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Journal of Orthopaedics Jul 2024Developmental Coxa Vara (DCV) consists on a pathological reduction in head-shaft angle (HSA) and increased femoral retroversion. Several case series reported outcomes on... (Review)
Review
BACKGROUND
Developmental Coxa Vara (DCV) consists on a pathological reduction in head-shaft angle (HSA) and increased femoral retroversion. Several case series reported outcomes on proximal femoral valgus osteotomy (PFVO), but no evidence synthesis had been conducted. This systematic review aimed to (1) analyze success rate and complications, (2) report the degree of correction according to the HSA and the Hilgenreiner Epiphyseal Angle (HEA), compare success rate and degree of correction of subtrochanteric (SVO) vs intertrochanteric (IVO) osteotomy, and (4) difference in success rate and correction between patients in which an internal (IF) or external fixation (EF) technique was used.
METHODS
Four databases (PubMed, Scopus, Embase, and Cochrane Database of Systematic Reviews) were searched until February 20th 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies presenting outcomes on PFVO for DCV with >2 years follow-up and >5 patients were included. Review articles, language other than English and coxa vara secondary to other conditions were excluded. Study quality was evaluated through MINORS criteria.
RESULTS
10 case series (level of evidence IV) were located for a total of 153 patients and 192 hips. Baseline results were as follows: male/female ratio was 1.45, mean age at surgery was 6.7 ± 1.5 and follow-up 5.1 ± 5.5 years. Overall success rate was 88.8%, with failure considered as any indication to revision surgery. Complications included loss of correction (10.9%), deep (1.0%) or superficial wound infection (2.6%). Revision surgery was performed in 18 hips (9.4%). Average correction was measured through HSA (preoperative 94.6 ± 8.1, postoperative 134.4 ± 10.2, change 38.2 ± 7.5°, p < 0.001) and HEA (preoperative 71.9 ± 5.5, postoperative 31.7 ± 5.7°, change 33.7 ± 10.5°, p < 0.001). Success rate was similar between osteotomy techniques (SVO: 91.0%; IVO: 94.1%; p = 0.48) and fixation strategy (IF: 85.4%; EF 95.8%; p = 0.096).
CONCLUSIONS
PFVO presented satisfactory results for the treatment of DCV, with similar outcomes concerning the osteotomy site and fixation technique used. HSA and HEA correction were correlated to PFVO success rate. However, coxa vara is a tridimensional deformity, thus other parameters such as posterior sloping angle, mechanical axial deviation and proximal femoral offset should be included in future studies.
PubMed: 38495579
DOI: 10.1016/j.jor.2024.03.001 -
Journal of Epidemiology and Global... Mar 2024Developmental dysplasia of the hip (DDH) leads to pain, joint instability, and early degenerative joint disease. Incidence, prevalence, and management strategies of DDH... (Review)
Review
BACKGROUND
Developmental dysplasia of the hip (DDH) leads to pain, joint instability, and early degenerative joint disease. Incidence, prevalence, and management strategies of DDH have been well-documented in several countries, but not in Saudi Arabia.
OBJECTIVE
We synthesized the current evidence regarding incidence, prevalence, risk factors, and clinical treatment for children with DDH in Saudi Arabia.
METHODS
We searched 3 databases to locate studies. Studies that included children with DDH in Saudi Arabia; reported either incidence rate, prevalence, risk factors, and/or clinical practice; and were available in English or Arabic were included. We excluded reviews, case studies, or animal studies. Two independent authors reviewed potential studies and assessed study's quality.
RESULTS
Our search yielded 67 potential studies, of which 16 studies were included (total DDH sample = 3,127; age range = 2.5 to 86.4 months). Three studies reported incidence rates ranging from 3.1 to 4.9 per 1000 births, and 3 studies reported prevalence ranging from 6 to 78%. Nine studies reported that female sex, breech position, family history, and age less than 3 years were risk factors associated with DDH. Four studies reported that brace applications and closed reduction were conservative treatments, and 9 studies reported that open hip reduction, adductor tenotomy, and/or pelvic osteotomy were surgical approaches to treat DDH.
CONCLUSIONS
In Saudi Arabia, the Incidence and prevalence rates of DDH are 3.1 to 4.9 per 1,000 births, and 6-78%, respectively (differ from what has been reported in other countries), but the risk factors of DDH in Saudi Arabia appear to be similar in comparison to other countries (female, breech presentation, family history of DDH).
