-
Knee Surgery, Sports Traumatology,... Sep 2023The relationship between osteotomies around the knee and ankle alignment has been well established. However, little is known about the incidence of new-onset ankle pain...
PURPOSE
The relationship between osteotomies around the knee and ankle alignment has been well established. However, little is known about the incidence of new-onset ankle pain after knee osteotomies in the setting of both varus and valgus lower limb malalignments. The purpose of this study is to determine the incidence and characteristics of ankle pain after knee osteotomies; and to clarify the relationship between knee alignment correction, coronal changes suffered by the ankle joint and the development of new-onset ankle pain.
METHODS
Fifty-four lower limbs in 51 consecutive patients, who underwent realignment osteotomies around the knee between April 2013 and October 2020, were retrospectively reviewed. Ultimately, 39 patients (42 knees) were enrolled: 34 had varus deformities and eight had valgus deformities. Ankle pain was assessed according to the Numerical Pain Rating Scale by telephonic interview. The magnitude of alignment correction and the consequent change of both knee and ankle joint lines were analyzed. Correlation between the former and the onset of post-operative ankle pain was evaluated. Patient satisfaction and complications were also noted.
RESULTS
The incidence of new-onset ankle pain after knee realignment osteotomy was 14%, at a mean follow-up of 55 ± 26 months (range 12-93 months). The mean time between osteotomy and onset of ankle pain was 21 ± 25 months (range 2-60 months). The degree of coronal correction was significantly correlated with ankle joint obliquity changes. However, a significant correlation with post-operative ankle pain was not found (p > 0.05).
CONCLUSION
Fourteen percent of the patients who underwent osteotomies around the knee developed new-onset persistent low-intensity ankle pain. The knee and ankle joint biomechanics are closely related, however, only a small percentage of patients suffer from low-intensity ankle pain which is successfully managed with occasional analgesics. Most osteotomies around the knee seem to require no particular concern for the ipsilateral ankle function.
Topics: Humans; Ankle; Ankle Joint; Retrospective Studies; Tibia; Knee Joint; Lower Extremity; Pain, Postoperative; Osteotomy
PubMed: 34409552
DOI: 10.1007/s00167-021-06699-1 -
Archives of Orthopaedic and Trauma... May 2023Patellar malalignment has been considered one of the major pathomechanical causes of patellofemoral instability and pain. The results have been reported after femoral...
Combined distal femoral osteotomy and tibial tuberosity distalization is effective in patients presenting with patellar instability and patellofemoral pain due to patella alta and femoral malalignment.
INTRODUCTION
Patellar malalignment has been considered one of the major pathomechanical causes of patellofemoral instability and pain. The results have been reported after femoral varization/torsional osteotomy and tibial tuberosity distalization osteotomy (TTD-O). However, the combination of a femoral deformity (genu valgum/increased femur antetorsion) and patella alta remains underreported. Therefore, the aim of this study was to investigate the clinical outcomes of patients simultaneously treated by distal femoral osteotomy and TTD-O. The hypothesis was that restoration of patellofemoral (PF) alignment via the abovementioned osteotomies would achieve good patient-reported outcome measures.
MATERIALS AND METHODS
Between 2016 and 2019, a series of 25 knees in 20 patients were treated by a distal femoral osteotomy combined with a TTD-O aiming to correct patellofemoral malalignment consisting of genu valgum and/or increased femur antetorsion and patella alta. Six patients were lost to follow-up, and one patient refused to participate. Thus, 17 knees in 13 patients (male/female 1/12; age 27.4 ± 5.4 years) were included and comprised the study group for this investigation. Patients were evaluated after a mean of 3.1 ± 0.9 years postoperatively. The Kujala anterior knee pain scale and the PF-subscale of the Knee Osteoarthritis and Outcome score (KOOS-PF) were used to assess patients' reported outcome measures from pre- to postoperatively.
