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Hip and knee
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The most commonly performed operation is a high tibial osteotomy (HTO) for a varus knee. Realignment is achieved with either an opening-wedge medial HTO or a closing-wedge lateral HTO. In valgus knees with relatively mild deformity (less than 12°) a varus-producing HTO on the medial side can be performed. A deformity of 12° or more requires distal femoral varus osteotomy.
Optimal definitions for computing HKA angle in caos: an in-vitro comparison study
Published in Computer Assisted Surgery, 2022
Guillaume Dardenne, Bhushan Borotikar, Hoel Letissier, Ahmed Zemirline, Eric Stindel
The precision of HKAA measurement was very influenced by the FP definition, making FPtibial_spines the worst plane of choice and FPhelical the best plane of choice. Thus, for a precise measurement of the HKAA, determination of the medio-lateral vector plays a major role, which was highlighted by this study. Previous studies have warranted the need to standardize the method for the HKAA measurement realized from an AP x-ray radiographs to avoid the influence of the lower limb rotation [2,30]. The current study enhances this understanding by providing a comparison for different FP selection methods and thus can be effectively used as a guide. In some clinical applications such as high tibial osteotomy, the anatomical landmarks are not visible, reachable or exposed. In such cases, FP and KC must be determined using noninvasive methods, either morpho-functional approaches (helical or circle) or cutaneous methods (localization of both femoral epicondyles on the skin). This study found that the helical method was more precise than the cutaneous methods.
Biomechanical effects of screw orientation and plate profile on tibial condylar valgus osteotomy - Finite-element analysis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Chih-Ting Cheng, Chu-An Luo, Yi-Chih Chen
High tibial osteotomy (HTO) corrects the extra-articular deformities and has become a well-established treatment for the patients with early stage of medial knee osteoarthritis (OA) (Spahn 2004; Ryohei et al. 2009; Amis 2013). However, severe medial OA will develop intra-articular deformities, thus the clinical outcomes may not as good as expected when treating with HTO (Teramoto 2015; Chiba et al. 2017). Tibial condylar valgus osteotomy (TCVO) is a type of opening wedge HTO that was developed in 1990 in Japan (Chiba 1992; Teramoto 2015; Chiba et al. 2017; Koseki et al. 2017). It corrects intra-articular deformities by a L-shaped opening wedge osteotomy at medial tibial condyle. The osteotomy combines a transverse cut from the proximal medial tibia and a vertical cut extends to the lateral intercondylar eminence (Figure 1). Both TCVO and HTO correct the lower limb alignment, but HTO is usually used for mild to moderate medial knee OA (Trieb et al. 2006; Bonasia et al. 2014), while TCVO is believed that it can treat severe medial OA and reduce lateral subluxation of the joint (Chiba et al. 2017; Koseki et al. 2017).
Design and application of personalized surgical guides to treat complex tibial plateau malunion
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Chi-Pin Hsu, Shang-Chih Lin, Aamer Nazir, Chen-Te Wu, Shih-Sheng Chang, Yi-Sheng Chan
Figure 7 shows the preoperative, intraoperative, and postoperative results of the two-stage PSG for the seven cases. According to Schatzker classification, all cases were classified into type II TPM (Schatzker et al. 1979). The surgical positions for case 1 was right medial, those for cases 2 and 3 were left lateral, and the others were left medial. The surgical steps for the cases with a central depression (cases 2, 3, and 5) involved drilling of the cutting holes along the fracture boundary and chiseling out the concave area. The concave area was shifted to the horizontal plane of the desired tibial plateau and fixed with a plate. The surgical steps for cases with a split involved the same steps that were used for a central depression if the collapsed area and fracture boundary were obvious (cases 1, 6, and 7). However, the surgical procedure for case 4 was similar to a high tibial osteotomy in that the medial tibial plateau was distracted.