Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study

The results in ninety-three knees that had been treated by proximal tibial opening-wedge osteotomy for varus deformity and osteoarthritis of the medial compartment were evaluated after a mean length of follow-up of 11.5 years (range, ten to thirteen years). After ten years, only forty-two (45 per cent) of the ninety-three knees had an excellent or good result, and in fifty-one knees there was recurrent pain for which seventeen had another operation. At five years, on the other hand, 90 per cent of the knees had a good result. Deterioration occurred at an average of seven years after the osteotomy and was always associated with recurrence of pain. Although the results deteriorated with time, time was not the only determinant of the result. Alignment, measured as the hip-knee-ankle angle on radiographs of the whole limb that were made with the patient bearing weight, was also a determinant of long-term results. The best results were obtained in the twenty knees that had a hip-knee-ankle angle of 183 to 186 degrees. In these knees, there was no pain and no progression of the arthrosis in either the medial or the lateral tibiofemoral compartment. Of the five knees that had an angle of more than 186 degrees, all five had progressive degenerative changes in the lateral compartment. In the sixty-eight undercorrected knees (an angle of less than 183 degrees), the results were less satisfactory, and there was a tendency toward recurrence of the varus deformity and progression of the arthritis of the medial compartment. However, when the correction was insufficient the deterioration was slow (average, seven years), and it was not associated with lateral laxity and deterioration of the lateral compartment, which are the changes that characterize the natural course of gonarthrosis as described by Hernborg and Nilsson. Therefore, proximal tibial osteotomy is a very suitable operation for patients who have gonarthrosis of the medial compartment, but a rigidly standardized and precise operative technique is required as well as accurate radiographic measurements of the mechanical axis of the limb, because exact postoperative alignment is the prerequisite for the longest possible period of relief of symptoms after osteotomy.     

Evans calcaneal osteotomy for flexible pes valgus deformity. A preliminary study

This procedure was quite successful, particularly in patients with a transverse plane dominant flexible pes valgus deformity. The modifications that have proved to be successful include the use of the oblique skin incision following the relaxed skin tension lines, the use of allogeneic bone graft, and the use of ancillary procedures, including the gastrocnemius recession and medial arch tendosuspension. The procedure is less predictable in those patients whose deformity is primarily in the frontal or sagittal plane. It is most critical that preoperative analysis be used to discover the presence of the masked metatarsus adductus prior to performing this procedure.     

Lymphogenic osteomyelitis of the foot (author's transl)]

The special way of infection of the lymphogenic osteomyelitis caused by trivial trauma is demonstrated in 4 cases. Germ ascension is done by lymphatics or fissures in the tissue, as it is well known in the panaritium ossale. The treatment consists in removing the focus of infection, irrigation-suction drainage and specific antibiotic therapy. Trivial trauma of the lower extremity should be treated according to the principles of asepsis.     

Double calcaneal osteotomy in treatment of flexible planovalgus foot deformity in ambulatory cerebral palsy. A case series study

BackgroundThe aim of this prospective non randomized case series study was to assess the intermediate-term outcomes of double calcaneal osteotomy (lateral column lengthening and medial slide calcaneal osteotomy) use in ambulatory cerebral palsy with flexible planovalgus feet.Methods16 cases with planovalgus feet were surgically treated by double calcaneal osteotomy and observed over an average of 33.5 months. The mean age at the time of surgery was 10.74 years. The functional outcomes were assessed clinically and radiologically.ResultsThere were a statistical improvement of clinical heel valgus and all radiological parameters as regard talar head uncoverage, calcaneal pitch, talo-calcaneal angle, and talus 1st metatarsal angle at the end of follow up period.ConclusionDouble calcaneal osteotomy is a good option in the treatment of flexible planovalgus feet in ambulatory cerebral palsy patients.     

Planning of a complex intertrochanteric osteotomy (author's transl)]

The article describes in detail the preoperative planning on a complex intertrochenteric osteotomy with eight corrections. Attention is drawn to two main complication risks and how to avoid them, namely, necrosis of the head of the femur and tilting of the proximal fragment when inserting the blade of the rectangular plate.     

