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Revue de Chirurgie Orthopedique Et... 1994In cases of severe hip osteoarthritis in young patients, the intertrochanteric osteotomy can delay total hip arthroplasty. The main advantage of the osteotomy is to... (Review)
Review
INTRODUCTION
In cases of severe hip osteoarthritis in young patients, the intertrochanteric osteotomy can delay total hip arthroplasty. The main advantage of the osteotomy is to preserve the bone stock. The main disadvantages are the lasting postoperative invalidity and the varying longterm success rate. Our aim was to quantify these disadvantages using survivorship analysis.
MATERIAL AND METHODS
The study included 64 patients (65 osteotomies) ranging from 16 to 68 years. The osteotomies were performed between 1975 and 1987. The osteoarthritis was stage III or IV, with a joint space less than 50 per cent. Osteoarthritis was primitive in 25 cases and secondary in the others. The osteotomy always included a medial displacement of the shaft according to the principle of Mac Murray's procedure, but also 22 cases (33.8 per cent) had a varus angulation and 19 (29.2 per cent) a valgus angulation. The preoperative pain score according to the Merle d'Aubigné (MDA) grading was 2.6 (1 to 4) and the global functional score was 11.1 (5 to 15). The patients were reviewed in 1991 and examined clinically and radiographically.
RESULTS
The results of the 65 cases were distributed into 3 groups: -29 cases having reached the follow-up without difficulty, -7 patients were lost for follow-up examination, 6 of these latter than 9 years, -29 patients taking osteotomy failure as a pain lesser than the 3 MDA score. The postoperative delay to obtain the best functional result was 6 to 24 months (mean: 13.65). This result ranged from 5 to 17 MDA score (mean: 15) with pain ranging from 2 to 6 (mean: 5). The survivorship analysis curve showed 67.5 +/- 19.5 per cent survival for all osteotomies to the interval of 9-10 years. There were 3 types of results: -3 early failures (4.6 per cent) one because of a deep infection, -in 7 cases, after a short initial functional improvement, there was a progressive degradation leading to failure in 3.7 years (2 to 6 years), -55 cases with a lasting period of functional improvement, 26 osteotomies leading to failure in 3.5 to 15 postoperative years and, 29 cases having reached the follow-up (7 to 16 years mean 10 years). There was radiographic improvement of the osteoarthritis increasing the joint space in 59 cases (90.7 per cent). There was no radiographic improvement in the 6 other cases, including the 2 functional failures. The functional degradation appeared parallel to the radiographic degradation leading to a decrease of joint space to 90 per cent. We tested differences between various groups using Log Rank test. We found no difference in survival between the 3 different types of osteotomy.
DISCUSSION
The results of this study can help to choose between intertrochanteric osteotomy and THA in the case of severe osteoarthritis. The best functional result of the osteotomy is in one postoperative year, with a mean MDA score of 15 and a mean pain score of 5. It appears that we do not predict the duration of functional improvement, the patient has 2/3 chances that this improvement reaches 10 years.
Topics: Actuarial Analysis; Adolescent; Adult; Aged; Bone Nails; Bone Plates; Female; Femur; Follow-Up Studies; Humans; Male; Middle Aged; Osteoarthritis, Hip; Osteotomy; Radiography
PubMed: 7784644
DOI: No ID Found -
Operative Orthopadie Und Traumatologie Apr 2024Patient-specific cutting guides (PSCG) are used in osteotomy near to the knee joint to simplify the operative technique, shorten the duration of surgery, reduce... (Review)
Review
OBJECTIVE
Patient-specific cutting guides (PSCG) are used in osteotomy near to the knee joint to simplify the operative technique, shorten the duration of surgery, reduce radiation exposure and to exactly realize the preoperative planning during surgery, especially when complex deformities are corrected simultaneously in multiple planes.
INDICATIONS
The application of PSCG is in principle possible in all osteotomies near to the knee joint but is especially useful in multidimensional, complex osteotomy.
CONTRAINDICATIONS
No specific contraindications.
