Double-elevating osteotomy for late-presenting infantile Blount's disease: the importance of concomitant lateral epiphysiodesis

We reviewed 34 knees in 24 children after a double-elevating osteotomy for late-presenting infantile Blount's disease. The mean age of patients was 9.1 years (7 to 13.5). All knees were in Langenski?ld stages IV to VI. The operative technique corrected the depression of the medial joint line by an elevating osteotomy, and the remaining tibial varus and internal torsion by an osteotomy just below the apophysis. In the more recent patients (19 knees), a proximal lateral tibial epiphysiodesis was performed at the same time. The mean pre-operative angle of depression of the medial tibial plateau of 49 degrees (40 degrees to 60 degrees ) was corrected to a mean of 26 degrees (20 degrees to 30 degrees ), which was maintained at follow-up. The femoral deformity was too small to warrant femoral osteotomy in any of our patients. The mean pre-operative mechanical varus of 30.6 degrees (14 degrees to 66 degrees ) was corrected to 0 degrees to 5 degrees of mechanical valgus in 29 knees. In five knees, there was an undercorrection of 2 degrees to 5 degrees of mechanical varus. At follow-up a further eight knees, in which lateral epiphysiodesis was delayed beyond five months, developed recurrent tibial varus associated with fusion of the medial proximal tibial physis.     

Serrated W/M osteotomy. Results using a new technique for the correction of infantile tibia vara

The conventional osteotomies used to treat infantile tibia vara (Blount's disease) may require internal fixation and its subsequent removal. These techniques, which carry the risk of traction injury, and potential problems of stability and consolidation, do not always succeed in correcting the rotational deformity which accompanies the angular deformity. We have used a new surgical approach, the serrated W/M osteotomy of the proximal tibia, to correct infantile tibia vara in 15 knees of 11 patients. We present the results in 13 knees of nine patients who have been followed up for a mean of eight years. The mean angular correction achieved after operation was 18 +/- 5.8 degrees. The mean femorotibial shaft angle was corrected from 14.2 +/- 3.7 degrees of varus to 4.6 +/- 4.4 degrees of valgus. At the last follow-up, the mean angular correction had reduced to 1.3 +/- 4.9 degrees of valgus without compromising the rotational correction and the overall good clinical results. All the patients and parents were satisfied, rating the result as excellent or good. There were no major postoperative complications and no reoperations. Eight patients were free from pain and able to perform physical activities suitable for their age. One complained of occasional pain. This procedure has the advantage of allowing both angular and rotational correction with a high degree of success without the need for internal fixation.     

Chevron osteotomy for correction of hallux valgus: a long-term follow-up study

Seventy-six consecutive patients with 106 bunions were examined 6 years after chevron osteotomy. The feet were evaluated clinically and radiologically. The American Orthopaedic Foot and Ankle Society (AOFAS) scale (0–100) was used. The mean age of the patients was 46 years at time of operation. Ninety-six % of the operated patients were female. At 6 year follow-up, the hallux valgus angle was 17,9 degrees (range, 2–42 degrees) and the intermetatarsal angle was 10,5 degrees (range, 4–20 degrees). The change of the hallux valgus angle (compared to the preoperative X-ray picture) was 6,4 degrees (P<0,001, 95% confidence interval 4,0 to 8,7 degrees). The mean AOFAS score was 81 (±SD15). The study indicates that the long term results of chevron osteotomy are variable. The clinical evidence of effectiveness is still weak and there is an obvious need for randomized controlled trials in this field.     

Scarf osteotomy for hallux valgus. A prospective clinical and pedobarographic study

We prospectively reviewed 24 patients (35 feet) who had been treated by a Scarf osteotomy and Akin closing-wedge osteotomy for hallux valgus between June 2000 and June 2002. There were three men and 21 women with a mean age of 46 years at the time of surgery. The mean follow-up time was 20 months. Our results showed that 50% of the patients were very satisfied, 42% were satisfied, and 8% were not satisfied. The mean American Orthopaedic Foot and Ankle Society score improved significantly from 52 points pre-operatively to 89 at follow-up (p < 0.001). The intermetatarsal and hallux valgus angles improved from the mean pre-operative values of 15 degrees and 33 degrees to 9 degrees and 14 degrees, respectively. These improvements were significant (p < 0.0001). The change in the distal metatarsal articular angle was not significant (p = 0.18). There was no significant change in the mean pedobarographic measurements of the first and second metatarsals after surgery (p = 0.2). The mean pedobarographic measurements of the first and second metatarsals at more than one year after surgery were within the normal range. Two patients had wound infections which settled after the administration of antibiotics. One patient had an intra-operative fracture of the first metatarsal and one required further surgery to remove a long distal screw which was irritating the medial sesamoids. We conclude that the Scarf osteotomy combined with the Akin closing-wedge osteotomy is safe and effective for the treatment of hallux valgus.     

