Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes

2021 ◽  
Author(s):  
Léo-Pôhl Bardot ◽  
Grégoire Micicoi ◽  
Henri Favreau ◽  
Petr Zeman ◽  
Raghbir Khakha ◽  
...  
Keyword(s):  
Varus Malalignment ◽  
Single Leg Stance

scholarly journals Novel Analytic Approaches to Investigate Minute-Level Actigraphy and Associations With Physical Function

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 194-195
Author(s):  
Kaiyuan Hua ◽  
Sheng Luo ◽  
Katherine Hall ◽  
Miriam Morey ◽  
Harvey Cohen
Keyword(s):  
Physical Activity ◽  
Data Analysis ◽  
Physical Function ◽  
Functional Data Analysis ◽  
Functional Data ◽  
Gait Speed ◽  
Community Dwelling ◽  
Accelerometer Data ◽  
Single Leg Stance ◽  
Minute Walk

Abstract Background. Functional decline in conjunction with low levels of physical activity has implications for health risks in older adults. Previous studies have examined the associations between accelerometry-derived activity and physical function, but most of these studies reduced these data into average means of total daily physical activity (e.g., daily step counts). A new method of analysis “functional data analysis” provides more in-depth capability using minute-level accelerometer data. Methods. A secondary analysis of community-dwelling adults ages 30 to 90+ residing in southwest region of North Carolina from the Physical Performance across the Lifespan (PALS) study. PALS assessments were completed in-person at baseline and one-week of accelerometry. Final analysis includes 669 observations at baseline with minute-level accelerometer data from 7:00 to 23:00, after removing non-wear time. A novel scalar-on-function regression analysis was used to explore the associations between baseline physical activity features (minute-by-minute vector magnitude generated from accelerometer) and baseline physical function (gait speed, single leg stance, chair stands, and 6-minute walk test) with control for baseline age, sex, race and body mass index. Results. The functional regressions were significant for specific times of day indicating increased physical activity associated with increased physical function around 8:00, 9:30 and 15:30-17:00 for rapid gait speed; 9:00-10:30 and 15:00-16:30 for normal gait speed; 9:00-10:30 for single leg stance; 9:30-11:30 and 15:00-18:00 for chair stands; 9:00-11:30 and 15:00-18:30 for 6-minute walk. Conclusion. This method of functional data analysis provides news insights into the relationship between minute-by-minute daily activity and health.

scholarly journals Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy

2021 ◽  
Author(s):  
Marco-Christopher Rupp ◽  
Philipp W. Winkler ◽  
Patricia M. Lutz ◽  
Markus Irger ◽  
Philipp Forkel ◽  
...  
Keyword(s):  
Femoral Osteotomy ◽  
Common Finding ◽  
Fracture Type ◽  
Varus Malalignment ◽  
Distal Femoral Osteotomy ◽  
Closing Wedge ◽  
Increased Risk ◽  
Surgical Data ◽  
Technical Factors ◽  
Hinge Fracture

Abstract Purpose To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications. Methods Seventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors’ institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior–posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted. Results The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p < 0.05). Conclusion Medial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided. Level of evidence Prognostic study; Level IV.

Effect of foot deformity on conventional mechanical axis deviation and ground mechanical axis deviation during single leg stance and two leg stance in genu varum

The Knee ◽  
2007 ◽  
Vol 14 (6) ◽  
pp. 452-457 ◽  
Author(s):  
Sameer Shrikrishna Desai ◽  
Gautam M. Shetty ◽  
Hae-Ryong Song ◽  
Seok Hyun Lee ◽  
Tae Young Kim ◽  
...  
Keyword(s):  
Mechanical Axis ◽  
Genu Varum ◽  
Axis Deviation ◽  
Foot Deformity ◽  
Mechanical Axis Deviation ◽  
Single Leg Stance

The Fate of Bone Marrow Lesions After Open Wedge High Tibial Osteotomy: A Comparison Between Knees With Primary Osteoarthritis and Subchondral Insufficiency Fractures

2021 ◽  
pp. 036354652110021
Author(s):  
Han Gyeol Choi ◽  
Joo Sung Kim ◽  
Hyun Jin Yoo ◽  
You Sun Jung ◽  
Yong Seuk Lee
Keyword(s):  
Bone Marrow ◽  
High Tibial Osteotomy ◽  
Insufficiency Fracture ◽  
Tibial Osteotomy ◽  
Pathological Feature ◽  
Open Wedge ◽  
Varus Malalignment ◽  
Bone Marrow Lesions ◽  
Wedge High Tibial Osteotomy

