scholarly journals Guided Growth Vs. Tibial Osteotomy in Early Stage of Blount Disease

2021 ◽  
Author(s):  
Beaudelaire Romulus ASSAN ◽  
Anne-Laure SIMON ◽  
Sonia ADJADOHOUN ◽  
Geraud Garcia Philemon Satingo SEGBEDJI ◽  
Cedric Bignon Ulrich ASSOUTO ◽  
...  
Keyword(s):  
Analytical Study ◽  
Mechanical Axis ◽  
Early Stage ◽  
Tibial Osteotomy ◽  
Tibial Torsion ◽  
Guided Growth ◽  
Tibiofemoral Angle ◽  
Blount Disease ◽  
Radiological Stage

Abstract Background: There are no real comparative study between guided growth and tibial osteotomy in early stage of Blount disease. The aim of this work was to compare the results of patients treated by these two techniques. Method: We had performed a multicenter retrospective, descriptive and analytical study over a period of 05 years. All children admitted for Blount disease without medial proximal tibial epiphysiodesis and treated by one of these techniques were included. Age, sex, existence of tibial torsion, radiological stage based on Catonne's classification were studied. We also evaluated preoperatively, immediately postoperatively, and at latest follow-up tibiofemoral angle, mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, and the tibial metaphyso-diaphyseal angle. Results: Seventeen (17) patients for 24 knees were included. The sex ratio was 0.54. All patients had tibial torsion. Fourteen knees (64%) were treated by guided growth at a mean age of 5.5±2.5 (range, 3-9 years). With a mean follow-up of 12 ± 3.5 months (range 6-15month); tibiofemoral, mechanical medial proximal tibial, and tibial metaphyso-diaphyseal angles were significantly corrected with normalization of the mechanical axis in 8 patients (60%). Ten patients (36%) were treated by revisited Rab osteotomy at a mean age of 7.7±4.9 years (range, 4-12 years). At a mean follow-up of 23±15 months (range, 10-48 months), only tibial metaphyso-diaphyseal angle was significantly corrected. The recurrence rate was 60%. Despite perfect correction of tibiofemoral, and mechanical medial proximal tibial angles in immediate postoperative follow-up, they gradually decrease in patients treated by Rab osteotomy, whereas they gradually increased in case of guided growth. Conclusion: Guided growth appears to be the best treatment for early stage of Blount disease. Trial registration: Retrospectively registered

Guided growth vs.Tibial osteotomy at early stage of Blount disease in squelletically immature patients

2021 ◽  
Author(s):  
Beaudelaire Romulus Assan ◽  
Anne-laure Simon ◽  
Sonia Adjadohoun ◽  
Géraud Garcia PS. Segbedji ◽  
Philippe Souchet ◽  
...  
Keyword(s):  
Early Stage ◽  
Guided Growth ◽  
Blount Disease

scholarly journals Evaluation of Accuracy of Preoperative Planning of the Femurofibular Angle in Open-Wedge High Tibial Osteotomy for Mild Medial Knee Osteoarthritis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Peizhao Wang ◽  
Xiao Wang ◽  
Xiaotao Shi ◽  
Honglue Tan
Keyword(s):  
Lower Limb ◽  
Preoperative Planning ◽  
Mechanical Axis ◽  
Weight Bearing ◽  
Tibial Osteotomy ◽  
Medial Knee ◽  
Knee Oa ◽  
Significant Difference ◽  
Wedge High Tibial Osteotomy

