High Tibial Osteotomy (HTO) is an established treatment for unicompartmental osteoarthritis of the knee with malalignment. The classic procedure for correcting varus deformity is the lateral closed wedge osteotomy of the tibia with osteotomy of the fibula. The disadvantages of this technique are well known. Open wedge osteotomy from the medial sideeliminates the risk of compartment syndrome and peroneal nerve injuries. A new fixation device (TomoFix(tm)) with an adapted surgical technique allows stable fixation of the osteotomy without the need to fill the osteotomy gap with bone grafts. In a prospective study, 92 consecutive cases were treated with this procedure. Bony healing with remodelling of the medial and posterior cortical bone was observed. Full weight-bearing was possible ten weeks after surgery. There were no implant failures. Complications included one delayed union, two revarisations and one deep infection. Keywords: High Tibial Osteotomy (HTO), openwedge osteotomy, TomoFix(tm) plate, medial osteoarthritis, varus knee

Tomofix: a new lcp-concept for open wedge osteotomy of the medial proximal tibia. early results in 92 cases

Background: Various types of corrective osteotomies of the distal femur have been described in the literature for genu valgum deformity such as lateral opening wedge, medial closing wedge, dome osteotomy, wedgeless spike osteotomy, and wedgeless “V” osteotomy. Objectives: We aimed in this study to evaluate the effectiveness of medial closing wedge osteotomy in correction of deformity. Patients and Methods: This study was done on 32 knees (18 patients) with age ranged from 10 to 18 years with mean average of 15.61 ± 1.28 years. After recording history and physical examination, appropriate radiographs were taken. We did varus distal femoral osteotomy by standard medial subvastus approach then followed the patients clinically and radiographically. Results: Mean operation time was 139.72 ± 42.4 minutes, with minimum 90 minutes and maximum 170 minutes. The mean time to union of osteotomy was 8.9 weeks (ranged from 7 to 11 weeks). The mean preoperative tibiofemoral angle (TFA) was 16.5° (range: 12°–19°) that improved after surgery to a mean postoperative value of 2.57° (range: 1.3°–4.7°), which was statistically significant (P < 0.001). Conclusion: Distal femoral varus osteotomy can be a reliable procedure for the treatment of valgus knee deformity. In this procedure, with more tibiofemoral angle correction, more congruence angle correction can be achieved. Therefore, along with genu valgum correction, the patella should be stabilized simultaneously.

https://ejhm.journals.ekb.eg/article_184668_5151bdff64338ef667c9ae1adcfcf756.pdf

Treatment of Genu Valgum Deformity in Adolescent by Closed Wedge Femoral Osteotomy

The concept of surgical osteotomy (osteo = bone, tomy = cut) for the treatment of isolated unicompartmental osteoarthritis of the knee associated with angular deformity has been in existence for decades [1]. Originally popularized by several surgeons in mid-twentieth century, it however failed to gain popularity due to its history of unpredictable and oftentimes poor results [2–4]. The commonly associated complications included high infection rate, loss of correction, and postoperative stiffness of the joint [5, 6]. Osteotomies finally fell out of favor with orthopedic surgeons as evolution of knee prostheses in the 1980s led to subsequent success of knee arthroplasty, especially in low demand and older patients [1, 7]. Only after considerable improvement in surgical techniques, fixation devices and patient selection in the recent years, osteotomy began to regain its past reputation as a highly effective treatment option with fewer complications and reproducible functional outcomes, reaching a survival rate of more than 90% at 5 years and more than 70% at 15 years [1, 8–10].

Anatomic Knee Joint Realignment

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Anatomic Knee Joint Realignment