Outcome of the scarf osteotomy in adolescent hallux valgus

Purpose  We have reported the radiological and clinical outcome of scarf osteotomy in the treatment of moderate to severe hallux valgus among adolescent children. Method  Data were collected retrospectively between April 2001 and June 2006. The pre- and post-operative intermetatarsal angle (IMA), hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA) were determined. Patients were followed up for a mean of 37.6 months. Results  Thirteen patients with 19 operated feet were available at the time of the latest follow-up. There was significant improvement in the mean post-operative IMA, which was maintained to the last follow-up. There was statistically significant improvement in the 6-week post-operative HVA and DMAA. However, this was lost at the final follow-up. The mean American Orthopaedic Foot and Ankle Society score for the whole group was 80 (54–100). Conclusion  This study indicates that scarf osteotomy should be used with caution in symptomatic adolescent hallux valgus, as there is a high recurrence rate.     

Plate fixation for crescentic metatarsal osteotomy in the treatment of hallux valgus: an eight-year followup study

BACKGROUND: Distal soft tissue realignment and crescentic metatarsal osteotomy is a popular procedure in the treatment of hallux valgus. The traditional technique of screw fixation for crescentic osteotomy is technically demanding, and the inferior stability of this construct has been described. We evaluated the long-term results of a modified fixation method. METHODS: Twenty-six patients (32 feet) undergoing this procedure were retrospectively reviewed. Five patients (six feet) were lost to followup. Mean age of the patients was 47 (14 to 74) years. The osteotomy was fixed with a 2.7 mm AO plate. Assessment of clinical and radiographic results was performed at a mean followup of 2.7 (1.3 to 7.2) years and 8.0 (6.1 to 12.0) years, respectively. RESULTS: The mean American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 57.9 to 90.5 at 2.7 years of mean followup, whereas the patient satisfaction rate was 96%. The intermetatarsal angle (IMA) and hallux valgus angle (HVA) improved from the mean preoperative values of 16.1 degrees and 34.2 degrees to 9.5 degrees and 16.3 degrees. At eight years of mean followup, the mean AOFAS score and patient satisfaction rate remained at 88.5% and 92%. The mean IMA and mean HVA were 9.7 degrees and 17.0 degrees. Complications included one case of hallux varus (4%) and two cases of recurrence (8%). The osteotomy achieved union in all cases. CONCLUSIONS: Dorsal plate fixation of crescentic metatarsal osteotomy is a technically easier procedure. Equally good results can be achieved when compared with screw fixation methods, and the results can be maintained long-term.     

A modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus

Abstract

The purpose of this brief paper is to present the preliminary results of a modified Austin/chevron osteotomy for treatment of hallux valgus and hallux rigidus. In this procedure, the dorsal arm of the osteotomy is performed orthogonal to the horizontal plane of the first metatarsal, the main advantage being that this allows much easier and more accurate multiplanar correction of first metatarsal deformities. From 2010 to 2013, 184 consecutive patients with symptomatic hallux valgus and 48 patients with hallux rigidus without severe metatarsophalangeal joint degeneration underwent such modified chevron osteotomy. Mean patient age was 54.9 (range 21–70) years, and mean follow-up duration was 41.7 (range 24–56) months. Ninety-three percent of patients were satisfied with the surgery. Mean American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 56.6 preoperatively to 90.6 at last follow-up, and mean visual analog scale (VAS) pain score decreased from 5.7 preoperatively to 1.6 at final follow-up (p < 0.05). In patients treated for hallux valgus, mean hallux valgus angle decreased from 34.1° preoperatively to 6.2° at final follow-up, and mean intermetatarsal angle decreased from 18.5° preoperatively to 4.1° at final follow-up (p < 0.05). One patient developed postoperative transfer metatarsalgia, treated successfully with second-time percutaneous osteotomy of the minor metatarsals, whilst one patient had wound infection that resolved with systemic antibiotics.

Level of evidence

Level IV.     