SURGICAL TECHNIQUE
After multidimensional 3D analysis and planning using a preoperative computed tomography (CT) protocol, a 3D-printed patient-specific cutting guide is produced. This PSCG is used during standard osteotomy near to the knee. Using this PSCG the guided sawcut and predrilling of the screw positions inside the bone for the screws of the planned angle stable osteotomy plate are performed. The amount of the deformity correction needed is "stored" in the PSCG and is converted to the bony geometry during placement of the screws in the predrilled holes through the plate after opening or closing the osteotomy. Apart from that, the surgical approach and technique are equivalent to the standard osteotomy types near to the knee.
POSTOPERATIVE MANAGEMENT
The application of PSCG in osteotomy near to the knee does not change the postoperative management of the specific osteotomy.
RESULTS
The use of patient-specific cutting guides leads to a higher accuracy in the implementation of the preoperative planning and the desired target axis is achieved with greater accuracy. Multidimensional complex corrections can also be exactly planned and implemented. In addition, the intraoperative radiation exposure for the operation team can possibly be reduced.
Topics: Humans; Treatment Outcome; Knee Joint; Osteotomy
PubMed: 38573503
DOI: 10.1007/s00064-024-00842-0 -
Der Orthopade Aug 2016The Bernese periacetabular osteotomy (PAO) is a surgical technique for the treatment of (1) hip dysplasia and (2) femoroacetabular impingement due to acetabular... (Meta-Analysis)
Meta-Analysis Review
The Bernese periacetabular osteotomy (PAO) is a surgical technique for the treatment of (1) hip dysplasia and (2) femoroacetabular impingement due to acetabular retroversion. The aim of the surgery is to prevent secondary osteoarthritis by improvement of the hip biomechanics. In contrast to other pelvic osteotomies, the posterior column remains intact with this technique. This improves the inherent stability of the acetabular fragment and thereby facilitates postoperative rehabilitation. The birth canal remains unchanged. Through a shortened ilioinguinal incision, four osteotomies and one controlled fracture around the acetabulum are performed. The direction of acetabular reorientation differs for both indications while the sequence of the osteotomies remains the same. This surgical approach allows for a concomitant osteochondroplasty in the case of an aspherical femoral head-neck junction. The complication rate is relatively low despite the complexity of the procedure. The key point for a successful long term outcome is an optimal reorientation of the acetabulum for both indications. With an optimal reorientation and a spherical femoral head, the cumulative survivorship of the hip after 10 years is 80-90 %. For the very first 75 patients, the cumulative 20-year survivorship was 60 %. The preliminary evaluation of the same series at a 30-year follow-up still showed a survivorship of approximately 30 %. The PAO has become the standard procedure for the surgical therapy of hip dysplasia in adolescents and adults.
Topics: Acetabuloplasty; Adolescent; Child; Child, Preschool; Comorbidity; Evidence-Based Medicine; Female; Femoracetabular Impingement; Hip Dislocation; Humans; Infant; Male; Osteoarthritis, Hip; Osteotomy; Prevalence; Risk Factors; Treatment Outcome
PubMed: 27250618
DOI: 10.1007/s00132-016-3265-6 -
Clinical Oral Investigations Nov 2019The aim of this in vitro study was to evaluate osteotomy speed, heat development, and bone structure influence from osteotomies performed by various piezoelectric...
OBJECTIVES
The aim of this in vitro study was to evaluate osteotomy speed, heat development, and bone structure influence from osteotomies performed by various piezoelectric devices and insert tips. These devices and tips were compared among each other with regard to conventional rotatory and oscillating systems with special focus on the insert tip design and thickness.
MATERIAL AND METHODS
The osteotomies were conducted on porcine ribs utilizing 12 different insert tips (straight and angulated) and three conventional systems. After time and temperature measurements, histological analysis was carried out. Light microscopy was used to evaluate the roughness of the osteotomic surface and to search for indications of thermal bone necrosis. A special software analyzing tool was employed to determine cutting width (mm) and debris (%).
