Transtrochanteric posterior rotational osteotomy for osteonecrosis.
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ABSTRACT:
SUBMITTER: Sugioka Y
PROVIDER: S-EPMC2311463 | biostudies-other | 2008 May
REPOSITORIES: biostudies-other
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Project description:Osteonecrosis of the femoral head is a disabling condition affecting young patients and treatment of the disease in these patients is variable. We retrospectively reviewed 39 patients (43 hips) in whom a modified transtrochanteric rotational osteotomy was performed for osteonecrosis. The minimum followup was 24 months (mean, 36.6 months; range, 24-52 months). The mean patient age was 34.3 years (range, 20-51 years). Based on the ARCO classification, 17 hips were classified as Stage II and 26 as Stage III. We performed rotational osteotomy alone in 15 cases, in combination with simple bone grafting in three, and in combination with muscle-pedicle-bone grafting in 25. Sixteen of 17 ARCO Stage II cases and 24 of 26 ARCO Stage III cases had no progression of collapse or lesion size; three hips progressively collapsed. Of the 40 hips without progression the Harris hip score improved from a mean 70 to 92 points at final followup, as did the range of motion of the hip. Modified transtrochanteric rotational osteotomy is an effective method for delaying the progression of collapse in the treatment of selected cases of osteonecrosis of the femoral head.
| S-EPMC2311485 | biostudies-other
Project description:Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.
| S-EPMC4761609 | biostudies-literature
Project description:Increased tibial slope can be a cause of recurrent instability after anterior cruciate ligament reconstruction. This article presents a technique for an anterior closing-wedge osteotomy for slope correction. The indications for this procedure are patients with recurrent instability after anterior cruciate ligament reconstruction with a neutral leg axis or slightly varus deformity and a posterior slope of more than 12°. The exposure of the anterior aspect of the tibia is best made through an anterior approach approximately 1 to 2 cm medial to the tibial tuberosity. Hohmann retractors are placed from the medial and lateral sides behind the proximal tibia. The osteotomy lines are marked with 2 converging Kirschner wires with the use of an image intensifier. The entry point of the first Kirschner wire is just below the most inferior fibers of the patellar tendon. The hinge of the osteotomy should be just below the tibial insertion of the posterior cruciate ligament. The osteotomy is performed with an oscillating saw. The posterior cortex of the tibia should be left intact. After removal of the anterior base wedge, the osteotomy is closed by manual pressure. Osteosynthesis is performed with a lag screw from the tibial tuberosity to the distal tibia and an angular stable plate fixator.
| S-EPMC6261062 | biostudies-literature
Project description:High tibial osteotomy is a common procedure to address unicompartment knee osteoarthritis and other conditions. Regarding the specific surgical methods, medial open wedge osteotomy and lateral close wedge osteotomy are the most used. Both methods have a common disadvantage in that they are not so suitable to correct a severe deformity. Thus, we would like to introduce an anterior proximal-to-posterior distal oblique proximal tibial osteotomy technique, which is especially suitable to correct severe tibial deformity. The most critical point of this technique is to create an osteotomy plane from the most proximal posterior site of the tibial tubercle posteriorly and distally to the posterior cortex of the tibia, with each horizontal osteotomy maneuver in the coronal plane. Combined fibular osteotomy is always needed, and better results can be obtained when it is combined with arthroscopic debridement of the knee. We consider the introduction of this technique will provide a useful option when tibial osteotomy is needed to preserve the knee, especially for a great deformity correction. Technique Video Video 1 Anterior proximal-to-posterior distal oblique proximal tibial osteotomy. This procedure is performed in the right knee. Arthroscopy is performed to confirm the osteoarthritis status of the medial compartment and the healthier status of the lateral compartment. Debridement and other indicated arthroscopic procedures are performed. A K-wire is drilled in the coronal plane from the medial to the lateral side of the tibia at a level approximately 1 cm distal to the joint line, parallels the joint line as far as possible, and is used as a proximal reference wire. Another K-wire is drilled into the tibia also in the coronal plane at a level in the distal one third of the leg and used as a distal reference wire. The angle between the 2 reference wires is controlled being equal to the to-be-corrected angle of the tibia as far as possible. A longitudinal incision is made over the midline of the medial surface of the tibia. The pes anserinus is peeled off from its tibial insertion. A K-wire is placed at the most proximal and posterior site of the tibial tubercle and an osteotomy line is marked posterodistally to the posteromedial ridge of the tibia with 30° angulation to the tibial axis. The posterior osteofascial compartments are opened at the distal end of the osteotomy line. A 2.5-mm K-wire is used to drill through the medial tibial cortex along the osteotomy line to make a line of holes with approximately 5 mm distance between the neighboring holes. An osteotome is used to cut the bone and connect the holes along the osteotomy line at the medial side of the tibia. The lateral tibial cortex is drilled through the medial tibial fissure with each drilling maneuver along the coronal plane, to create a line of holes on the lateral side of the tibia. The osteotome is put into the fissure at the medial side of the tibia to connect the holes on the lateral side of the tibia to create an osteotomy plane. The distal posterior tibial cortex is cut along the osteotomy plane. A K-wire is drilled perpendicular to the coronal plane through the middle of the osteotomy plane. A fibula osteotomy is performed at its middle point with a wire saw. Valgus stress is applied to correct the varus deformity of the tibia till the 2 reference wires parallel to each other. Two additional K-wires are placed across the osteotomy plane for temporary fixation of the fracture. A tibial condyle plate is placed at the medial side of the tibia. Four self-locking screws are placed in respectively at the proximal and distal segments of the tibia for fracture fixation. The K wires for temporary fixation and correction reference are removed. A suction drainage tube is placed to the osteotomy site. The wounds are closed.