Femoral varus: an important component in late-onset Blount's disease.

Femoral varus has proven a significant deformity in late-onset Blount's disease. In a retrospective study, six adolescent patients demonstrated mean femoral varus deformity of 10 degrees (range 5 degrees-16 degrees) more than the calculated ideal femoral joint angle (p less than 0.01). This represented between 34 and 76% of the net genu vara deformity of the affected limbs. In the eight infantile patients, all genu vara deformity was in the tibia. The significance of femoral varus should be determined for each patient afflicted with late-onset genu vara preoperatively to avoid compensatory deformity.     

Hallux valgus and first ray mobility. A prospective study

BACKGROUND: There have been few prospective studies that have documented the outcome of surgical treatment of hallux valgus deformities. The purpose of this investigation was to evaluate the effect of operative treatment of hallux valgus with use of a proximal crescentic osteotomy and distal soft-tissue repair on the first metatarsophalangeal joint. METHODS: All adult patients in whom moderate or severe subluxated hallux valgus deformities had been treated with surgical repair between September 1999 and May 2002 were initially enrolled in the study. Those who had a hallux valgus deformity treated with a proximal crescentic osteotomy and distal soft-tissue reconstruction (and optional Akin phalangeal osteotomy) were then invited to return for a follow-up evaluation at a minimum of two years after surgery. Outcomes were assessed by a comparison of preoperative and postoperative pain and American Orthopaedic Foot and Ankle Society scores; objective measurements included ankle range of motion, Harris mat imprints, mobility of the first ray (assessed with use of a validated calibrated device), and radiographic angular measurements. RESULTS: Of the 108 patients (127 feet), five patients (five feet) were unavailable for follow-up, leaving 103 patients (122 feet) with a diagnosis of moderate or severe primary hallux valgus who returned for the final evaluation. The mean duration of follow-up after the surgical repair was twenty-seven months. The mean pain score improved from 6.5 points preoperatively to 1.1 points following surgery. The mean American Orthopaedic Foot and Ankle Society score improved from 57 points preoperatively to 91 points postoperatively. One hundred and fourteen feet (93%) were rated as having good or excellent results following surgery. Twenty-three feet demonstrated increased mobility of the first ray prior to surgery, and only two feet did so following the bunion surgery. The mean hallux valgus angle diminished from 30 degrees preoperatively to 10 degrees postoperatively, and the mean first-second intermetatarsal angle decreased from 14.5 degrees preoperatively to 5.4 degrees postoperatively. Plantar gapping at the first metatarsocuneiform joint was observed in the preoperative weight-bearing lateral radiographs of twenty-eight (23%) of 122 feet, and it had resolved in one-third (nine) of them after hallux valgus correction. Complications included recurrence in six feet. First ray mobility was not associated with plantar gapping. There was a correlation between preoperative mobility of the first ray and the preoperative hallux valgus (r = 0.178) and the first-second intermetatarsal angles (r = 0.181). No correlation was detected between restricted ankle dorsiflexion and the magnitude of the preoperative hallux valgus deformity, the post-operative hallux valgus deformity, or the magnitude of hallux valgus correction. CONCLUSIONS: A proximal crescentic osteotomy of the first metatarsal combined with distal soft-tissue realignment should be considered in the surgical management of moderate and severe subluxated hallux valgus deformities. First ray mobility was routinely reduced to a normal level without the need for an arthrodesis of the metatarsocuneiform joint. Plantar gapping is not a reliable radiographic indication of hypermobility of the first ray in the sagittal plane.     

Scarf osteotomy in hallux valgus: a review of 72 cases

The Scarf osteotomy is now widely used for the correction of hallux valgus. The aim of our study was to evaluate the results after Scarf osteotomy considering patient's satisfaction as well as the clinical and radiological results. Between 1996 and 1999, 72 feet underwent a Scarf osteotomy of the first metatarsal and, in 11 feet, an additional Akin osteotomy of the proximal phalanx, for the correction of hallux valgus (55 patients: 49 female, 6 male; mean age: 52 years). The hallux valgus angle improved significantly, from 32 degrees preoperatively to 18 degrees at follow-up (minimal follow-up: 6 years; mean: 7.5 years). A second operation was necessary in two patients because of recurrence of hallux valgus, and a fusion of the first metatarsophalangeal joint was performed in two patients. At the time of latest follow-up 78% of the patients were satisfied or very satisfied with the result. The Scarf osteotomy combined with Akin's closing wedge osteotomy is a safe and effective procedure for the treatment of moderate hallux valgus deformities.     