RESULTS
The mean amount of torsional correction, valgus correction, and tibial tuberosity distalization averaged 14° (10°-18°), 5.2° (3.8°-8°), and 9 mm (6°-15 mm), respectively. The Kujala score increased by an average of 24.18 points from a mean of 66.6 ± 18.3 points (34-93 points) preoperatively to 90.8 ± 14.2 points (44-100 points) postoperatively (95% CI - 33.0 to - 15.3; p < 0.0001). The KOOS-PF score increased by an average of 33.7 points from a mean of 49.5 ± 24.5 points (9.1-88.6 points) preoperatively to 83.2 ± 21.6 points (15.9 -100 points) postoperatively (95% CI - 47.5 to - 19.9; p < 0.0001).
CONCLUSION
The findings of this study indicate that the combination of a distal femoral osteotomy and a tibial tuberosity distalization osteotomy is effective in patients presenting with patellar instability and patellofemoral pain due to patella alta and femoral malalignment.
Topics: Humans; Male; Female; Young Adult; Adult; Patella; Joint Instability; Genu Valgum; Patellofemoral Pain Syndrome; Patellofemoral Joint; Retrospective Studies; Femur; Tibia; Osteotomy; Patellar Dislocation
PubMed: 35861870
DOI: 10.1007/s00402-022-04541-y -
Arthroscopy : the Journal of... Feb 2021High tibial osteotomy is a widespread treatment option and has been performed in the treatment of osteoarthritis long before joint replacements started their triumphant...
High tibial osteotomy is a widespread treatment option and has been performed in the treatment of osteoarthritis long before joint replacements started their triumphant era in the last third of the last century. However, osteotomies have again gained increased interest and popularity within the last 2 decades. Historically, osteotomies have mainly been recommended for early osteoarthritis and contraindicated for advanced osteoarthritis. However, over time, some historic but widespread dogmas have already been contradicted regarding high tibial osteotomy. Osteotomies are very well possible and can yield excellent outcomes, even in patients with severe osteoarthritis. Thus, another dogma from the past is contradicted.
Topics: Bone and Bones; Humans; Osteoarthritis, Knee; Osteotomy; Tibia
PubMed: 33546801
DOI: 10.1016/j.arthro.2020.11.025 -
Plastic and Reconstructive Surgery Jan 2021Reduction of a nasal hump and nasal base narrowing are very common steps during a primary rhinoplasty procedure. The greatest difficulty is to obtain stable fracture...
Reduction of a nasal hump and nasal base narrowing are very common steps during a primary rhinoplasty procedure. The greatest difficulty is to obtain stable fracture lines, a natural appearance, beautiful dorsal aesthetic lines, and the absence of palpable or visible irregularities, especially in the long term. The surgeon strives for a reproducible technique, which seems to be more feasible with mechanical osteotomies (powered or piezoelectric) than with traditional manual osteotomies. The aim of this article is to describe powered osteotomy in a step-by-step fashion to provide a clear guideline for rhinoplasty surgeons.
Topics: Esthetics; Humans; Nasal Bone; Osteotomy; Practice Guidelines as Topic; Reproducibility of Results; Rhinoplasty; Treatment Outcome
PubMed: 33370051
DOI: 10.1097/PRS.0000000000007505 -
Skeletal Radiology Sep 2023Hallux valgus surgery concerns many patients and various techniques are performed. The assessment of the first toe deformity correction is mainly visual and imaging is... (Review)
Review
Hallux valgus surgery concerns many patients and various techniques are performed. The assessment of the first toe deformity correction is mainly visual and imaging is required to analyze the intermetatarsal angle and depict complications. However, it is often difficult for the radiologist to distinguish normal and pathological conditions, especially in case of osteotomies which may show various aspects of bone mineralization and healing. In this review, the most relevant imaging features of the post-operative hallux valgus are summarized.
