osteotomiesaboutknee

8/8/2019 OsteotomiesAboutKnee

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OSTEOTOMIES ABOUTOSTEOTOMIES ABOUTTHE KNEETHE KNEE

Rod Martin M.D. FRCS(C)Rod Martin M.D. FRCS(C)


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OutlineOutline

I ntroductionI ntroductionDistal Femoral OsteotomyDistal Femoral OsteotomyProximal Osteotomies of the TibiaProximal Osteotomies of the Tibia Closing wedge osteotomyClosing wedge osteotomy

CoventryCoventry

SlocumSlocumHTO with jig & plateHTO with jig & plate BarrelBarrel--vault osteotomyvault osteotomy Opening wedge osteotomyOpening wedge osteotomy


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OSTEOTOMIES ABOUTOSTEOTOMIES ABOUT

THE KNEETHE KNEEPatients with malalignment andPatients with malalignment andunicompartment diseaseunicompartment disease

Varus(4X) & valgus(5X) OA Varus(4X) & valgus(5X) OA2020 OA will have largest increase of 2020 OA will have largest increase of new cases of any diseasenew cases of any diseaseUnicompartment OA 30Unicompartment OA 30--60 age group60 age groupHigh demand / middle aged athleteHigh demand / middle aged athlete


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Var us Dist a l Femo ra l Var us Dist a l Femo ra l

OsteotomyOsteotomyI ndicationsI ndications Valgus deformity > Valgus deformity >

12 to 15 degrees12 to 15 degrees Plane of the kneePlane of the knee

deviates from thedeviates from thehorizontal >10horizontal >10

degreesdegrees

2525--2222


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Dist a l Femo ra l OsteotomyDist a l Femo ra l Osteotomy

Reported success 71%Reported success 71% - - 86%86%

Poor results with RAPoor results with RASatisfactory results with TKR 94%Satisfactory results with TKR 94% (13 of 18 had complications)(13 of 18 had complications) Difficulty restoring desired 5Difficulty restoring desired 5--10 degrees10 degrees

valgusvalgus


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C ovent r y Dist a l Femo ra lC ovent r y Dist a l Femo ra l

OsteotomyOsteotomyCoventryCoventry Medial or midlineMedial or midline

incisionincision Rectus/medialisRectus/medialisintervalinterval

I nsert blade at I nsert blade at templated angletemplated angle

Osteotomy of femurOsteotomy of femur Close wedge/secureClose wedge/secure

plateplate

2525--2323


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P r oxim a l Osteotomies ofP r oxim a l Osteotomies of

the Tibi athe Tibi aTreatment of unicompartmental OATreatment of unicompartmental OA80% satisfactory results @ 5 years80% satisfactory results @ 5 years

Varus deformity = medial OA Varus deformity = medial OA Valgus deformity = lateral OA Valgus deformity = lateral OA

Osteotomy unloads the overloadedOsteotomy unloads the overloaded


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the Tibi athe Tibi aCoventry (1965)Coventry (1965)

Medial closing wedge for valgus deformityMedial closing wedge for valgus deformity

Lateral closing wedge for varus deformityLateral closing wedge for varus deformity Advantages Advantages

Near the deformityNear the deformityCancellous bone heals quicklyCancellous bone heals quickly

Fragments held firmly by 1Fragments held firmly by 1- -2 staples2 staplesPermits evaluation of the knee through the samePermits evaluation of the knee through the sameincisionincision


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the Tibi athe Tibi aCoventry (1979)Coventry (1979) 80% at 5 years & 60% at 10 years (21380% at 5 years & 60% at 10 years (213

knees)knees) Recurrence of deformity = recurrence of Recurrence of deformity = recurrence of

painpain

Minimum overcorrection 8 degreesMinimum overcorrection 8 degreesvalgusvalgus >30% ideal body weight = high failure>30% ideal body weight = high failure


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the Tibi athe Tibi aI ndicationsI ndications Pain and disabilityPain and disability Unicompartment OAUnicompartment OA Ability to use crutches post Ability to use crutches post- -opop Good vascular statusGood vascular status


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the Tibi athe Tibi aContraindicationsContraindications Narrowing of lateral compartment Narrowing of lateral compartment Lateral tibial subluxation of > 1 cmLateral tibial subluxation of > 1 cm Medial compartment bone loss > 2Medial compartment bone loss > 2- -3 mm3 mm Flexion contracture > 15 degreesFlexion contracture > 15 degrees

Knee flection < 90 degreesKnee flection < 90 degrees Correction of > 10Correction of > 10--15 degrees15 degrees I nflammatory arthropathiesI nflammatory arthropathies


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P r oxim a l Osteotomies of theP r oxim a l Osteotomies of the

Tibi aTibi aCoventry correction formulaCoventry correction formula

(1) Normal valgus (5(1) Normal valgus (5--8 degrees)8 degrees) (2) + amount of varus deformity(2) + amount of varus deformity (3) + overcorrection factor of 3 to 5(3) + overcorrection factor of 3 to 5

degreesdegrees= total correction required= total correction required(approx. 1 mm / degree)(approx. 1 mm / degree)


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Tibi aTibi a2525--1010


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the Tibi a ( C ovent r y)the Tibi a ( C ovent r y)


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the Tibi a ( C ovent r y)the Tibi a ( C ovent r y)


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the Tibi a (Slocum)the Tibi a (Slocum)


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the Tibi a (jig a nd pl a te)the Tibi a (jig a nd pl a te)


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Tibi aTibi a


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Tibi aTibi aMaquet (barrelMaquet (barrel--vault) osteotomyvault) osteotomy I nherently stableI nherently stable extensive degrees of correction possible extensive degrees of correction possible Technically difficult Technically difficult I ntraarticular fractureI ntraarticular fracture

Scarring about the patellofemoralScarring about the patellofemoralmechanismmechanism


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the Tibi a (B arr elthe Tibi a (B arr el--v a ult)va ult)


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Tibi aTibi aMedial openingMedial openingwedge osteotomywedge osteotomy Does not shortenDoes not shorten

the extremitythe extremity Correct medial laxityCorrect medial laxity Surgery directed toSurgery directed to

the diseasedthe diseasedcompartment compartment Corrects up to 15Corrects up to 15


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P r oxim a l Osteotomy of theP r oxim a l Osteotomy of the

Tibi a (opening wedge)Tibi a (opening wedge)


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43 ye ar fem a le with43 ye ar fem a le with

inc r e a sing knee p a ininc r e a sing knee p a in


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M.B. 43 ye ar fem a leM.B. 43 ye ar fem a leinc r e a singinc r e a singknee p a inknee p a in


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Opening wedge HTOOpening wedge HTO


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6mos post op6mos post opResumed all adl sResumed all adl s

knee feels 75% knee feels 75%betterbetter


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Thank youThank you

osteotomiesaboutknee

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