Ludloff截骨治疗中重度拇外翻的临床疗效观察

目的研究Ludloff截骨术对中、重度拇外翻的治疗效果。方法 2007年9月至2008年10月对26例（34足）中、重度拇外翻患者使用Ludloff截骨配合远端软组织手术进行矫形手术治疗,截骨使用螺钉固定。男4例,女22例,年龄48～67岁,平均58岁。术后采用AOFAS评分对患足进行临床功能评价,同时拍负重位足的正侧位X线片进行影像学评价,比较术后AOFAS评分及跖拇角和第一二跖间角的变化,了解患者的满意程度。结果平均随访时间25个月（19～36个月）。在最后一次随访时,31足基本无痛,3足偶有疼痛或轻微疼痛。患者对拇外翻畸形纠正满意。AOFAS评分为从术前的51分（27～65分）提高到术后的88分（72～96分）,HVA从术前的31°（21°～42°）改善为10.3°（7°～15°）,IMA从术前的17°（16°～23°）改善为术后的7.8°（6°～10°）。23例（31足）患者对治疗效果满意,3例（3足）比较满意。所有患者均对外形满意。没有严重的并发症出现。结论 Ludloff截骨术是治疗中重度拇外翻可靠有效的方法。     

Surgical management of hallux valgus deformity in children with cerebral palsy

Twenty-six cases of hallux valgus deformity, in 16 children with cerebral palsy, were managed with great toe metatarsophalangeal (MTP) arthrodesis. Mean age at the time of surgery was 16 years (range, 10 years and 11 months to 21 years and 11 months), and mean follow-up was 4 years and 11 months (range, 2 years and 1 month to 10 years). Significant improvement in the hallux valgus angle (preoperative, 36.3 degrees; follow-up, 9.6 degrees; p < 0.05), the intermetatarsal angle (preoperative, 12.3 degrees; follow-up, 8.4 degrees; p < 0.05), and lateral metatarsophalangeal angle (preoperative, 4.8 degrees; follow-up, 25.8 degrees; p < 0.05), were achieved and maintained after MTP arthrodesis. Functional outcome was documented by significant improvement in the modified American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale (preoperative mean score, 46.2; follow-up mean score, 90.9; p < 0.05). Patient/ parent/caregiver satisfaction (as determined by a questionnaire), with improvements in cosmesis, footwear, hygiene, activity, and pain were high, ranging from 81% to 100%. Hallux valgus deformity in children with cerebral palsy is best managed by MTP arthrodesis, in conjunction with other surgical procedures that address segmental foot malalignment and dynamic gait deviations.     

The scarf osteotomy for severe hallux valgus

We reviewed the outcome of 33 patients (45 feet) treated by scarf osteotomy for hallux valgus deformity with an intermetatarsal (IM) angle equal to or greater than 16 degrees. The average follow-up was 26 months. The hallux valgus angle improved by an average of 21.1 degrees from a preoperative mean value of 32.1 degrees. The IM 1-2 angle improved an average of 9.9 degrees from a preoperative mean value of 18.3 degrees. American Orthopedic Foot and Ankle Society (AOFAS) score changed from a preoperative average of 35.7 points to 89.8 at follow-up. Our midterm results indicate that the scarf osteotomy provides an effective method for the treatment of severe bunion deformity.     

Roentgenographical evaluation of physiological bow-leg and the infantile type of Blount's disease in children

Roentgenographical examinations were carried out in 41 joints of 22 cases with physiological bowleg and 7 joints of 5 cases with the infantile type of Blount's disease. The observation periods were from 1 year and 4 months to 8 years and 1 month with an average of 4 years and 2 months. The femorotibial angle, the proximal tibial metaphyseal diaphyseal angle, the distal tibial metaphyseal diaphyseal angle and the tibial metaphyseal metaphyseal angle were measured, and evaluated statistically. The measurement of the proximal tibial metaphyseal diaphyseal angle and the tibial metaphyseal metaphyseal angle were more significant than that of the femorotibial angle for early differentiation of the infantile type of Blount's disease from physiological bowleg. The degree and it's change of the distal tibial metaphyseal diaphyseal angle show no difference between physiological bowleg and the infantile type of Blount's disease.     