Background: Subchondral insufficiency fracture of the knee (SIFK) is characterized by a subchondral lesion that may lead to end-stage osteoarthritis (OA). In patients who have SIFK in a precollapse state with varus malalignment, a joint-preserving technique such as open wedge high tibial osteotomy (OWHTO) should be considered. Purpose: To evaluate the efficacy of OWHTO in primary OA and SIFK-dominant OA by clinical and radiological evaluations including magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence 3. Methods: A total of 33 SIFK-dominant OA knees and 66 with primary OA that underwent biplanar OWHTO between March 2014 and February 2016 were included after 1:2 propensity score matching. The MRI Osteoarthritis Knee Score was used to assess bone marrow lesions (BMLs) preoperatively and at follow-up. The weightbearing line ratio, the hip-knee-ankle angle, and the joint line convergence angle were measured. The clinical outcomes assessed were range of motion, the American Knee Society Score, and the Western Ontario and McMaster University (WOMAC) score. Results: The mean follow-up period was 41.2 ± 12.6 months. The distribution of preoperative BML grade in the SIFK-dominant OA group was significantly higher in both the femur and tibia ( P < .001 and <.001, respectively) than that in the primary OA group. However, the difference was not significant postoperatively (femur, P = .425; tibia, P = .462). In both groups, postoperative BMLs showed significant improvement compared with preoperative BMLs (primary OA [femur, P < .001; tibia, P = .001] and SIFK-dominant OA [femur, P < .001; tibia, P < .001]). The WOMAC pain score was higher in the SIFK-dominant OA group preoperatively (primary OA, 7.0 ± 3.73; SIFK-dominant OA, 9.17 ± 2.6; P = .032) even though it was not different at the final follow-up (primary OA, 2.11 ± 1.7; SIFK-dominant OA, 1.79 ± 1.32; P = .179). Conclusion: OWHTO is an effective procedure not only for primary OA but also for SIFK-dominant OA. OWHTO can improve BMLs, which represent the main pathological feature of SIFK. Therefore, in patients who have SIFK with varus malalignment, OWHTO can be an attractive treatment option for preserving the joint and enhancing subchondral bone healing.

Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment

2018 ◽  
Vol 46 (6) ◽  
pp. 1362-1370 ◽  
Author(s):  
Philipp Schuster ◽  
Markus Geßlein ◽  
Michael Schlumberger ◽  
Philipp Mayer ◽  
Raul Mayr ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Cartilage Regeneration ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Varus Malalignment ◽  
Medial Osteoarthritis ◽  
Ikdc Score ◽  
Chondral Resurfacing

Background: High tibial osteotomy (HTO) is a widely used treatment option for medial osteoarthritis and varus malalignment, especially in young patients with early osteoarthritis. Limited outcome data are available for this procedure in severe osteoarthritis, and no long-term data are available using newer implants. Purpose: To determine survivorship and functional results of medial open-wedge HTO combined with a chondral resurfacing (CR) procedure (abrasion plus microfracture) in severe medial osteoarthritis (Kellgren-Lawrence grade 3 and 4) and varus malalignment. Furthermore, factors that potentially influence the outcome were analyzed. Study Design: Case series; Level of evidence, 4. Methods: From September 2005 to December 2008, all cases of HTO (fixation with an angular-stable internal fixator) combined with CR were prospectively surveyed with regard to survival (Kaplan-Meier-method, not requiring arthroplasty) and functional outcome (subjective International Knee Documentation Committee [IKDC] score). Cartilage regeneration at the time of hardware removal, tibial bone varus angle (TBVA), pre- and postoperative mechanical medial proximal tibial angle (MPTA), and postoperative alignment were analyzed with regard to the result. Results: Seventy-nine knees were included (73 patients; mean age 50.9 ± 7.6 years). The follow-up rate was 90% at 10.0 ± 1.2 years (range, 8.3-12.1 years). Pre- and postoperative mechanical tibiofemoral axis were 9.6° ± 3.0° of varus and 0.6° ± 2.7° of valgus, respectively. Survival rate was 81.7% (95% CI, 72.5%-90.9%) at 10 years. Subjective IKDC score significantly improved from 44 ± 11 preoperatively to 70 ± 13 at one, 66 ± 15 at three, 66 ± 15 at five, and 65 ± 17 at ten years ( P < .001 at any point of follow-up). Poor cartilage regeneration and low preoperative IKDC score (<40) were associated with decreased survival. High preoperative TBVA was associated with better and an overcorrected MPTA (>95°) with inferior functional outcome at final follow-up, respectively. Conclusion: Even in cases of severe medial osteoarthritis and varus malalignment, HTO in combination with a CR procedure is a good to excellent treatment option. The role of the CR procedure remains unclear. Although good results are obtained with overcorrected MPTA, long-term functional outcome is inferior.

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