Journal of Clinical & Experimental Orthopaedics

Description

High tibial osteotomy is effective for managing a variety of knee conditions, including gonarthrosis with varus or valgus misalignment, osteochondritis dissecans, osteonecrosis, posterolateral instability, and chondral resurfacing. The fundamental goals of the procedure are to unload diseased articular surfaces and to correct angular deformity at the tibiofemoral articulation. Although the clinical success of total knee arthroplasty has resulted in fewer high tibial osteotomies being done during the past decade, the procedure remains useful in appropriately selected patients with unicompartmental knee disease. Renewed interest in high tibial osteotomy has occurred for a number of reasons. These include the prevalence of physiologically young active patients presenting with medial compartment osteoarthritis; the advent of new techniques for performing the procedure (ie, improved instrumentation and fixation plates for medial opening wedge osteotomy, dynamic external fixation for medial opening wedge osteotomy, and improved instrumentation for lateral closing wedge osteotomy); and the need to concomitantly correct misalignment when performing chondral resurfacing procedures (i.e., autologous chondrocyte transplantation, mosaicplasty, and microfracture).

Subluxation

Fifty-one osteoarthritic knees treated by high tibial osteotomy were followed for at least five years. Deterioration after an initial good result was uncommon (five cases). Most of the good results were in knees (thirty of forty-five) with mild varus deformity and good ligament stability. It is, therefore, possible to select the knee suitable for osteotomy from measurement of the preoperative standing roentgenogram. We recommend that tibial osteotomy be done only when there is less than 10 degrees of varus deformity. In a knee with more than 15 degrees of varus deformity there will be subluxation on weight-bearing and tibial osteotomy is contraindicated. The tibial tubercle (interchangeable with tuberosity) is the most distal anchor of the extensor mechanism and can serve as a tool in altering patellofemoral (PF) mechanics. Known collectively as distal realignment procedures, osteotomies of the tibial tubercle are a useful method to treat a variety of PF conditions by allowing coronal, axial, and sagittal plane adjustments of the patellofemoral articulation which redistribute patellar contact pressures (force and contact area) and potentially improve tracking. There was a statistically significant decrease in major complications from 17% to 2.9 % when comparing the first 35 cases with the second 35 cases of periacetabular osteotomy performed by one surgeon. There were no cases of intra articular fracture, conversion to total hip replacement, or deaths in this series. Of considerable significance was that almost all major complications, as defined for disclosure in this report, left the patients with no permanent sequelae after either successful treatment, as in intraoperative bleeding, or with observation with time, as for recovery of sciatic nerve function. The complication rate of periacetabular osteotomy decreases significantly in proportion to increasing experience, as documented in this study. Patients in ongoing studies completed the Western Ontario and McMaster Universities Osteoarthritis Index and the Short Form- 36 preoperatively, which will add to the authors' ability to comment on functional outcomes in future reports.

Left Intact

A modification of the triple pelvic osteotomy for children over 8 years and the young adult is described. The results of the first 32 cases are reviewed. These show that the indications for the operation can be widened so that not only primary dysplasias but also subluxed or dislocated hips with secondary dysplasia can be operated on successfully. The operation is done in two stages. At first the patient is lying prone. The osteotomy of the ischial ramus is done dorsally by cutting the connection between the sciatic notch and obturator foramen immediately behind and below the acetabulum. In the second stage, with the patient lying supine, the public and the iliac osteotomy are performed rather circular and parallel to the hip joint. These modifications have several advantages: (a) the operator has a direct field of view at all times; (b) the osteotomy is performed close to the acetabulum, thus allowing a great amount of lateral rotation and medial displacement of the acetabulum, thereby providing good coverage of the femoral head by hyaline cartilage the ischial ramus and its ligaments to the sacrum are left intact, leading to greater stability of the pelvis and spine. With increasing requirements for medical effects, and huge differences among individuals, traditional surgical instruments are difficult to meet the patients' growing medical demands. 3D printing is increasingly mature, which connects to medical services critically as well. The patient specific surgical guide plate provides the condition for precision medicine in orthopaedics. Global sagittal misalignment is significantly correlated with health-related quality-of-life scores in the setting of spinal deformity. In order to address rigid deformity patterns, the use of spinal osteotomies has seen a substantial increase. Unfortunately, variations of established techniques and hybrid combinations of osteotomies have made comparisons of outcomes difficult.