| S-EPMC8626582 | biostudies-literature
Project description:PurposeTo analyze the change in rotational alignment caused by double level osteotomy (DLO) based on comparative three-dimensional image analysis of pre- and postoperative CT images.MethodsPre- and postoperative CT examination of the lower extremities were performed with informed consent for 39 consecutive knees undergoing DLO for varus knee deformity. The DLO procedure consisted of closed wedge distal femoral osteotomy (CWDFO) and open wedge high tibial osteotomy (OWHTO). Among those cases, 20 knees complicated with hinge fracture at the osteotomy site were excluded from the analysis to eliminate a confounding factor affecting the results. Consequently, data obtained from 19 knees were subjected to the study analysis while osteotomies with hinge fractures complications were excluded from the study. In the three-dimensional CT image analysis of axial plane images, femoral torsion (the angle between midline along the femoral neck axis and the tangent of the posterior edges of the medial/lateral femoral condyles) and tibial torsion (the angle between the tangent of the posterior edges of the medial/lateral tibial condyles and the transmalleolar axis) were measured. The torsion angle was measured in each of the femurs and the tibias on both pre- and postoperative CT axial images, and the change induced by the osteotomy was calculated and statistically(using Wilcoxon signed-rank test) compared.ResultsThe mean pre- and postoperative femoral torsion (anteversion) angles were 29.3° and 31.4° with a significant postoperative increase in internal rotation of the bony segment distal to the osteotomy(P = 0.002). On the tibial side, the mean pre- and postoperative torsion angles were 26.5° and 25.7°, indicating no significant postoperative change(P = 0.199)（NS）.ConclusionsThis study showed that the DLO procedure (combining CWDFO and OWHTO) increased torsion (anteversion) of the femur by 2.1° on average while inducing no significant rotational change on the tibial side.
| S-EPMC8167197 | biostudies-literature
Project description:An excessive posterior tibial slope has been identified as a potential risk factor for anterior cruciate ligament tears. Anterior closing-wedge osteotomy decreases the posterior slope and can eliminate this risk factor in patients with recurrent instability and greater than 12° posterior slope. We will describe an anterior closing-wedge osteotomy technique performed at the tibial tubercle (TT), in which the TT is not detached to preserve the extensor mechanism attachment. A vertical cut is performed in the sagittal plane just posterior to the TT, leaving a distal cortical hinge. Two proximal parallel K-wires and 2 distal parallel K-wires convergent to the proximal ones are inserted from the anterior cortex on both sides of the tubercle toward the tibial posterior cortex at the posterior cruciate ligament's tibial insertion. Proximal and distal cuts are performed to remove the bone wedge. Reduction is achieved by gentle knee extension. Fixation is completed with 2 staples placed medially and laterally to the TT.
| S-EPMC6948133 | biostudies-literature
Project description:Purpose:To evaluate the refractive results and rotational stability of Eyecryl toric phakic intraocular lens (pIOL). Methods:In this retrospective single-surgeon case series, manifest refraction, visual acuities, endothelial cell density (ECD), and pIOL rotation were evaluated over 6 months. Results:43 eyes from 23 patients were included. At 6 months, the SE was within ±0.50? D of emmetropia in 30 (70%) eyes and within ±1.00? D of emmetropia in 39 (91%) eyes. The efficacy and safety indices were 1.25?±?0.38 and 1.41?±?0.34, respectively. Mean ECD was 2719?±?296?cells/mm2 at the preoperative visit and 2779.42?±?422?cells/mm2 at the 6-month visit (p > 0.05). The mean value of absolute axis orientation error was 4.95?±?5.28°. Mean absolute change in axis orientation between visits was less than 3° for all visit intervals. Ninety percent or more of lenses were found to rotate 5° or less between all visit intervals. None of the patients experienced a vision-threatening complication, and no patient required secondary IOL repositioning. Conclusion:The pIOL appears to effectively reduce subjective manifest astigmatism and provide good visual acuity. Its position was found to be stable throughout the follow-up.