Topics: Humans; Hallux Valgus; Osteotomy; Foot Deformities; Diagnostic Imaging; Radiologists; Metatarsal Bones; Treatment Outcome; Retrospective Studies
PubMed: 36949167
DOI: 10.1007/s00256-023-04322-7 -
Knee Surgery, Sports Traumatology,... Oct 2023To assess whether there is evidence supporting the use of augmentation strategies, either cartilage surgical procedures or injective orthobiologic options, to improve... (Review)
Review
Biological intra-articular augmentation for osteotomy in knee osteoarthritis: strategies and results : A systematic review of the literature from the ESSKA Orthobiologics Initiative.
PURPOSE
To assess whether there is evidence supporting the use of augmentation strategies, either cartilage surgical procedures or injective orthobiologic options, to improve the results of osteotomies in knees with osteoarthritis (OA).
METHODS
A systematic review of the literature was performed on the PubMed, Web of Science and the Cochrane databases in January 2023 on osteotomies around the knee associated with augmentation strategies (either cartilage surgical procedures or injective orthobiologic options), reporting clinical, radiological, or second-look/histological outcomes at any follow-up. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS).
RESULTS
Out of the 7650 records identified from the databases, 42 articles were included for a total of 3580 patients and 3609 knees treated; 33 articles focused on surgical treatments and 9 on injective treatments performed in association with knee osteotomy. Out of the 17 comparative studies with surgical augmentation, only 1 showed a significant clinical benefit of an augmentation procedure with a regenerative approach. Overall, other studies showed no differences with reparative techniques and even detrimental outcomes with microfractures. Regarding injective procedures, viscosupplementation showed no improvement, while the use of platelet-rich plasma or cell-based products derived from both bone marrow and adipose tissue showed overall positive tissue changes which translated into a clinical benefit. The mean modified CMS score was 60.0 ± 12.1.
CONCLUSION
There is no evidence to support the effectiveness of cartilage surgical treatments combined with osteotomies in terms of pain relief and functional recovery of patients affected by OA in misaligned joints. Orthobiologic injective treatments targeting the whole joint environment showed promising findings. However, overall the available literature presents a limited quality with only few heterogeneous studies investigating each treatment option. This ORBIT systematic analysis will help surgeons to choose their therapeutic strategy according to the available evidence, and to plan further and better studies to optimize biologic intra-articular osteotomy augmentation.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Osteoarthritis, Knee; Injections, Intra-Articular; Knee Joint; Cartilage; Osteotomy; Treatment Outcome
PubMed: 37330935
DOI: 10.1007/s00167-023-07469-x -
Hand Surgery & Rehabilitation Sep 2021This study aimed to compare medium-term results for partial capitate shortening (PCS) and radial shortening (RS) osteotomies on lunate bone revascularization and disease...
This study aimed to compare medium-term results for partial capitate shortening (PCS) and radial shortening (RS) osteotomies on lunate bone revascularization and disease progression in patients with stage II or IIIA Kienböck's disease. Patients who underwent surgery for Kienböck's disease between March 2010 and July 2020 were retrospectively evaluated. Clinical evaluation included assessment of pain, joint range of motion, strength, DASH, visual analog scale (VAS) for pain, Modified Mayo Wrist Score (MMWS), satisfaction and time to return to work, with comparison as appropriate to the contralateral side. Preoperative and postoperative plain radiographs and magnetic resonance imaging (MRI) were used for radiological evaluation. Lichtman staging and signal changes in the lunate were evaluated using MRI. Group 1 (PCS) included 14 patients and Group 2 (RS) 14. Mean follow-up was 57.8 months (range 24-102) in Group 1 and 49.4 months (range 36-73) in Group 2. Clinical evaluation included pain on VAS, DASH score, MMWS, range of motion, and grip, palmar and key pinch strength. Regarding lunate bone vascularization, increased signal on final follow-up MRI was observed in 10 of the 14 patients in Group 1 and 7 of the 14 patients in Group 2. There was a positive correlation between revascularization and final follow-up MMWS (p = 0.006). The present study thus showed that functional scores were improved by revascularization in Kienböck's disease. Both osteotomies had clinically and radiologically satisfactory results. However, we believe that PCS osteotomy is preferable, as it leads to higher revascularization rates without increasing ulnolunate load.