RESULTS
All piezoelectric tips created smooth cuts. Cutting widths in general were wider than the actual insert tip size with a tendency for narrow straight insert tips producing relatively wide osteotomies, whereas narrow angulated inserts produced relatively small osteotomies. None of the samples demonstrated distinct indication of necrosis. Overall, there was only a small amount of debris in all osteotomy gaps. Conventional rotatory saws were faster and created less heat compared to all tested piezoelectric systems. Straight tips proved faster osteotomy speed than angulated tips. Thin insert tips indicated to have a positive correlation to osteotomy time and performed faster than conventional microsaw. The average temperature rise was lower when using conventional systems, but critical exceeding temperatures were only observed in short-time exceptional cases. In general, temperature rise was less when using angulated inserts.
CONCLUSION
All tested tips are appropriate for bone surgery. Only small differences were found among the piezoelectric insert tips. Although conventional rotatory systems in general performed faster osteotomies, special designed and thin piezoelectric insert tips seem to have a positive influence on osteotomy speed. Ultimately, none of the tested devices or inserts combined all best features of speed, heat development, bone structure influence, and safety.
CLINICAL RELEVANCE
Narrow and straight piezoelectric insert tips demonstrated reduced osteotomy times. Nevertheless, a combination of conventional and piezoelectric systems in clinical practice might be the best way to work time-efficient, patient-oriented, and safe. The choice of instrument should be based on clinical experience of the user and should be evaluated individually depending on the case.
Topics: Animals; Bone and Bones; Hot Temperature; Osteotomy; Piezosurgery; Swine
PubMed: 30826919
DOI: 10.1007/s00784-019-02838-8 -
The Laryngoscope Sep 1978The purpose is to assist the surgeon in the selection of modifications for nasal osteotomies. Details of the technique include: 1. Incision for osteotomy made...
The purpose is to assist the surgeon in the selection of modifications for nasal osteotomies. Details of the technique include: 1. Incision for osteotomy made perpendicular to the pyriform rim and modified incisions, intraoral or through the Weir incision. 2. Rasping of the lateral nasal vault prior to any osteotomies. 3. Removal of a modified beveled wedge of bone prior to the medial osteotomy, unroofing the bony dorsum to a higher level. 4. The medial osteotomy done prior to either the lateral or the intermediate osteotomy. The intermediate osteotomy is performed prior to the lateral. 5. "Complete" and "fading" medial osteotomies are utilized as indicated. 6. The lateral osteotomy may be relatively straight and low depending then on a transverse fracture or may be high and curved meeting the fading medial osteotomy. 7. A sub-periosteal tunnel with the osteotome guard external to the bone is preferred to a submucosal tunnel.
Topics: Humans; Osteotomy; Rhinoplasty
PubMed: 682801
DOI: 10.1002/lary.1978.88.9.1449 -
The Journal of Craniofacial Surgery Jun 2020To review the specific techniques of closing wedge osteotomy and open osteotomy, compare their clinical and radiographic outcomes, and apply these findings to mandibular...
PURPOSE
To review the specific techniques of closing wedge osteotomy and open osteotomy, compare their clinical and radiographic outcomes, and apply these findings to mandibular reconstruction.
METHODS
A thorough review of the otolaryngology, facial plastic and reconstructive surgery, oral and maxillofacial surgery, and orthopedic surgery literature was conducted in the Ovid MEDLINE, EMBASE, and Google Scholar databases using the terms 'osteotomy' and 'mandibular reconstruction.'
RESULTS
Traditionally, open osteotomies were thought to result in greater rates of malunion. However, multiple meta-analyses within the orthopedic literature have refuted this. Closing wedge osteotomies, on the other hand, may increase the chance of damaging a perforator. Again, no studies have evaluated the relationship between type of osteotomy and flap survival or wound healing. The particular type of osteotomy performed often depends on the type of osseous flap being utilized.
CONCLUSIONS
Open osteotomies are a viable and even preferred alternative, particularly in flaps without consistent perforators, such as scapular free flaps.