| S-EPMC7171658 | biostudies-literature
Project description:The medial meniscal root tear, a particular meniscal injury at the level of its posterior bone insertion, leads to a loss of impact absorption and load distribution capacity, similar to total meniscectomy. Therefore, its repair is fundamental for knee joint longevity. This type of injury often occurs in middle-aged patients with lower limbs varus malalignment, which results in mechanical overloading of the medial compartment and induces premature cartilage wear out. The success of meniscal root repair, with meniscal bone reinsertion, depends on the correction and realignment of varus deformities greater than 5° for physiological levels. In this situation, corrective tibial osteotomy combined with meniscal repair is indicated. Our goal is to describe the step-by-step technique of the valgus opening wedge tibial osteotomy combined with the arthroscopic reinsertion of the posterior meniscal root in tibia during the treatment of a patient with varus deformity and medial meniscus root tear.
| S-EPMC8185971 | biostudies-literature
Project description:The treatment of residual deformity following surgery for developmental dysplasia of the hip remains controversial. The rationale for the use of the rotational acetabular osteotomy (RAO) is that it increases the weight-bearing area by shifting the osteotomized acetabulum to cover the femoral head. This can improve joint function as well as achieve relief of pain. However, it is unclear if this osteotomy can improve a compromised hip when performed for the treatment of residual deformity and acetabular dysplasia after surgery for developmental dysplasia of the hip. We aimed to report the clinical outcome as assessed by need for total hip arthroplasty (THA) and by the Merle d'Aubigné and Postel scores. In addition, we tried to assess the radiographic outcomes as assessed by Tönnis's classification. Only two hips required THA, which was performed in two patients at 11 and 12 years after RAO, respectively. The mean Merle d'Aubigné clinical score improved from 14.1 +/- 2.3 points (range, 10 to 17) preoperatively to 15.8 +/- 2.9 points (8 to 18) at final follow-up (p < 0.02). Radiological assessment at final follow-up showed the obvious progression of osteoarthritis in five hips. One patient in grade 1 preoperatively progressed into grade 3 at final follow-up; four patients in grade 2 preoperatively progressed into grade 3. In our study, this osteotomy prolonged the functional life of the hip, and only two hips needed THA after a mean follow-up of 11 years. We found that advanced arthritis pre-osteotomy is associated with progression of radiologic changes.
| S-EPMC2744757 | biostudies-other
Project description:BackgroundFew have explored the safety and efficacy of posterior vertebral column subtraction osteotomy (PVCSO) to treat tethered cord syndrome (TCS).ObjectiveTo evaluate surgical outcomes after PVCSO in adults with TCS caused by lipomyelomeningocele, who had undergone a previous detethering procedure(s) that ultimately failed.MethodsThis is a multicenter, retrospective analysis of a prospectively collected cohort. Patients were prospectively enrolled and treated with PVCSO at 2 institutions between January 1, 2011 and December 31, 2018. Inclusion criteria were age ≥18 yr, TCS caused by lipomyelomeningocele, previous detethering surgery, and recurrent symptom progression of less than 2-yr duration. All patients undergoing surgery with a 1-yr minimum follow-up were evaluated.ResultsA total of 20 patients (mean age: 36 yr; sex: 15F/5M) met inclusion criteria and were evaluated. At follow-up (mean: 23.3 ± 7.4 mo), symptomatic improvement/resolution was seen in 93% of patients with leg pain, 84% in back pain, 80% in sensory abnormalities, 80% in motor deficits, 55% in bowel incontinence, and 50% in urinary incontinence. Oswestry Disability Index improved from a preoperative mean of 57.7 to 36.6 at last follow-up (P < .01). Mean spinal column height reduction was 23.4 ± 2.7 mm. Four complications occurred: intraoperative durotomy (no reoperation), wound infection, instrumentation failure requiring revision, and new sensory abnormality.ConclusionThis is the largest study to date assessing the safety and efficacy of PVCSO in adults with TCS caused by lipomyelomeningocele and prior failed detethering. We found PVCSO to be an excellent extradural approach that may afford definitive treatment in this particularly challenging population.
| S-EPMC7884146 | biostudies-literature