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Discrepancy in Length of the Femur
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Christopher Prior, Nicholas Peterson, Selvadurai Nayagam
Bone age assessments suggested she had a skeletal immaturity of about two years behind her chronological age. When leg length equality was established, the femoral 8-plates were removed to avoid over-shortening. At the same time, a varus deformity at the knee, which had recently developed arising from the proximal tibia, was treated using guided growth (Figure 36.9). This surgery coincided with the patient starting a trial of MEK inhibitor therapy.4
Clinical Management of Spasticity and Contractures in Stroke
Published in Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway, Neurological Rehabilitation, 2018
Judith F. M. Fleuren, Jaap H. Buurke, Alexander C. H. Geurts
In the coronal plane, muscular imbalance between evertors and invertors is often seen. When activity of the lateral foot elevators, i.e., the long toe extensors and peroneus tertius, is decreased during swing phase, excessive varus of the hindfoot will occur (Perry and Burnfield, 2010). In mild cases, a slight (lateral) foot clearance deficit occurs during swing and initial contact is made at the lateral side of the foot, but a fast return to plantigrade support is seen during the loading response. In these cases, the anterior tibialis muscle is activated based on selective control or as part of a flexor synergy. Extensor muscle synergy takes over as soon as weight is loaded onto the affected foot, leading to tibialis anterior relaxation. In more severe cases, varus may persist throughout the stance phase as a result of prolonged anterior tibialis activity, which is often accompanied by (excessive) posterior tibialis muscle activity. When the dysfunctional equinovarus posture persists during the stance phase, the supporting surface of the foot will decrease, by increased loading of the forefoot and/or lateral foot, thereby decreasing stability in stance. When more proximal control (knee extension, hip extension) is reduced as well, stance stability, step length, and walking velocity are compromised even more. As a result, these patients experience an increased risk of falling and are frequently unable to walk either unassisted or without orthotic devices (Weerdensteyn et al., 2008).
The elbow
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
With both upper limbs exposed the arms are held by the patient’s side with the elbow extended and palms facing forward (the anatomical position). In this position the forearms are normally angled slightly outward relative to the line of the arm — a valgus or carrying angle of 5–15 degrees. ‘Varus’ or ‘valgus’ deformity is determined by angular deviation towards the body or away beyond those limits or, in unilateral abnormalities, by comparison with the normal side. Note that the carrying angle cannot be assessed reliably if there is a flexion contracture of the elbow.
Uncemented monoblock trabecular metal posterior stabilized high-flex total knee arthroplasty: similar pattern of migration to the cruciate-retaining design — a prospective radiostereometric analysis (RSA) and clinical evaluation of 40 patients (49 knees) 60 years or younger with 9 years’ follow-up
Published in Acta Orthopaedica, 2019
Radoslaw Wojtowicz, Anders Henricson, Kjell G Nilsson, Sead Crnalic
1 patient (female, 55 years) with bilateral operations staged 6 months apart had her second (right) operated knee revised 3 months postoperatively. Postoperative knee alignment was 3° varus and tibial component alignment 4° varus. The tibial implant subsided 9 mm medially within the first weeks postoperatively, resulting in a severe varus malalignment. There were no signs of infection. At revision 3 months after the index operation, the tibial implant was firmly fixed to bone and had to be cut out with saw and chisels. Bone underneath and adjacent to the implant showed signs of bone necrosis on microscopic analysis. A stemmed revision tibial component was inserted. The first (left) knee operated on this patient had postoperative HKA angle 180° and tibial component alignment of 1° varus, and functioned very well during the follow-up.
Custom-made asymmetric polyethylene liner to correct tibial component malposition in total knee arthroplasty — a case report
Published in Acta Orthopaedica, 2019
Andreas Kappel, Claes Sjørslev Blom, Anders El-Galaly
In this case, malpositioning of the tibial component caused varus malalignment. Tibial component revision would be the standard treatment to address this. However, this otherwise straightforward procedure was considered rather complicated, as a standard stemmed component, due to the posterior translation of the tibial plateau, would not fit the actual anatomy (Figure 6). We considered the use of a very short cemented stem, but due to the bony deformity the risk of repeated malpositioning and risk of difficulties in balancing the knee gave reason for concern. A hinged implant was less tempting due to the young age of the patient. Correction of the sagittal deformity with one or more osteotomies was also considered, but the complexity and high risk of complications caused concern. The decision to use a custom-made liner was preceded by thorough physical and radiological examination. Coronal mechanical alignment, sagittal alignment and component rotation was examined with EOS and CT scan. Coronal and sagittal malposition of the tibial component was evident while the femoral component was well placed and the soft-tissue envelope intact.
Blount’s disease successfully treated with intraepiphyseal osteotomy with elevation of the medial plateau of the tibia—a case report with 65 years’ follow-up
Published in Acta Orthopaedica, 2018
Terje Terjesen, Darko Anticevic
Severe varus deformity should be surgically corrected; if left untreated, OA predictably occurs early in life (Hofmann et al. 1982). It is, however, difficult to evaluate the association between deformity following Blount’s disease and OA, because follow-up in most studies is too short. The longest previous follow-up after elevation osteotomy of the tibial plateau seems to be in a patient aged 41 years (Langenskiöld 1989). The follow-up time of our patient was 65 years (patient age 78 years) and thus more than long enough for a proper evaluation of OA. Surprisingly, only moderate OA had developed during this long time. This shows that a good result at skeletal maturity in a patient with severe preoperative varus (Støren 1969) can remain good even with long follow-up if the deformity has been adequately corrected.