The Results of Patient-Specific Instrument Guided Chevron-cut Distal Femur Osteotomy: A Retrospective Analysis

Abstract BackgroundDistal femur osteotomy (DFO) has been gaining popularity in treating subjects with genu valgum and the associated lateral compartment osteoarthritis. However, the risk of non-union and a period of protective weight bearing still remain unsolved even with the advent of locking plates. To improve the inherent stability of medial close-wedge DFO, we create bone cut in chevron shape with the guidance of a patient-specific instrument (PSI). The patients were allowed immediate weight-bearing as tolerated. The objective of the study was to assess the results of this technique.MethodsTwenty-five knees in twenty-three consecutive patients with genu valgum and lateral compartment osteoarthritis received chevron-cut medial close-wedge DFO. The alignment parameters of the knee, including the weight-bearing line (WBL) ratio, hip-knee-ankle angle (HKA), and mechanical lateral distal femoral angle (mLDFA) were assessed. We defined outliers as those with a difference of more than 10% from the targeted 50% WBL ratio. Patient-reported evaluation included the Oxford Knee Score (OKS), Knee Society Score (KSS), and a visual analog scale (VAS) pain scale.ResultsThe WBL ratio, HKA, and mLDFA were corrected from a mean of 78.7% ± 12.0%, 9.3° ± 2.8° valgus, and 83.6° ± 1.9° to 48.7% ± 2.9%, 0.5° ± 1.1° varus, and 91.4° ± 3.5° (respectively) postoperatively. A mean operative time of 58.8 ± 18.3 minutes, and 6.2 ± 1.3 intraoperative radiographs were taken. A mean Hb drop of 1.4 g/dl was found, while no patient required transfusion. Only one knee (4%) postoperatively fell in the defined range of correction outliers. Consolidation of the osteotomy was achieved at 11.3 ± 2.8 weeks. The OKS, KSS, and VAS pain scale were significantly improved compared with the pre-operative data. Complications developed in three patients, including one periprosthetic fracture, one loss of fixation, and a case of non-union.ConclusionThe PSI-guided chevron-cut close-wedge DFO, followed by immediate weight-bearing as tolerated is accurate, safe, and effective in the correction of genu valgum deformity and the associated lateral compartment osteoarthritis.Level of evidence IV

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Patient-Specific Instrument Guided Double Chevron-Cut Distal Femur Osteotomy

Journal of Personalized Medicine ◽

10.3390/jpm11100959 ◽

2021 ◽

Vol 11 (10) ◽

pp. 959

Author(s):

Yen-Chun Huang ◽

Kuan-Jung Chen ◽

Kuan-Yu Lin ◽

Oscar Kuang-Sheng Lee ◽

Jesse Chieh-Szu Yang

Keyword(s):

Distal Femur ◽

Weight Bearing ◽

Lateral Compartment ◽

Genu Valgum ◽

Patient Specific ◽

Non Union ◽

Specific Instrument ◽

Distal Femur Osteotomy ◽

Patient Reported ◽

The Mean

The risk of non-union and prolonged periods of protected weight-bearing still remain unsolved issues after distal femur osteotomy (DFO). To improve the stability, we developed the double chevron-cut technique, which is a modified medial closing-wedge DFO guided by a patient-specific instrument. The purpose of this study was to investigate the feasibility and outcome of this operative approach. Twenty-five knees in twenty-three consecutive patients with genu valgum and lateral compartment osteoarthritis that received double chevron-cut DFO were included. The target of correction was 50% on the weight-bearing line (WBL) ratio. Patient-reported outcomes included the Oxford Knee Score (OKS) and the 2011 Knee Society Score (KSS). The mean of the WBL ratio was corrected from 78.7% ± 12.0% to 48.7% ± 2.9% postoperatively. The mean time to full weight bearing was 3.7 ± 1.4 weeks. Union of the osteotomy was achieved at 11.3 ± 2.8 weeks. At a mean follow-up of 17 months, the OKS improved from a mean of 27.6 ± 11.7 to 39.1 ± 7.5 (p = 0.03), and the KSS from a mean of 92.1 ± 13.0 to 143.9 ± 10.2 (p < 0.001). Three patients developed complications, including one case of peri-implant fracture, one of loss of fixation, and one of non-union. The double chevron-cut DFO followed by immediate weight-bearing as tolerated is effective in treating genu valgum deformity and associated lateral compartment osteoarthritis.

