Modified Aglietti procedure (supracondylar femoral osteotomy) for correction of the post-rachitic valgus deformity of the knee in adolescents – A short case series

Purpose. The aims of this study were to (1) examine the timeline of return to sport (RTS) following isolated lateral opening wedge distal femoral osteotomy (DFO), (2) evaluate the degree of participation on RTS, and (3) identify risk factors for failure to RTS. Methods. Nineteen consecutive patients undergoing isolated lateral opening wedge DFO were reviewed retrospectively at a minimum of 2 years postoperatively. Patients completed a sports questionnaire, visual analogue scale for pain (VAS-Pain), Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Results. Seventeen patents (89.5%; age 32.1 ± 10.1 years; gender 9 males, 52.9%) were contacted at 7.3 ± 4.4 years (range 2.0-13.8 years). Twelve patients (70.6%) resumed playing ≥1 sport at an average time of 9.5 ± 3.3 months (range 3-12 months). Of these 12 patients, 6 returned to a lower level of participation (50.0%). Seven patients (41.2%) had returned to the operating room for further surgery, which included removal of hardware (5.9%) and total knee arthroplasty (5.9%). The average VAS-Pain, SANE, and Marx scores were 3.4 ± 2.6 (range 0-8), 56.2 ± 18.7 (range 20-85), and 5.0 ± 5.3 (range 0-16), respectively. Fourteen patients (82.4%) were at least somewhat satisfied with their procedure. Conclusion. In patients with isolated lateral compartment osteoarthritis and valgus deformity, lateral opening wedge DFO allows 70.6% of patients to RTS by 9.5 ± 3.3 months. However, most patients may be unable to return to their presymptomatic level of function. Patient expectations regarding RTS can be appropriately managed with adequate preoperative patient education. Level of Evidence. IV, case series.

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Radiographic Outcomes, Union Rates, and Complications Associated With Plantar Implant Positioning for Midfoot Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/24730114211027115 ◽

2021 ◽

Vol 6 (3) ◽

pp. 247301142110271

Author(s):

Tyler W. Fraser ◽

Daniel T. Miles ◽

Neal Huang ◽

Franklin B. Davis ◽

Burton D. Dunlap ◽

...

Keyword(s):

Hallux Valgus ◽

Skin Irritation ◽

Case Series ◽

Deformity Correction ◽

Valgus Deformity ◽

Union Rate ◽

Radiographic Outcomes ◽

Hallux Valgus Deformity ◽

Metatarsal Angle ◽

Radiographic Union

Background: Midfoot arthrodesis has long been successfully included in the treatment paradigm for a variety of pathologic foot conditions. A concern with midfoot arthrodesis is the rate of nonunion, which historically has been reported between 5% and 10%. Plantar plating has also been noted to be more biomechanically stable when compared to traditional dorsal plating in previous studies. Practical advantages of plantar plating include less dorsal skin irritation and the ability to correct flatfoot deformity from the same medial incision. The purpose of this study is to report the arthrodesis rate, the success of deformity correction, and the complications associated with plantar-based implant placement for arthrodesis of the medial column. Methods: A retrospective review was undertaken of all consecutive patients between 2012 and 2019 that underwent midfoot arthrodesis with plantar-positioned implants. Radiographic outcomes and complications are reported on 62 patients who underwent midfoot arthrodesis as part of a correction for hallux valgus deformity, flatfoot deformity, degenerative arthritis, Lisfranc injury, or Charcot neuroarthropathy correction. Results: Statistically significant improvement was seen in the lateral talus–first metatarsal angle (Meary angle) and medial arch sag angle for patients treated for flatfoot deformity correction. In patients treated for hallux valgus deformity, there was a reduction in the intermetatarsal angle from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The rate of nonunion was higher at the NC joint compared to the TMT joint and with compression claw plates. One symptomatic nonunion required revision surgery (1.7%). There were no nonunions when excluding neuroarthropathy patients and smokers. The odds ratio (OR) for nonunion in patients with neuroarthropathy was 6.05 ( P < .05), and in active smokers the OR was 2.33 ( P < .05). Conclusion: Plates placed on the plantar bone surface for midfoot arthrodesis achieved and maintained deformity correction with rare instances of symptomatic hardware for a variety of orthopedic conditions. An overall clinical and radiographic union rate of 94% was achieved. The radiographic union rate improved to 100% when excluding both neuroarthropathy patients and smokers. The incidence of nonunion was higher in smokers, neuroarthropathy patients, naviculocuneiform joint fusions, use of compression claw plates, and when attempting to fuse multiple joints. Incisional healing complications were rarely seen other than in active smokers. Level of Evidence: Level IV, case series.