Topics: Humans; Mandibular Reconstruction; Osteotomy; Surgical Flaps
PubMed: 32282471
DOI: 10.1097/SCS.0000000000006344 -
Plastic and Reconstructive Surgery May 1991An improved method for performing angle osteotomies is described. An angle-osteotomy nomogram has been constructed allowing calculation of the width of a wedge osteotomy...
An improved method for performing angle osteotomies is described. An angle-osteotomy nomogram has been constructed allowing calculation of the width of a wedge osteotomy from the known thickness of the bone and the desired final degree of angulation. Use of the nomogram will speed operating time, improve technical precision, and minimize the chance of inadvertent injury to a vascularized bone graft that might occur in the event of repeated saw cuts.
Topics: Humans; Mathematics; Osteotomy; Patient Care Planning
PubMed: 2017511
DOI: 10.1097/00006534-199105000-00028 -
Foot and Ankle Clinics Mar 2018Metatarsal osteotomies can be divided into proximal and distal. The proximal osteotomies, such as the oblique, segmental, set cut, and Barouk-Rippstein-Toullec (BRT)... (Review)
Review
Metatarsal osteotomies can be divided into proximal and distal. The proximal osteotomies, such as the oblique, segmental, set cut, and Barouk-Rippstein-Toullec (BRT) osteotomy, all provide the ability to significantly change the position of the metatarsal head without violating the joint. These osteotomies, however, have a high rate of nonunion when done without internal fixation and can lead to transfer metatarsalgia when done without regard to the parabola of metatarsal head position. Distal osteotomies such as the Weil and Helal offer superior healing but have an increased incidence of recurrent metatarsalgia, joint stiffness, and floating toe.
Topics: Humans; Metatarsal Bones; Metatarsalgia; Osteotomy; Postoperative Complications
PubMed: 29362033
DOI: 10.1016/j.fcl.2017.10.001 -
Facial Plastic Surgery Clinics of North... May 2017Osteotomies are critical techniques in rhinoplasty. There are a variety of approaches, trajectories, and tools used with no widely standardized classification or... (Review)
Review
Osteotomies are critical techniques in rhinoplasty. There are a variety of approaches, trajectories, and tools used with no widely standardized classification or nomenclature. Percutaneous osteotomies are gaining in popularity, and picture framing the nasomaxillary bone is crucial for predictable fracture and reproducible results. This is best accomplished with medial, lateral, and transverse osteotomies. Intermediate osteotomies are used less frequently, but provide more mobility. With a detailed understanding of anatomy and a thorough approach to nasal osteotomies, the contour and function of the bony vault can be reshaped with a successful outcome for both the surgeon and patient.
Topics: Anesthesia; Humans; Nose; Osteotomy; Photography; Postoperative Complications; Preoperative Care; Rhinoplasty
PubMed: 28340651
DOI: 10.1016/j.fsc.2016.12.005 -
Spine Sep 2006Author experience and literature review. (Review)
Review
STUDY DESIGN
Author experience and literature review.
OBJECTIVES
To investigate and discuss decision-making on when to perform a Smith-Petersen osteotomy as opposed to a pedicle subtraction procedure and/or a vertebral column resection.
SUMMARY OF BACKGROUND DATA
Articles have been published regarding Smith-Petersen osteotomies, pedicle subtraction procedures, and vertebral column resections. Expectations and complications have been reviewed. However, decision-making regarding which of the 3 procedures is most useful for a particular spinal deformity case is not clearly investigated.
METHODS
Discussed in this manuscript is the author's experience and the literature regarding the operative options for a fixed coronal or sagittal deformity.
RESULTS
There are roles for Smith-Petersen osteotomy, pedicle subtraction, and vertebral column resection. Each has specific applications and potential complications.
CONCLUSION
As the magnitude of resection increases, the ability to correct deformity improves, but also the risk of complication increases. Therein, an understanding of potential applications and complications is helpful.
Topics: Algorithms; Decision Trees; Humans; Osteotomy; Spinal Curvatures; Spine
PubMed: 16946635
DOI: 10.1097/01.brs.0000231963.72810.38