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Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Using Transfibular Approach

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000107 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001 ◽

Cited By ~ 1

Author(s):

Alexej Barg ◽

Charles Saltzman

Keyword(s):

Range Of Motion ◽

Weight Bearing ◽

Total Ankle Replacement ◽

Trabecular Metal ◽

Non Union ◽

Early Loosening ◽

Early Results ◽

Ankle Replacement ◽

Patient Reported

Category: Ankle, Ankle Arthritis Introduction/Purpose: In the last two decades, total ankle replacement (TAR) has gained more acceptance as a treatment option in patients with end-stage ankle osteoarthritis. However, there is a lack of literature on TAR using a lateral transfibular approach. Therefore, we sought to report early clinical and radiographic results of a patient cohort treated with TAR using a lateral transfibular approach by a single surgeon. Methods: Fifty-five primary total ankle arthroplasties using the Zimmer trabecular metal implant were performed in 54 patients (29 men and 25 women; mean age, 67.0 years) from October 2012 to December 2014. Clinical assessment including pain evaluation and measurement of ankle range of motion was done preoperatively and at the latest follow-up. Weight-bearing radiographs were used to determine the angular alignment of the tibial and talar components and to analyze the bone-implant interface. Intraoperative and postoperative complications, revision surgeries, and failures were evaluated. Results: Implant survival was 93% at 36 months follow-up. There were 3 revisions of a tibial component due to aseptic loosening. In 10 of 55 procedures, a secondary procedure was performed during follow-up. Mean follow-up duration was 26.6 ± 4.2 months. No delayed union or non-union was observed for fibula healing. The average VAS pain score decreased significantly from 7.9 ± 1.3 to 0.8 ± 1.2. The average total range of motion increased significantly from 22.9° ± 11.8° to 40.2° ± 11.8°. Conclusion: Early results of Zimmer trabecular metal total ankle replacement demonstrated improved patient-reported outcomes and increased ankle motion at a minimum follow-up of one year. In the first 55 consecutive cases, the fibular osteotomy required for access to the ankle healed without complications. Painful early loosening requiring revision due to lack of bony ingrowth was seen in 3 of 55 cases.

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Clinical Experience Using a 3D-Printed Patient-Specific Instrument for Medial Opening Wedge High Tibial Osteotomy

BioMed Research International ◽

10.1155/2018/9246529 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Jesse Chieh-Szu Yang ◽

Cheng-Fong Chen ◽

Chu-An Luo ◽

Ming-Chau Chang ◽

Oscar K. Lee ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Weight Bearing ◽

Ct Scanning ◽

Tibial Slope ◽

Patient Specific ◽

Tibial Osteotomy ◽

Opening Wedge ◽

Time Saving ◽

X Ray ◽

Specific Instrument

Purpose. High tibial osteotomy (HTO) has been adopted as an effective surgery for medial degeneration of the osteoarthritis (OA) knee. However, satisfactory outcomes necessitate the precise creation and distraction of osteotomized wedges and the use of intraoperative X-ray images to continually monitor the wedge-related manipulation. Thus HTO is highly technique-demanding and has a high radiation exposure. We report a patient-specific instrument (PSI) guide for the precise creation and distraction of HTO wedge. Methods. This study first parameterized five HTO procedures to serve as a design rationale for an innovative PSI guide. Preoperative X-ray and computed tomography- (CT-) scanning images were used to design and fabricate PSI guides for clinical use. The weight-bearing line (WBL) of the ten patients was shifted to the Fujisawa’s point and instrumented using the TomoFix system. The radiological results of the PSI-guided HTO surgery were evaluated by the WBL percentage and tibial slope. Results. All patients consistently showed an increased range of motion and a decrease in pain and discomfort at about three-month follow-up. This study demonstrates the satisfactory accuracy of the WBL adjustment and tibial slope maintenance after HTO with PSI guide. For all patients, the average pre- and postoperative WBL are, respectively, 14.2% and 60.2%, while the tibial slopes are 9.9 and 10.1 degrees. The standard deviations are 2.78 and 0.36, respectively, in postoperative WBL and tibial slope. The relative errors of the pre- and postoperative WBL percentage and tibial slope averaged 4.9% and 4.1%, respectively. Conclusion. Instead of using navigator systems, this study integrated 2D and 3D preoperative planning to create a PSI guide that could most likely render the outcomes close to the planning. The PSI guide is a precise procedure that is time-saving, radiation-reducing, and relatively easy to use. Precise osteotomy and good short-term results were achieved with the PSI guide.

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Review of patient-reported outcomes in periprosthetic distal femur fractures after total knee arthroplasty: a plate or intramedullary nail?