Topics: Capitate Bone; Humans; Osteonecrosis; Osteotomy; Radius; Retrospective Studies
PubMed: 33775890
DOI: 10.1016/j.hansur.2021.03.004 -
Clinics in Orthopedic Surgery Sep 2020The supramalleolar osteotomy is a joint-preserving surgical procedure. It is a very good treatment option for the asymmetric varus ankle and medial compartment... (Review)
Review
The supramalleolar osteotomy is a joint-preserving surgical procedure. It is a very good treatment option for the asymmetric varus ankle and medial compartment osteoarthritis. The primary objective of the procedure is to shift medial concentration of stress toward the lateral intact articular cartilage to redistribute the joint loads during ambulation. Several studies have shown that deformities of the ankle result in uneven load distribution in the ankle joint, which eventually leads to articular cartilage degeneration. Since the lateral articular cartilage is intact, joint-sacrificing procedures such as total ankle replacement or ankle arthrodesis are not the most appropriate treatment choices for medial compartment arthritis. Results of supramalleolar osteotomies are very promising in terms of functional outcome and pain relief. In younger patients with medial compartment varus ankle osteoarthritis or even with a normal tibial anterior surface angle, supramalleolar osteotomies can be performed to realign the ankle to promote regeneration of the asymmetrically damaged cartilage. In this review article, we will discuss the indications, complications, surgical techniques, and outcomes of the supramalleolar osteotomy reported in the current literature.
Topics: Ankle Joint; Humans; Osteoarthritis; Osteotomy
PubMed: 32904071
DOI: 10.4055/cios20038 -
The Journal of the American Academy of... Jul 2024High tibial osteotomy is a dynamic operation, used as an effective procedure in both joint preservation and knee stability. Applications and indications are expanding,... (Review)
Review
High tibial osteotomy is a dynamic operation, used as an effective procedure in both joint preservation and knee stability. Applications and indications are expanding, with good results in the treatment of malalignment associated with arthrosis, knee instability, meniscus deficiency or transplants, and/or cartilage restoration. Appropriate patient selection and preoperative planning are critical to achieving good outcomes after surgery. Coronal and sagittal plane corrections made through the proximal tibia can effectively alter joint mechanics creating a more favorable environment for cartilage, meniscus, and ligamentous structures about the knee. Advancing techniques and technologies have allowed for more precise planning and execution of osteotomies.
Topics: Humans; Osteotomy; Tibia; Knee Joint; Joint Instability; Plastic Surgery Procedures; Osteoarthritis, Knee
PubMed: 38175969
DOI: 10.5435/JAAOS-D-23-00323 -
Journal of Surgical Orthopaedic Advances 2023High tibial osteotomy (HTO) is a surgical procedure that can be used as a primary or as an adjunctive treatment for a variety of knee pathologies, most commonly isolated...
High tibial osteotomy (HTO) is a surgical procedure that can be used as a primary or as an adjunctive treatment for a variety of knee pathologies, most commonly isolated medial compartment arthrosis in a knee with varus alignment. More recently, indications for HTO have been expanded to include its use in combination with cartilage preserving techniques, to offload the effected compartment, and in conjunction with ligamentous reconstruction. HTO also has utility in delaying total knee arthroplasty (TKA) in select patients with favorable literature on future TKA outcomes. Numerous techniques for HTO have been published, however, medial opening wedge and lateral closing wedge osteotomies remain the most common. The purpose of this article is to summarize HTO patient selection and indications, surgical techniques, common complications, and review outcomes from recent literature. (Journal of Surgical Orthopaedic Advances 32(3):148-155, 2023).
Topics: Humans; Osteotomy; Orthopedics; Knee Joint; Arthroplasty, Replacement, Knee; Osteoarthritis
PubMed: 38252599
DOI: No ID Found