OsteotomiesAboutKnee

OsteotomiesAboutKnee - OSTEOTOMIES ABOUT OSTEOTOMIES ABOUT...

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Unformatted text preview: OSTEOTOMIES ABOUT OSTEOTOMIES ABOUT THE KNEE Rod Martin M.D. FRCS(C) Outline Outline Introduction Distal Femoral Osteotomy Proximal Osteotomies of the Tibia – Closing wedge osteotomy Coventry Slocum HTO with jig & plate – Barrel­vault osteotomy – Opening wedge osteotomy OSTEOTOMIES ABOUT OSTEOTOMIES ABOUT THE KNEE Patients with malalignment and unicompartment disease Varus(4X) & valgus(5X) OA 2020 OA will have largest increase of new cases of any disease Unicompartment OA 30­60 age group High demand / middle aged athlete Varus Distal Femoral Varus Distal Femoral Osteotomy Indications – Valgus deformity > 12 to 15 degrees – Plane of the knee deviates from the horizontal >10 degrees 25­22 Distal Femoral Osteotomy Distal Femoral Osteotomy Reported success 71% ­ 86% Poor results with RA Satisfactory results with TKR 94% – (13 of 18 had complications) – Difficulty restoring desired 5­10 degrees valgus Coventry Distal Femoral Coventry Distal Femoral Osteotomy Coventry – Medial or midline incision – Rectus/medialis interval – Insert blade at templated angle – Osteotomy of femur – Close wedge/secure plate 25­23 Proximal Osteotomies of Proximal Osteotomies of the Tibia Treatment of unicompartmental OA 80% satisfactory results @ 5 years Varus deformity = medial OA Valgus deformity = lateral OA Osteotomy “unloads” the “overloaded” Proximal Osteotomies of Proximal Osteotomies of the Tibia Coventry (1965) – – – Medial closing wedge for valgus deformity Lateral closing wedge for varus deformity Advantages Near the deformity Cancellous bone heals quickly Fragments held firmly by 1­2 staples Permits evaluation of the knee through the same incision Proximal Osteotomies of Proximal Osteotomies of the Tibia Coventry (1979) – 80% at 5 years & 60% at 10 years (213 knees) – Recurrence of deformity = recurrence of pain – Minimum “overcorrection” 8 degrees valgus – >30% ideal body weight = high failure Proximal Osteotomies of Proximal Osteotomies of the Tibia Indications – Pain and disability – Unicompartment OA – Ability to use crutches post­op – Good vascular status Proximal Osteotomies of Proximal Osteotomies of the Tibia Contraindications – Narrowing of lateral compartment – Lateral tibial subluxation of > 1 cm – Medial compartment bone loss > 2­3 mm – Flexion contracture > 15 degrees – Knee flection < 90 degrees – Correction of > 10­15 degrees – Inflammatory arthropathies Proximal Osteotomies of the Proximal Osteotomies of the Tibia Coventry correction formula – (1) Normal valgus (5­8 degrees) – (2) + amount of varus deformity – (3) + “overcorrection factor” of 3 to 5 degrees = total correction required (approx. 1 mm / degree) Proximal Osteotomies of the Proximal Osteotomies of the Tibia 25­10 Proximal Osteotomies of Proximal Osteotomies of the Tibia (Coventry) Proximal Osteotomies of Proximal Osteotomies of the Tibia (Coventry) Proximal Osteotomies of Proximal Osteotomies of the Tibia (Slocum) Proximal Osteotomies of Proximal Osteotomies of the Tibia (jig and plate) Proximal Osteotomies of the Proximal Osteotomies of the Tibia Proximal Osteotomies of the Proximal Osteotomies of the Tibia Maquet (barrel­vault) osteotomy – Inherently stable – “extensive” degrees of correction possible – Technically difficult – Intraarticular fracture – Scarring about the patellofemoral mechanism Proximal Osteotomies of Proximal Osteotomies of the Tibia (Barrel­vault) Proximal Osteotomies of the Proximal Osteotomies of the Tibia Medial opening wedge osteotomy – Does not “shorten” the extremity – Correct medial laxity – Surgery directed to the diseased compartment – Corrects up to 15˚ Proximal Osteotomy of the Proximal Osteotomy of the Tibia (opening wedge) conclusions conclusions Delays/avoids arthroplasty Refute claims osteotomies compromise arthroplasty Second “wave” of osteotomies coming 43 year female with 43 year female with increasing knee pain M.B. 43 year female M.B. 43 year female increasing knee pain Opening wedge HTO Opening wedge HTO 6mos post op Resumed all adl’s “knee feels 75% better” Thank you ...
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