Objective. The purpose of this study was to evaluate the usefulness of preoperative planning of the femurofibular angle (FFA) in medial open-wedge high tibial osteotomy (OWHTO) for mild medial knee osteoarthritis. Methods. Thirty-two patients (32 knees) with mild medial knee OA were retrospectively reviewed. The patients underwent preoperative planning of the FFA for OWHTO. For preoperative planning, a full-length weight-bearing X-ray photograph of the lower limb was opened within Adobe Photoshop Software, and a targeted corrective mechanical axis line of the lower limb and its intersecting point at the lateral tibial plateau surface was drawn using rectangle selection and filling tools. A frame, which encircled the tibia and fibula, was created around the predicted osteotomy plane and then rotated until the ankle center was on the targeted mechanical axis line. Subsequently, a distal femoral condyle line and a proximal fibula axis line were drawn, and the angle between the two lines was measured and defined as the femurofibular angle (FFA). During biplane OWHTO, the preoperatively determined FFA was used to complete the correction of the mechanical axis. During follow-up, the postoperative mechanical weight-bearing line (WBL) of the lower limb, the mechanical femorotibial angle (mFTA), and the FFA were measured and compared with the preoperatively determined values. Results. The mechanical WBL shifted from a preoperative value of 25.36 ± 5.02 % to a postoperative value of 56.19 ± 0.10 % from the medial border along the mediolateral width of the tibial plateau, and it was 56.57 ± 0.08 % at the final follow-up ( P < 0.01 ). The preoperatively determined value was 56.25%, and no significant difference was found compared with postoperative week-one and final follow-up values ( P > 0.05 ). The mFTA was corrected from a preoperative varus of 4.02 ± 0.63 ° to a postoperative week-one valgus of 2.37 ± 0.28 ° , and it had a valgus of 2.48 ± 0.39 ° at the final follow-up ( P < 0.01 ). No significant difference in the valgus was found compared with the postoperative week-one, final follow-up and preoperatively determined valgus of 2.34 ± 0.26 ° ( P > 0.05 ). The postoperative week-one and final follow-up FFAs were 90.34 ± 1.53 ° and 90.33 ± 1.52 ° , respectively, and no significant difference was found compared with the preoperatively determined value of 90.12 ± 1.72 ° and the intraoperative setting value of 90.25 ± 1.67 ° ( P > 0.05 ). All corrected values were within the acceptable range of preoperative planning. Conclusion. Preoperative planning of the FFA may be useful in OWHTO for patients with mild medial knee OA. Satisfactory correction of the postoperative targeted mechanical axis line of the lower limb can be obtained.

Recurrence of Varus Deformity After Proximal Tibial Osteotomy in Blount Disease: Long-Term Follow-Up

2002 ◽  
Vol 22 (5) ◽  
pp. 638-641 ◽  
Author(s):  
Chatupon Chotigavanichaya ◽  
Guillermo Salinas ◽  
Terri Green ◽  
Colin F. Moseley ◽  
Norman Y. Otsuka
Keyword(s):  
Varus Deformity ◽  
Tibial Osteotomy ◽  
Proximal Tibial Osteotomy ◽  
Long Term Follow Up ◽  
Blount Disease

scholarly journals Relationship between the bony correction angle and mechanical axis change and their differences between closed and open wedge high tibial osteotomy

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Takahiro Ogino ◽  
Ken Kumagai ◽  
Shunsuke Yamada ◽  
Tomotaka Akamatsu ◽  
Shuntaro Nejima ◽  
...  
Keyword(s):  
Soft Tissue ◽  
High Tibial Osteotomy ◽  
Mechanical Axis ◽  
Tibial Osteotomy ◽  
Axis Deviation ◽  
Open Wedge ◽  
Correction Angle ◽  
Closed Wedge ◽  
Wedge High Tibial Osteotomy

Abstract Background The purpose of this study was to investigate the relationship between the bony correction angle and mechanical axis change and their differences between closed wedge high tibial osteotomy (CWHTO) and open wedge high tibial osteotomy (OWHTO). Methods A total of 100 knees of 89 patients who underwent OWHTO (50 knees) or CWHTO (50 knees) between 2011 and 2015 with a clinical follow-up for 1 year and a radiological follow-up for 1 month were investigated in a case control study. Anteroposterior radiographs of the knee and full-length leg were taken in the standing position using digital acquisition. The femorotibial angle (FTA), % mechanical axis deviation (MAD), % anatomical tibial axis deviation (ATAD), % mechanical tibial axis deviation (MTAD), mechanical medial proximal tibial angle (mMPTA), and joint line convergence angle (JLCA) were measured on preoperative and postoperative radiographs using a dedicated software. Results CWHTO resulted in a greater variation between the tibial anatomical and mechanical axes than OWHTO (P <  0.05), and a greater soft tissue correction than OWHTO (P <  0.05). However, no significant difference was found between CWHTO and OWHTO in the ratio of MAD change to the correction angle. When the osteotomy was planned with the same bony correction angle, %MAD passed more laterally in OWHTO than in CWHTO (P <  0.05). These results suggested a lesser valgus bony correction ratio due to greater medial shift of the tibial axis and greater valgus compensation of the soft tissue in CWHTO compared to OWHTO. Conclusions The ratio of mechanical axis shift to the correction angle differed in preoperative planning, but postoperative alignment was comparable between opening wedge and closed wedge high tibial osteotomy.