Arthroplasty ◽

10.1186/s42836-021-00080-w ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Dustin Rinehart ◽

Tyler Youngman ◽

Junho Ahn ◽

Michael Huo

Keyword(s):

Total Knee Arthroplasty ◽

Range Of Motion ◽

Knee Arthroplasty ◽

Intramedullary Nail ◽

Distal Femur ◽

Non Union ◽

Femur Fractures ◽

Patient Reported ◽

Total Knee ◽

The Mean

Abstract Purpose This study reviewed the literature regarding the patient-reported treatment outcomes of using either open reduction and internal fixation (ORIF) with a plate and screw system or intramedullary nail (IMN) fixation for periprosthetic distal femur fractures around a total knee arthroplasty. Methods A total of 13 studies published in the last 20 years met the inclusion criteria. The studies included 347 patients who were allocated to ORIF (n = 249) and IMN (n = 98) groups according to the implants used. The primary outcome measures were the Knee Society Score or the Western Ontario and McMaster Universities osteoarthritis index. The secondary outcome measures included knee range of motion and the rates of complications, including non-union, malunion, infection, revision total knee arthroplasty, and reoperation. Statistical significance was set at P < 0.05. Results The mean Knee Society Scores of ORIF and IMN groups were 83 and 84, respectively; the mean postoperative range of motion of the knee were 99° and 100°, respectively (P < 0.05); the non-union rates were 9.4 and 3.8%, respectively (P > 0.05); the malunion rates were 1.8 and 7.5%, respectively (P < 0.05); surgical site infection rates were 2 and 1.3%, respectively (P > 0.05); the reoperation rates were 9.6 and 5.1%, respectively (P > 0.05); and revision rates of total knee arthroplasty were 2 and 1%, respectively (P > 0.05). Conclusion Based on the patient-reported outcome assessments, both ORIF with a plate and screw system and IMN fixation are well-accepted techniques for periprosthetic distal femur fractures around a TKA, and they produce similar functional outcomes.

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A clinical study of surgical management of distal femur fracture using locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193132 ◽

2019 ◽

Vol 5 (5) ◽

pp. 787

Author(s):

A. Varun Kumar Reddy ◽

S. Srikanth ◽

Gudapati Omkarnath

Keyword(s):

Clinical Outcome ◽

Traffic Accidents ◽

Distal Femur ◽

Road Traffic ◽

Weight Bearing ◽

Early Weight Bearing ◽

Non Union ◽

Femur Fractures ◽

Locking Compression Plates ◽

Fall From Height

Background: Fractures of distal femur are common due to increased road traffic accidents and fall from height because of increased construction activities. These fractures are quite disabling hence, these fractures necessitate early stabilization of fractures. Internal fixation with LCP has shown to give one of the best results in terms of recovery, fracture union, and clinical outcome. The aim of the study the clinical outcome of treatment of distal femur fractures using locking compression plates.Methods: A total of n=20 cases of distal femur fractures treated with LCP from December 2013 to June 2015 at NMCH and RC, Raichur. They were admitted and examined according to protocol clinically and radiologically. All patients were followed up for a minimum of 6 months and outcome assessed with Neer’s score.Results: All fractures healed with an average duration of 16 weeks which is comparable with other studies. We had two cases of varus collapse one was due to early weight bearing in one case and other case is due to gross communition. One case had an implant failure (plate breakage) due to early weight bearing. Cases needing hardware revision is comparable to other studies at 10%. Average Neer's knee score was 76.Conclusions: we have found higher Neer’s scores in this study. The LCP also prevents compression of periosteal vessels. It may not completely solve the age-old problems associated with any fracture like non-union and malunion, but is a valuable technique in the management of these fractures. But however, in type C fractures the outcome is poorer.

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Physical activity after distal femur osteotomy for the treatment of lateral compartment knee osteoarthritis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-012-2316-8 ◽

2012 ◽

Vol 22 (7) ◽

pp. 1607-1611 ◽

Cited By ~ 14

Author(s):

Lúcio Honório de Carvalho ◽

Eduardo Frois Temponi ◽

Luiz Fernando Machado Soares ◽

Matheus Braga Jacques Gonçalves ◽

Lincoln Paiva Costa

Keyword(s):

Physical Activity ◽

Knee Osteoarthritis ◽

Distal Femur ◽

Lateral Compartment ◽

Distal Femur Osteotomy

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Knee arthroplasty for acute fractures around the knee

EFORT Open Reviews ◽

10.1302/2058-5241.5.190059 ◽

2020 ◽

Vol 5 (10) ◽

pp. 713-723

Author(s):