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Difficult Cases in Robotic Arm-Assisted Total Knee Arthroplasty: A Case Series

The Journal of Knee Surgery ◽

10.1055/s-0037-1608839 ◽

2017 ◽

Vol 31 (01) ◽

pp. 027-037 ◽

Cited By ~ 7

Author(s):

Robert Marchand ◽

Anton Khlopas ◽

Nipun Sodhi ◽

Caitlin Condrey ◽

Nicolas Piuzzi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Case Series ◽

Valgus Deformity ◽

Robotic Assisted ◽

Surgical Technology ◽

Flexion Contractures ◽

Total Knee ◽

Robotic Devices ◽

Sagittal Deformity

AbstractSagittal deformity of the knee is commonly corrected to neutral biomechanical axis (±3 degrees) during total knee arthroplasty (TKA), which is a widely accepted goal. Recent advances in surgical technology have made it possible to accurately plan and fulfill these goals. One of these is robotic-assisted TKA, which has been noted to help increase accuracy and precision of restoring a neutral mechanical axis. While there are data confirming the ability of robotic devices to better correct knee alignment than the manual technique, there is a lack of data concerning the use of the robotic devices in more complex cases, such as those in patients with severe varus or valgus deformity, as well as in flexion contractures. Therefore, the purpose of this case study is to present three cases in which the robotic-assisted TKA device was used to correct a severe varus and severe valgus deformities. Based on this case series, it should be noted that the robotic device can also help correct severe varus/valgus deformities and flexion contractures.

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Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO)

Foot & Ankle Orthopaedics ◽

10.1177/2473011418790071 ◽

2018 ◽

Vol 3 (3) ◽

pp. 247301141879007 ◽

Cited By ~ 1

Author(s):

Pablo Wagner ◽

Emilio Wagner

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Level Of Evidence ◽

Reliable Technique ◽

Intermetatarsal Angle ◽

Hallux Valgus Deformity ◽

The Mean ◽

Prospective Case Series

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

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DISTAL FEMORAL OSTEOTOMY FOR VALGUS DEFORMITY OF THE KNEE

Orthopedics ◽

10.3928/0147-7447-19921101-07 ◽

1992 ◽

Vol 15 (11) ◽

pp. 1283-1290

Author(s):

Glenn C Terry ◽

Peter M Cimino

Keyword(s):

Valgus Deformity ◽

Femoral Osteotomy ◽

Distal Femoral Osteotomy

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Surgical Outcomes and Predictive Factors of Medial Toe Excision for Polysyndactyly of the Fifth Toe

Foot & Ankle International ◽

10.1177/1071100720971289 ◽

2020 ◽

pp. 107110072097128

Author(s):

Kyung Rae Ko ◽

Jong Sup Shim ◽

Jiwon Kang ◽

Jaesung Park

Keyword(s):