Arthordesis of foot joints with the Cloward-technique (author's transl)]

The Cloward instruments can be used not only for the interbody cervical fusion, but also for the arthrodesis of the talo-crural and talo-navicular joints. By exact pinning with autolog spongiosa pins while the joints are distracted further internal is not necessary. In contrast to other methods the arthrodesis of the talo-crural joint is not accompanied by a shortening of the leg. Technical details of the method are described and the first results of 15 cases are reported.     

高弓马蹄内翻足术后复发与跟骨截骨

目的 探讨高弓内翻足手术治疗后的内翻复发,跟骨截骨外移的矫正度与内翻复发的关系.方法 23例(31足)成人高弓内翻足患者,年龄13～59岁,平均36岁.以术前Coleman试验可否矫正、经内侧软组织和(或)肌腱松解后后足内翻被动矫正情况以及是否行跟骨截骨,将患足分为4组.并以被动可矫正至中立位和外翻5°以上为两个界限.进行统计.跟骨截骨可以为跟骨轴位水平方向上的截骨外移,截骨外移后的欠状面上的上移,以及跟骨的楔形闭合截骨.结果 内翻复发9足,5°以下5足,5°以上4足,平均4.23°±2.15°.末行跟骨截骨12足中,术前Coleman试验可矫正至中立位3足均复发,术前Coleman试验可矫正至外翻5°以上的4足均未复发.术前Coleman试验不町矫正,术中经软组织松解后可矫正至中立位的2足,术后均复发;术前Coleman试验不可矫正,术中可矫正至外翻5°以上的3足,内翻复发1足.行跟骨外移截骨19足中,术前Coleman试验可矫正至中立位9足,1足内翻复发;术前Coleman试验不可矫正,术中可矫正至中立位的7足,术后2足复发;术前Coleman试验不可矫正,术中可矫正至外翻5°以上者3足,无内翻复发.结论 Coleman试验能否矫正后足的内翻,并非是否行跟骨外移截骨术的依据;而被动手法矫正是判断是否行跟骨截骨的关键,外翻5°是一个重要的指标.     

Intraosseous osteotomy in arthrosis of the knee joint (author's transl)]

The article describes a surgical method in which removal of the spongiosa is effected in the region of the upper tibia and the lower femur after fenestration of the cortex. Results are reported on the surgical treatment of 24 knee joints with painful arthrosis without any deformation worth mentioning. Worthwhile pain relief was achieved in 22 cases. In these cases, no osteotomy with correction was indicated.     

Distal femoral varus osteotomy for valgus deformity of the knee

Twenty-four patients who had degenerative arthritis of the lateral compartment of the knee that was associated with a valgus deformity and a superolateral tilt of the joint line were treated by distal femoral varus osteotomy. A surgical technique that was designed to produce a horizontal joint line and a tibiofemoral angle of zero degrees is described. At an average length of follow-up of four years, twenty-two of twenty-four patients had a successful result as judged by our protocol for evaluation. One osteotomy had to be revised for failure of fixation, and one patient had a pulmonary embolism that had a satisfactory outcome after the administration of anticoagulants. One patient required manipulation of the knee at six months. The simple surgical technique that we used was effective in realigning the femoral with the tibial axis in patients who had a valgus deformity of the knee, a superolateral tilt of the joint line, and osteoarthritis of the lateral compartment.     

A cooled blade for use in upper tibial osteotomy (author's transl)

A cooled blade for an oscillating saw has been developed. Using this blade heat necrosis can be completely avoided.     

Long-term follow-up after arthrodesis of the hip-joint using cross-plates and pelvic osteotomy, particularly late complications. Results of follow-up for 4-8 years (author's transl)]

In two thirds of our patients there were no complications. All fractures could be healed after osteosynthesis or plaster. At least those patients who had tight pseudarthroses were relatively free from pain on weight-bearing. But 34% of our patients showed severe complications - pseudarthroses and post-operative fractures. The argument in favor of early mobilisation, the mainstay for the choice of this technique of arthrodesis, does not - as our long-term follow-up shows - carry conviction.