Treatment of hallux valgus with an increased distal metatarsal articular angle: evaluation of double and triple first ray osteotomies

During a 12-year period in which 878 hallux valgus corrections were performed, 18 patients (21 feet) with symptomatic hallux valgus deformity and an increased distal metatarsal articular angle (DMAA) underwent periarticular osteotomies (double or triple first ray osteotomies). They were studied retrospectively at an average follow-up of 33 months. The surgical technique comprised a closing wedge distal first metatarsal osteotomy combined with either a proximal first metatarsal osteotomy or an opening wedge cuneiform osteotomy (double osteotomy). When a phalangeal osteotomy was added, the procedure was termed a "triple osteotomy." The average age of the patients at the time of surgery was 26 years. At final follow-up, the average hallux valgus correction measured 23 degrees and the average 1-2 intermetatarsal angle correction was 9 degrees. The DMAA averaged 23 degrees preoperatively and was corrected to an average of 9 degrees postoperatively. One patient developed a postoperative hallux varus deformity, and one patient developed a malunion, both of which required a second surgery. A hallux valgus deformity with an increased DMAA can be successfully treated with multiple first ray osteotomies that maintain articular congruity of the first metatarsophalangeal joint.     

Bilateral valgus-extension osteotomy of hip using hybrid external fixator in spondyloepiphyseal dysplasia: early results of a salvage procedure

The treatment of spondyloepiphyseal dysplasia (SED) congenita patients with severe bilateral hip involvement is difficult because it involves deformities of multiple joints and of the spine. The purpose of this study was to evaluate the results of the procedure described below as a method of treatment for bilateral hip involvement in SED congenita patients. We performed proximal femoral valgus-extension osteotomy with distal femoral varus osteotomy using a hybrid external fixator in eight patients (seven male patients and one female patient) or 16 hips. The patients had a mean age of 16.37 years (range, 9-25 years) at the time of surgery. The mean valgus angle at the proximal osteotomy site was 53.4 degrees on the right side and 52.5 degrees on the left side, and the mean varus angle at the distal osteotomy site was 22 degrees . Mean fixator time was 19.8 weeks (range, 10-42 weeks). After an average follow-up of 25.9 months, the mean modified Harris hip score had improved from 67.9 points to 79.1 points, which was statistically significant (P=0.012). Preoperative knee range of motion was achieved at the last follow-up in all patients. Waddling gait was absent in three patients, reduced in four patients, and was the same in one at the last follow-up. Mean limb length gain was 3.5 cm (range, 0-5 cm), mean limb length discrepancy less than 0.5 cm, and the mechanical axis was realigned in all. In conclusion, our early results suggest that proximal valgus-extension osteotomy with distal femoral varusization can be a useful treatment option in young patients with bilateral hip involvement in SED congenita.     

The SCARF osteotomy for the correction of hallux valgus deformities

The authors report their experience with a modified SCARF osteotomy with three years follow-up. Correction of moderate to severe hallux valgus deformities was achieved using a Z step osteotomy cut to realign the first metatarsal bone. A retrospective analysis was undertaken in 89 consecutive patients (111 feet). Results were analyzed by clinical examination, a questionnaire including the AOFAS forefoot score, and plain roentgenograms. Hallux valgus and intermetatarsal angle improved at mean 19.1 degrees and 6.6 degrees, respectively. Mean forefoot score improved from 50.1 to 91 points out of 100 possible points. Satisfactory healing time was expressed by an average return back to work of 5.8 weeks and back to sport of 8.3 weeks. Persistence or recurrence of hallux valgus was seen in seven patients (6%). The complication rate was 5.4% including superficial wound infection, traumatic dislocation of the distal fragment, and hallux limitus. The presented technique provides predictable correction of moderate to severe hallux valgus deformities.     