PubMed: 38483754
DOI: 10.1007/s44197-024-00217-5 -
Sensors (Basel, Switzerland) Mar 2024Ensuring precise angle measurement during surgical correction of orientation-related deformities is crucial for optimal postoperative outcomes, yet there is a lack of an... (Review)
Review
Ensuring precise angle measurement during surgical correction of orientation-related deformities is crucial for optimal postoperative outcomes, yet there is a lack of an ideal commercial solution. Current measurement sensors and instrumentation have limitations that make their use context-specific, demanding a methodical evaluation of the field. A systematic review was carried out in March 2023. Studies reporting technologies and validation methods for intraoperative angular measurement of anatomical structures were analyzed. A total of 32 studies were included, 17 focused on image-based technologies (6 fluoroscopy, 4 camera-based tracking, and 7 CT-based), while 15 explored non-image-based technologies (6 manual instruments and 9 inertial sensor-based instruments). Image-based technologies offer better accuracy and 3D capabilities but pose challenges like additional equipment, increased radiation exposure, time, and cost. Non-image-based technologies are cost-effective but may be influenced by the surgeon's perception and require careful calibration. Nevertheless, the choice of the proper technology should take into consideration the influence of the expected error in the surgery, surgery type, and radiation dose limit. This comprehensive review serves as a valuable guide for surgeons seeking precise angle measurements intraoperatively. It not only explores the performance and application of existing technologies but also aids in the future development of innovative solutions.
Topics: Surgery, Computer-Assisted; Fluoroscopy
PubMed: 38475148
DOI: 10.3390/s24051613 -
Head & Face Medicine Mar 2024The purpose of this study was to systematically review the randomized and non-randomized clinical trials (RCT; nRCT) concerning the different available osteotomies for...
The purpose of this study was to systematically review the randomized and non-randomized clinical trials (RCT; nRCT) concerning the different available osteotomies for surgically assisted rapid maxillary expansion (SARME): pterygomaxillary disjunction (SARME + PD vs SARME-PD) and segmental Le Fort I osteotomy (2-piece vs 3-piece). Outcomes focused on skeletal, dental, upper airway changes, complications, and relapse. Two authors investigated five databases (PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science) until August 2023. The Cochrane Collaboration Tool and the Newcastle-Ottawa scale were used for the quality assessment of the included RCTs and nRCTs, respectively. A total of 554 articles were retrieved and after duplicates removing and full-text reading, 40 studies were included. Two RCTs showed a low risk of bias, one an unclear risk and one a high risk. Among the non-RCTs, 15 studies showed a good quality, while 21 exhibited a fair quality score. SARME + PD resulted in more homogeneous posterior bone expansion, with minimal dental effects. No difference between 2-piece and 3-piece in asymmetric expansion was observed, although 3SO showed 1-2 mm of more transverse increase. The oropharynx minimum cross-sectional area, the nasopharynx and the oropharynx volume were greater in SARME + PD. Both dental and bone relapse can occur but no differences between the groups were observed. All osteotomies guaranteed a correction of transverse maxillary deficiency. Lower side effects were described in SARME + PD. Two-piece and 3-piece segmental Le Fort I osteotomies did not show any differences in the symmetry and amount of expansion.
Topics: Humans; Clinical Trials as Topic; Maxilla; Osteotomy, Le Fort; Palatal Expansion Technique; Recurrence; Tooth
PubMed: 38459578
DOI: 10.1186/s13005-024-00415-3 -
Orthopaedic Journal of Sports Medicine Mar 2024High tibial osteotomy (HTO) can cause postoperative hemorrhage. The use of tranexamic acid to reduce the hemorrhage is still controversial.
BACKGROUND
High tibial osteotomy (HTO) can cause postoperative hemorrhage. The use of tranexamic acid to reduce the hemorrhage is still controversial.
PURPOSE
To investigate the efficacy and safety of tranexamic acid in HTO.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors conducted a comprehensive search of the Embase, Cochrane Library, PubMed, Web of Science, MEDLINE, and Foreign Medical Literature Retrieval Service databases between their inception and January 1, 2023. All clinical studies comparing the use of tranexamic acid versus no tranexamic acid during HTO were collected. The primary outcome measures were hemoglobin decrease, drainage volume, and blood loss, and the secondary outcome measures were wound complications, blood transfusion, and postoperative thrombosis. All indicators were analyzed using meta-analysis software. Results were reported as mean differences or risk ratios with 95% confidence intervals.
