS
A retrospective analysis identified all patients with congenital scoliosis were retrospectively identified from the prospectively collected spine register from 2010 to 2022. Operative technique, perioperative laboratory results and imaging studies were extracted. The primary outcome was total blood loss including intraoperative, drain output and hidden blood loss.
RESULTS
Fifty-seven children (32 boys) with a mean age of 8.3 years underwent spinal osteotomy for congenital scoliosis. Posterolateral hemivertebrectomy was sufficient in 34 (59%) patients, while vertebral column resection (VCR) was required in 23 patients. Total bleeding averaged 792 (523) ml accounting for 42% of the estimated blood volume. Hidden blood loss accounted for 40% of total bleeding and 21% of estimated blood volume with a mean of 317 (256) ml. VCR was associated with greater intraoperative and total bleeding than hemivertebrectomies (p = 0.001 and 0.007, respectively). After adjusting for patient weight and fusion levels, hidden blood loss was larger in hemivertebrectomies (4.18 vs. 1.77 ml/kg/fused level, p = 0.049). In multivariable analysis, intraoperative blood loss was inversely correlated with preoperative erythrocyte levels. Younger age was associated with significantly greater drain, hidden and total blood loss.
CONCLUSION
Hidden blood loss constitutes a significant portion (40%) of total bleeding in congenital scoliosis surgery. Younger age is a risk factor for bleeding and the hidden blood loss should be taken into consideration in their perioperative management.
Topics: Humans; Scoliosis; Male; Female; Child; Blood Loss, Surgical; Osteotomy; Retrospective Studies; Child, Preschool; Risk Factors; Adolescent; Spine; Spinal Fusion
PubMed: 38228759
DOI: 10.1007/s00264-024-06090-y