Comprehensive treatment of late-onset tibia vara

BACKGROUND: Late-onset tibia vara (Blount disease) can be difficult to treat because of frequent morbid obesity and associated deformities, including distal femoral varus, proximal tibial procurvatum, and distal tibial valgus, that contribute to lower extremity malalignment. We present a comprehensive approach that addresses all components of the deformity and allows restoration of the anatomic and mechanical axes. METHODS: Fifteen consecutive patients (nineteen lower extremities) with late-onset tibia vara were managed with this comprehensive approach. The mean age of the patients at the time of surgery was 14.9 years, and the mean weight was 113 kg. Standing anteroposterior and lateral radiographs were made preoperatively and at the time of the final follow-up. Preoperatively, the mean mechanical axis deviation was 108 mm, the mean lateral distal femoral angle was 95 degrees , and the mean mechanical medial proximal tibial angle was 71 degrees . In all nineteen extremities, the proximal tibial varus deformity was corrected by means of a valgus osteotomy and application of an Ilizarov ring external fixator. Distal femoral varus was corrected by means of either hemiepiphyseal stapling or valgus osteotomy with blade-plate fixation in thirteen of the nineteen extremities. Distal tibial valgus was treated either with hemiepiphyseal stapling or with varus osteotomy and gradual correction with use of the Ilizarov external fixator in eleven of the nineteen extremities. RESULTS: After a mean duration of follow-up of 5.0 years, the mean mechanical axis deviation had improved to 1 mm (range, 20 to -30 mm), the lateral distal femoral angle had improved to 87 degrees (range, 83 degrees to 98 degrees), and the mechanical medial proximal tibial angle had improved to 88 degrees (range, 83 degrees to 98 degrees ). The mean time required for correction of the proximal tibial varus deformity was thirty-one days, and the external fixator was removed at a mean of 4.5 months postoperatively. All patients had development of one or more superficial pin-track infections (mean, 1.9 pin-site infections per patient). No wound infections, nonunions, or neurovascular complications occurred. Eighteen of the nineteen extremities were pain-free at the time of the final follow-up. CONCLUSIONS: This comprehensive approach allowed restoration of the mechanical and anatomic axes of the lower extremity in patients with late-onset tibia vara, resulting in a resolution of symptoms as a result of normalization of the weight-bearing forces across the knee and ankle. We believe that this approach will decrease the risk of early degenerative arthritis of the knee.     

Corrective osteotomy for humerus varus

PURPOSE: Humerus varus caused by growth arrest of the medial proximal humeral physis is associated with upper limb length discrepancy and limitations in shoulder motion. The purpose of this study was to assess the results of proximal humeral valgus osteotomy for the treatment of humerus varus in skeletally immature patients. METHODS: Six patients were treated at our institution between 1994 and 2006. The average age at the time of surgery was 13 years (range, 9-17 years). The causes of humerus varus were posttraumatic physeal arrest (n = 2), infection (n = 2), acquired physeal arrest secondary to a benign bone cyst (n = 1), and idiopathic cause (n = 1). All patients underwent proximal humeral valgus osteotomy with tension-band fixation. The average clinical and radiographic follow-up period was 21 months (range, 3-81 months). RESULTS: All patients achieved bony union. Mean forward flexion improved from 76 degrees preoperatively (range, 45-100 degrees) to 148 degrees postoperatively (range, 100-180 degrees) (P = 0.01). Mean abduction improved from 63 degrees preoperatively (range, 30-100 degrees) to 116 degrees postoperatively (range, 90-160) (P = 0.02). Radiographically, the mean humeral neck-shaft angle improved from 95 degrees preoperatively (range, 75-105 degrees) to 130 degrees postoperatively (range, 112-160 degrees) (P = 0.001). Two patients had soft tissue irritation from the tension-band pins, which resolved with subsequent pin removal. CONCLUSIONS: Valgus osteotomy with tension-band fixation is an effective means of improving shoulder function and humeral neck-shaft angle in skeletally immature patients with proximal humerus varus.     

Dome-shaped proximal tibial osteotomy using percutaneous drilling for osteoarthritis of the knee

We have improved a surgical technique for proximal tibial osteotomy that involves percutaneous drillings. We performed the modified dome-shaped proximal tibial osteotomy on 44 knees in 42 patients (8 men and 34 women) with an average age of 66 years (range 50-78 years) for osteoarthritis of the knee. The mean follow-up period was 39 months (range 24-63 months). The varus angle was 4 degrees +/- 3.6 degrees (mean +/- SD) preoperatively, and the valgus angle was 12 degrees +/- 3.3 degrees postoperatively. Pain relief was obtained in all cases postoperatively. Transient pin tract infection occurred in one case, but it resolved completely following local irrigation. Intercondylar fracture of the upper fragment with no displacement was noted in two patients. They were treated with AO cancellous screw fixation, and improvement of pain was obtained in both cases. Osteotomy drill guide instruments are useful for accurately performing dome-shaped osteotomy. Our proximal tibial dome osteotomy with an external fixator allowed early motion and accurately maintained the angle of correction.