RESULTS
Of 152 initial results, 9 studies involving 908 patients were included. The tranexamic acid group had lower indicators for total blood loss, hemoglobin decrease, and total drainage volume ( < .00001 for all). There were no differences between patients with versus without tranexamic acid in wound complications, including hematoma ( = .21) or infection ( = .18), nor were there any group differences in the prevalence of blood transfusion ( = .21) or postoperative thrombosis ( = .36).
CONCLUSION
Tranexamic acid was able to effectively reduce postoperative hemorrhage in patients undergoing HTO without affecting the rates of wound complications, blood transfusion, or postoperative thrombosis.
PubMed: 38455151
DOI: 10.1177/23259671241231761 -
JBJS Case Connector Jan 2024A 16-year-old boy presented with a recurrent distal femur aneurysmal bone cyst accompanied by a combined sagittal knee deformity (20° of femoral antecurvatum and 26.8°...
CASE
A 16-year-old boy presented with a recurrent distal femur aneurysmal bone cyst accompanied by a combined sagittal knee deformity (20° of femoral antecurvatum and 26.8° of tibial recurvatum) and limb shortening. After preoperative planning, the treatment involved new intralesional curettage, phenolization, and bone allograft filling. Additional procedures included distal extension femoral osteotomy with plate fixation, and proximal tibial osteotomy with, gradually corrected through a hexapod frame. At 2-year follow-up, lower limbs exhibited normoalignment and equal length.
CONCLUSION
Complex knee deformities may occur with tumoral lesions around the knee but can be effectively addressed through double osteotomy and application of a hexapod frame.
Topics: Male; Humans; Adolescent; Bone Cysts, Aneurysmal; Joint Deformities, Acquired; Femur; Tibia; Knee Joint
PubMed: 38452160
DOI: 10.2106/JBJS.CC.23.00496 -
Cureus Feb 2024This systematic review aims to assess the management of knee osteoarthritis through proximal fibular osteotomy (PFO) in the Indian population by synthesizing data from... (Review)
Review
This systematic review aims to assess the management of knee osteoarthritis through proximal fibular osteotomy (PFO) in the Indian population by synthesizing data from various prospective cohort and interventional studies. We seek to provide an overview of the effectiveness and safety of PFO as a treatment modality and offer insights into its potential implications for clinical practice in India. A systematic search strategy was employed, targeting multiple medical databases to identify relevant studies published from 2018 to 2023. Inclusion criteria encompassed studies involving Indian patients with medial compartment knee osteoarthritis and varus deformity who underwent PFO. Data were extracted and evaluated according to the Newcastle-Ottawa Scale for observational studies. Eight studies were included in this review, each displaying varying designs, patient populations, and follow-up duration. The findings consistently indicated that PFO improved pain, knee function, and radiological outcomes, such as knee joint space and tibio-femoral angles. These improvements were generally sustained over several months to a year. The available evidence underscores the potential of PFO as a promising intervention for managing knee osteoarthritis in the Indian population, particularly in patients with medial compartment involvement and varus deformity. While these results are promising, the limitations inherent in the current literature, including study design variations and small sample sizes, necessitate further research with more extensive and diverse patient populations. This systematic review provides valuable insights for healthcare professionals and researchers, highlighting the need for more rigorous investigations and supporting the consideration of PFO as a viable treatment option for knee osteoarthritis in India.
PubMed: 38449963
DOI: 10.7759/cureus.53638 -
Journal of ISAKOS : Joint Disorders &... Jun 2024Derotational high tibial osteotomy (HTO) is a surgical intervention for correcting rotational malalignments in the lower limb, which may contribute to anterior knee pain... (Review)
Review
IMPORTANCE
Derotational high tibial osteotomy (HTO) is a surgical intervention for correcting rotational malalignments in the lower limb, which may contribute to anterior knee pain (AKP) and/or patellofemoral instability (PFI). This surgical technique is not yet widely implemented and requires a systematic evaluation of its outcomes.
AIM
To assess the effectiveness of derotational HTO in correcting rotational malalignments of the lower limb in patients with AKP and/or PFI through radiological, clinical, and patient-reported outcome measures.
EVIDENCE REVIEW
Searches were conducted in the PubMed, Embase, and Web of Science databases up to March 3, 2023, to identify studies utilizing derotational HTO in patients with AKP and/or PFI. The primary outcome measures of interest were measurements of lower limb angular correction. Other radiological, clinical, and patient-reported outcome measures were also analyzed. The risk of bias was judged with the RoBANS tool.