Surgical Outcomes ◽

Proximal Phalanx ◽

Case Series ◽

Valgus Deformity ◽

Retrospective Case ◽

Functional Disturbance ◽

Thickness Skin ◽

Fifth Toe ◽

The Mean

Background: We aimed to report surgical outcomes and analyze prognostic factors of medial toe excision for polysyndactyly of the fifth toe. Methods: We reviewed the details of 139 consecutive patients who underwent surgery for postaxial polydactyly of the foot from 2009 to 2018. Among these, 83 patients (90 feet) with polysyndactyly of the fifth toe, treated by medial toe excision (between the duplicated toes) and reconstruction of the fourth web space using a dorsal rectangular flap, were included. The toe alignment and stability were restored by chondroplasty and soft tissue balancing without an osteotomy. A full-thickness skin graft was performed in 52 feet. The mean age at surgery was 27.1 ± 17.5 months and the mean duration of follow-up was 42.8 ± 24.9 months. Results: At the last follow-up, a relatively small size of the reconstructed toe was observed in 19 feet (19/90, 21.1%). Proximal duplication level (metatarsal or proximal phalanx type) and preoperative hypoplasia of the remaining toe were related to the small postoperative size. Valgus deformity of the remaining toe was observed in 2 feet (2/90, 2.2%). We observed 17 cases with delayed healing or early postoperative wound infection. Among these, 7 cases (7/90, 7.8%) showed postoperative thickening or advancement of the web, which was not observed in cases without wound problems. No cases had functional disturbance or pain. Conclusion: The overall surgical outcomes were satisfactory without an osteotomy. Patients with a proximal duplication level or preoperative hypoplasia of the remaining toe should be informed of its possible small size postoperatively. Levels of Evidence: Level IV, retrospective case series.

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Supracondylar femoral osteotomy for knee flexion contracture resulting from poliomyelitis

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.64b2.7068740 ◽

1982 ◽

Vol 64-B (2) ◽

pp. 198-201 ◽

Cited By ~ 22

Author(s):

JC Leong ◽

CO Alade ◽

D Fang

Keyword(s):

Knee Flexion ◽

Flexion Contracture ◽

Femoral Osteotomy ◽

Knee Flexion Contracture ◽

Supracondylar Femoral Osteotomy

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Total knee arthroplasty after distal femoral osteotomy: a systematic review and current concepts

SICOT-J ◽

10.1051/sicotj/2020033 ◽

2020 ◽

Vol 6 ◽

pp. 35 ◽

Cited By ~ 1

Author(s):

Francesco Luceri ◽

Jacopo Tamini ◽

Paolo Ferrua ◽

Damiano Ricci ◽

Cécile Batailler ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Randomized Clinical Trials ◽

Case Series ◽

Femoral Osteotomy ◽

Long Term Results ◽

Radiographic Evaluation ◽

Distal Femoral Osteotomy ◽

Total Knee

Introduction: Distal Femoral Osteotomy (DFO) is a common procedure for correcting lower limb valgus deformity and lateral compartment overload. Low 20-year survivorship rate was reported with a consequent need for total knee arthroplasty (TKA). This study aims to review literature and to analyse the influence of a previous distal femoral osteotomy on outcomes of patients undergoing TKA. Methods: A systematic literature review was performed in PubMed/Medline and Embase in May 2020. Papers were selected based on the following criteria: patient with a previous distal femoral osteotomy; total knee replacement; Pre- and Postoperative outcomes; surgical outcomes: clinical scores, range of motion, radiographic evaluation and revisions for any cause; case series, retrospective studies, observational studies, open-label studies, randomized clinical trials; systematic reviews and meta-analyses were included to extract primitive studies. Results: 306 articles were found, of which five papers were considered eligible for this review. In every study included, postoperative clinical outcomes (Knee Society Score or Hospital for Special Surgery score) statistically improved from the preoperative. Complications were not uncommon; implant survivorship at the available follow-up seems to be similar to primary TKA, although being too short to draw any conclusions. Conclusions: Limited and highly heterogeneous evidence is currently available on the influence of DFO on outcomes after TKA. Knee replacement improves clinical middle-term outcomes in patients with previous distal femoral osteotomy. In this complex surgery, the use of technical tips and tricks could help surgeons to obtain an accurate knee balancing and better long-term results.

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