scholarly journals Comparison of HTO with articular cartilage surgery and UKA in unicompartmental OA

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668409 ◽  
Author(s):  
Yoon Sang Jeon ◽  
Chi Hoon Ahn ◽  
Myung-Ku Kim
Keyword(s):  
Articular Cartilage ◽  
Clinical Outcome ◽  
Mechanical Axis ◽  
International Knee Documentation Committee ◽  
Senior Author ◽  
Tibial Osteotomy ◽  
Vas Score ◽  
Significant Difference ◽  
Ikdc Score

Purpose: The purpose of this article was to assess the clinical outcome of high tibial osteotomy (HTO) with articular cartilage surgery compared with unicompartmental knee arthroplasty (UKA) in unicompartmental osteoarthritis (OA). Methods: We designed retrospective study and evaluated 47 patients with unicompartmental OA (Kellgren–Laurence [K–L] grade ≥III OA). Two groups of patients underwent either HTO with articular cartilage surgery or UKA by the senior author between January 2010 and April 2013. The minimum follow-up period is 2 years. Clinical outcomes were assessed using Knee Injury and Osteoarthritis Outcome Scores, International Knee Documentation Committee (IKDC), and visual analog scale (VAS) score. And we evaluated the radiologic result of HTO and UKA by measuring mechanical axis at preoperative period and at last follow-up. Results: The IKDC score was significantly better in the UKA group than in the HTO group at 6 months but there was no significant difference in the two groups at 2 years. The VAS score was improved at the final follow-up compared to before surgery in both groups and did not show significant intergroup difference ( p = 0.123). There was no significant difference in the preoperative mechanical axis in the two groups. But their mechanical axis at the final follow-up were significantly different ( p = 0.0001). Conclusion: The clinical outcome was significantly better in the UKA group at 6 months. But in the two groups, there were no significant differences at 12 months and 2-year follow-up, and the mechanical axis correction effect is greater than the UKA group. Based on our research, HTO with articular cartilage surgery can be considered as the treatment of choice for more active and younger patients with unicompartmental OA.

scholarly journals The efficacy of guided growth as an initial strategy for Blount disease treatment

2020 ◽  
Vol 14 (4) ◽  
pp. 312-317
Author(s):  
Barry Danino ◽  
Robert Rödl ◽  
John E. Herzenberg ◽  
Lior Shabtai ◽  
Franz Grill ◽  
...  
Keyword(s):  
Proximal Tibia ◽  
Average Rate ◽  
Line Treatment ◽  
First Line ◽  
Guided Growth ◽  
Level Of Evidence ◽  
Post Surgery ◽  
Blount Disease ◽  
First Line Treatment

Purpose The aim of this study was to evaluate the success of guided growth by temporal hemiepiphysiodesis of the lateral proximal tibia as a first line treatment option for Blount disease. Methods This was a retrospective multicentre study conducted in five centres, covering data on 55 limbs in 45 patients, with an average follow-up of 24.5 months following plate insertion. Preoperative alignment analysis was compared with three measurements taken postoperatively. The normalization of the mechanical medial proximal tibia angle (mMPTA) was defined as the primary outcome measure. Results Mean age at surgery was 9.5 years. Average preoperative mMPTA was 77°. On average, at 24.5 months post-surgery, mMPTA was 86.33°, while 43/55 limbs (78.18%) have achieved normalization (mMPTA 85° to 90°). Average rate of correction was 1° per month. When grouping the children as infantile (11 limbs), juvenile (12 limbs) and adolescent (32 limbs), operated on before the age of four years, between four and ten years and after the age of ten years, respectively, 63.63%, 66.67%, 87.5% have completed correction of deformity during the follow-up period. Interestingly, the femoral component of the deformity has achieved correction as well in 33/55 limbs (64%). Conclusion Hemiepiphysiodesis is an effective first line treatment for Blount disease. Overall success rate is good but varies according to child’s age. Adolescent Blount has the best chance of achieving full correction while same treatment is less effective in infantile Blount. Level of evidence: IV