Thomas Tampere ◽

Matthieu Ollivier ◽

Christophe Jacquet ◽

Maxime Fabre-Aubrespy ◽

Sébastien Parratte

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Distal Femur ◽

Weight Bearing ◽

Young Patients ◽

Revision Arthroplasty ◽

Patient Specific ◽

Full Weight Bearing ◽

Articular Fractures ◽

Primary Arthroplasty

Results of open reduction and internal fixation for complex articular fractures around the knee are poor, particularly in elderly osteoporotic patients. Open reduction and internal fixation may lead to an extended hospital stay and non-weight-bearing period. This may lead to occurrence of complications related to decubitus such as thrombo-embolic events, pneumonia and disorientation. Primary arthroplasty can be a valuable option in a case-based and patient-specific approach. It may reduce the number of procedures and allow early full weight-bearing, avoiding the above-mentioned complications. There are four main indications: 1) Elderly (osteoporotic) patients with pre-existing (symptomatic) end-stage osteoarthritis. 2) Elderly (osteoporotic) patients with severe articular and metaphyseal destruction. 3) Pathological fractures of the distal femur and/or tibia. 4) Young patients with complete destruction of the distal femur and/or tibia. The principles of knee (revision) arthroplasty should be applied; choice of implant and level of constraint should be considered depending on the type of fracture and involvement of stabilizing ligaments. The aim of treatment is to obtain a stable and functional joint. Long-term data remain scarce in the literature due to limited indications. Cite this article: EFORT Open Rev 2020;5:713-723. DOI: 10.1302/2058-5241.5.190059

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Structured physical therapy protocols following hip arthroscopy and their effect on patient-reported outcomes—a systematic review of the literature

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa042 ◽

2020 ◽

Author(s):

Hari K Ankem ◽

Mitchell J Yelton ◽

Ajay C Lall ◽

Alex M Bendersky ◽

Philip J Rosinsky ◽

...

Keyword(s):

Physical Therapy ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Patient Reported Outcomes ◽

Weight Bearing ◽

Return To Sport ◽

Rehabilitation Program ◽

Patient Specific ◽

Patient Reported ◽

Rehabilitation Protocols

Abstract The purpose of this study was to analyze the effect of structured physical therapy protocols on patient-reported outcomes (PROs) following hip arthroscopy. A literature search was completed in October 2019 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify articles reporting specific rehabilitation protocols following hip arthroscopy that document PROs. Studies meeting all inclusion and exclusion were reviewed and data were extracted. Six studies were included in analysis. The mean age was 34.7% and 56.6% were males. Five studies described rehabilitation protocols in phases with specific goals and progression criteria. All studies included range of motion (ROM) and weight-bearing (WB) precautions. Return to sport (RTS)/activity varied between 7 and 32 weeks. The studies used variations of 21 different PROs. Significant improvements in baseline and post-operative PROs noted across studies. Rehabilitation protocols following hip arthroscopy typically consist of 4–5 phase programs with set goals and progression criteria. Several commonalities existed between studies on WB, ROM precautions and gait normalization. However, timing and recommendations for RTS/return to work varied between studies and were dependent on the concomitant procedures performed as well as type of patient population. Clinically significant improvement in PROs from baseline noted in majority of the studies reviewed that involved a structured rehabilitation program following arthroscopic management of femoroacetabular impingement. As there is heterogeneity in patient-specific characteristics across the included studies, no determination can be made as to which protocol is most effective and further high-quality comparative studies are needed. Clinical relevance: Adopting phase-based rehabilitation protocols following arthroscopic femoroacetabular impingement treatment help achieve improved outcomes that are predictable

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PHYSIOTHERAPY AFTER SURGICALLY STABILIZED PROXIMAL TIBIA FRACTURE

Trakia Journal of Sciences ◽

10.15547/tjs.2020.02.011 ◽

2020 ◽

Vol 18 (2) ◽

pp. 156-160

Author(s):

R. Tasheva

Keyword(s):

Proximal Tibia ◽

Weight Bearing ◽

Lateral Compartment ◽

Recovery Phase ◽

Knee Extension ◽

Tibia Fracture ◽

Extension Deficit ◽

Proximal Tibia Fracture ◽

Ao Classification ◽

Correct Function

THE AIM OF THIS STUDY is to present the physiotherapy for overcoming the substitution movements and to restore the correct function in the phase of relative protection after surgical stabilized proximal tibia fracture. Material and method Seven patients after fracture in the proximal lateral compartment of the tibia (type b1 in AO classification) with an average age of 42, 9 years were treated. After surgery, an average of 30 days of the brace was used for relative protection. The aim of the physiotherapy was to overcome muscle imbalance to achieve proper movement in the respective planes. Emphasis on recovery was the proper weight bearing on the operated lower limb. RESULTS The results of the first recovery phase demonstrated very limited knee flexion in range of 22, 7º, and knee extension deficit in the range of -15º. After two weeks the results progressed to 115, 5º flexion and full restoration of the extension. Control of edema and hypotrophy of the thigh were proven by circumference. CONCLUSION The adequate physiotherapy provides overcoming of the substitution movements and to restore the correct knee function in the phase of relative protection after surgical stabilized fracture in the proximal tibia.

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Intraoperative Robotics for Patient Specific Instrument Manufacture: A Cadaver Trial

10.31256/hsmr2019.39 ◽

2019 ◽

Author(s):

A Darwood ◽

◽

S Hurst ◽

G Villatte ◽

R Fenton ◽

...

Keyword(s):

Patient Specific ◽

Instrument Manufacture ◽

Specific Instrument

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