FINDINGS
A total of 8 studies were included, comprising 215 patients (27.0 ± 3.9 years) and 245 knees. The most reported angle was tibial torsion (k = 6 studies, n = 173 knees), with a mean difference between postoperative and preoperative values (postsurgical correction) ranging from -37.8° to -10.8°. Patient-reported outcome measures showed significant improvements in the postoperative moment, exceeding the minimal clinically important difference in almost all cases, and with high patient satisfaction (93.6%).
CONCLUSIONS AND RELEVANCE
Derotational HTO allows the correction of rotational malalignments of the lower limb (tibial torsion) and promotes patient satisfaction.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Osteotomy; Tibia; Joint Instability; Patellofemoral Joint; Patient Reported Outcome Measures; Knee Joint; Adult
PubMed: 38430984
DOI: 10.1016/j.jisako.2024.02.015 -
Archives of Orthopaedic and Trauma... Mar 2024The role of valgus producing high tibial osteotomy (HTO) for the treatment of advanced knee osteoarthritis (OA) is still controversial. The aim of the current systematic... (Review)
Review
INTRODUCTION
The role of valgus producing high tibial osteotomy (HTO) for the treatment of advanced knee osteoarthritis (OA) is still controversial. The aim of the current systematic review was to assess survivorship and patient-reported outcomes (PROMs) of high tibial osteotomy in patients with radiological advanced medial knee OA.
METHODS
A systematic search of PubMed, Cochrane and EMBASE database was performed in July 2023 in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Inclusion and exclusion criteria were applied to identify studies investigating the survivorship rate and PROMs of valgus-producing high tibial osteotomy in patients with advanced knee OA at x-ray assessment in the medial compartment at minimum-two-years follow up. Advanced radiological OA was defined as Kellgren Lawrence (K-L) ≥ 3 or Ahlbäch ≥ 2. Survivorship was defined as percentage of patients free of total knee arthroplasty (TKA) at follow-up. Clinical interpretation of provided PROMs were performed according to minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) target values reported in literature. Survivorship data and PROMs scores were extracted, and studies were stratified based on selected study features. The quality of included studies was assessed with modified Coleman score.
RESULTS
A total of 18 studies, totalling 1296 knees with a mean age between 46.9 and 67 years old, were included. Average survivorship was of 74.6% (range 60 - 98.1%) at 10-years follow up. The subjective scoring systems showed good results according to MCID and PASS, and postoperative improvements were partially maintained until final follow-up.
CONCLUSION
HTO is worth considering as treatment choice even in patients affected by radiological advanced medial knee osteoarthritis. Long term survivorship and good patient reported clinical outcomes could be expected in this population.
LEVEL OF EVIDENCE
IV; systematic review of level III-IV studies.
PubMed: 38430233
DOI: 10.1007/s00402-024-05254-0 -
Journal of Clinical Orthopaedics and... Mar 2024Focal chondral defects are often treated with cartilage restoration procedures. Malalignment often accompanies chondral defects. High tibial osteotomy (HTO), classically... (Review)
Review
BACKGROUND
Focal chondral defects are often treated with cartilage restoration procedures. Malalignment often accompanies chondral defects. High tibial osteotomy (HTO), classically utilized to treat uni-compartmental knee osteoarthritis, corrects malalignment. HTO combined with cartilage restoration procedures can treat uni-compartmental osteoarthritis and focal chondral defects.
PURPOSE
To assess outcomes of combined HTO and cartilage restoration procedures and review prognostic factors that may assist in preoperative planning and patient counseling.
STUDY DESIGN
Systematic Review of published literature.
METHODS
A systematic review of PubMed and Scopus was performed following PRISMA guidelines. Thirty-four papers were included in qualitative considerations.
RESULTS
Thirty-four papers that reported the combined outcome of HTO and cartilage repair were included. Twenty of the 34 included papers reported prognostic factors that affected the success or failure of combined HTO and cartilage repair surgery for focal articular defect and uni-compartmental knee osteoarthritis. Cartilage repair techniques that were combined with HTO and included in this review are bone marrow stimulation, allograft transplantation, osteochondral autograft transplantation, autologous chondrocyte implantation, and mesenchymal stem cell implantation.
CONCLUSIONS
HTO with adjunctive cartilage repair procedures improve clinical outcome scores and restore alignment in patients with medial compartment osteoarthritis and isolated focal chondral defects. HTO with adjunctive cartilage procedures produces optimal results in younger, non-obese patients with focal chondral defects and varus malalignment, without significant lateral compartment and patellofemoral involvement.
PubMed: 38425335
DOI: 10.1016/j.jcot.2024.102360