A Comparative Study of Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana in the Management of Shweta Pradara

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Renuka M. Tenahalli
Keyword(s):  
Vitamin C ◽  
Early Stage ◽  
Pathological Condition ◽  
Before And After ◽  
Group A ◽  
Phosphorus Iron ◽  
Group B ◽  
Busy Schedule ◽  
Iron And Calcium

Shweta Pradara (Leucorrhoea) is the disease which is characterized by vaginal white discharge. Vaginal white discharge this symptom is present in both physiological and pathological condition, when it becomes pathological it disturbs routine life style of the woman. Most of the women in the early stage will not express the symptoms because of hesitation and their busy schedule. If it is not treated it may leads to chronic diseases like PID (Garbhashaya Shotha etc.) Charaka mentioned Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana. This treatment is used in Shweta Pradara shown positive results, hence a study was under taken to assess its clinical efficacy. 30 diagnosed patients of Shweta Pradara were randomly selected, allocated in three groups. Group A and Group B received Amalaki Choorna with Madhu and Vata Twak Kashaya Yoni Pichu Dharana respectively and Group C received Amalaki Choorna with Madhu followed by Vata Twak Kashaya Yoni Pichu Dharana for 15 days. The patients were assessed for the severity of the symptoms subjectively and objectively before and after the treatment and at the end of the follow up. Data from each group were statistically analyzed and were compared. No side effects were noted and it may be considered as an effective alternative medicine in Shweta Pradara (leucorrhea). Amalaki is rich in natural source of vitamin C and contains phosphorus, iron and calcium. Honey contains carbohydrate, vitamin C, phosphorus iron and calcium. All together these help to increase Hb% and immunity. Vata Twak Kashaya contains tannin which helps to maintain normal pH of the vagina.

scholarly journals Structural and functional radiomics for lung cancer

2021 ◽  
Author(s):  
Guangyao Wu ◽  
Arthur Jochems ◽  
Turkey Refaee ◽  
Abdalla Ibrahim ◽  
Chenggong Yan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Treatment Strategy ◽  
Early Stage ◽  
Quality Data ◽  
Clinical Implementation ◽  
Early Stage Lung Cancer ◽  
Treatment Response Evaluation ◽  
Advanced Stage Lung Cancer ◽  
Stage Lung Cancer

Abstract Introduction Lung cancer ranks second in new cancer cases and first in cancer-related deaths worldwide. Precision medicine is working on altering treatment approaches and improving outcomes in this patient population. Radiological images are a powerful non-invasive tool in the screening and diagnosis of early-stage lung cancer, treatment strategy support, prognosis assessment, and follow-up for advanced-stage lung cancer. Recently, radiological features have evolved from solely semantic to include (handcrafted and deep) radiomic features. Radiomics entails the extraction and analysis of quantitative features from medical images using mathematical and machine learning methods to explore possible ties with biology and clinical outcomes. Methods Here, we outline the latest applications of both structural and functional radiomics in detection, diagnosis, and prediction of pathology, gene mutation, treatment strategy, follow-up, treatment response evaluation, and prognosis in the field of lung cancer. Conclusion The major drawbacks of radiomics are the lack of large datasets with high-quality data, standardization of methodology, the black-box nature of deep learning, and reproducibility. The prerequisite for the clinical implementation of radiomics is that these limitations are addressed. Future directions include a safer and more efficient model-training mode, merge multi-modality images, and combined multi-discipline or multi-omics to form “Medomics.”

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