osteotomies about the knee l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
OSTEOTOMIES ABOUT THE KNEE PowerPoint Presentation
Download Presentation
OSTEOTOMIES ABOUT THE KNEE

Loading in 2 Seconds...

play fullscreen
1 / 29

OSTEOTOMIES ABOUT THE KNEE - PowerPoint PPT Presentation


  • 1588 Views
  • Uploaded on

OSTEOTOMIES ABOUT THE KNEE. Rod Martin M.D. FRCS(C). Outline. Introduction Distal Femoral Osteotomy Proximal Osteotomies of the Tibia Closing wedge osteotomy Coventry Slocum HTO with jig & plate Barrel-vault osteotomy Opening wedge osteotomy. OSTEOTOMIES ABOUT THE KNEE.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'OSTEOTOMIES ABOUT THE KNEE' - ostinmannual


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
osteotomies about the knee
OSTEOTOMIES ABOUT THE KNEE

Rod Martin M.D. FRCS(C)

outline
Outline
  • Introduction
  • Distal Femoral Osteotomy
  • Proximal Osteotomies of the Tibia
    • Closing wedge osteotomy
      • Coventry
      • Slocum
      • HTO with jig & plate
    • Barrel-vault osteotomy
    • Opening wedge osteotomy
osteotomies about the knee3
OSTEOTOMIES ABOUT THE KNEE
  • Patients with malalignment and unicompartment disease
  • Varus(4X) & valgus(5X) OA
  • 2020 OA will have largest increase of new cases of any disease
  • Unicompartment OA 30-60 age group
  • High demand / middle aged athlete
varus distal femoral osteotomy
Indications

Valgus deformity > 12 to 15 degrees

Plane of the knee deviates from the horizontal >10 degrees

25-22

Varus Distal Femoral Osteotomy
distal femoral osteotomy
Distal Femoral Osteotomy
  • Reported success 71% - 86%
  • Poor results with RA
  • Satisfactory results with TKR 94%
    • (13 of 18 had complications)
    • Difficulty restoring desired 5-10 degrees valgus
coventry distal femoral osteotomy
Coventry

Medial or midline incision

Rectus/medialis interval

Insert blade at templated angle

Osteotomy of femur

Close wedge/secure plate

25-23

Coventry Distal Femoral Osteotomy
proximal osteotomies of the tibia
Proximal Osteotomies of the Tibia
  • Treatment of unicompartmental OA
  • 80% satisfactory results @ 5 years
  • Varus deformity = medial OA
  • Valgus deformity = lateral OA
  • Osteotomy “unloads” the “overloaded”
proximal osteotomies of the tibia8
Proximal Osteotomies of the Tibia
  • Coventry (1965)
    • Medial closing wedge for valgus deformity
    • Lateral closing wedge for varus deformity
    • Advantages
      • Near the deformity
      • Cancellous bone heals quickly
      • Fragments held firmly by 1-2 staples
      • Permits evaluation of the knee through the same incision
proximal osteotomies of the tibia9
Proximal Osteotomies of the Tibia
  • Coventry (1979)
    • 80% at 5 years & 60% at 10 years (213 knees)
    • Recurrence of deformity = recurrence of pain
    • Minimum “overcorrection” 8 degrees valgus
    • >30% ideal body weight = high failure
proximal osteotomies of the tibia10
Proximal Osteotomies of the Tibia
  • Indications
    • Pain and disability
    • Unicompartment OA
    • Ability to use crutches post-op
    • Good vascular status
proximal osteotomies of the tibia11
Proximal Osteotomies of the Tibia
  • Contraindications
    • Narrowing of lateral compartment
    • Lateral tibial subluxation of > 1 cm
    • Medial compartment bone loss > 2-3 mm
    • Flexion contracture > 15 degrees
    • Knee flection < 90 degrees
    • Correction of > 10-15 degrees
    • Inflammatory arthropathies
proximal osteotomies of the tibia12
Proximal Osteotomies of the Tibia
  • Coventry correction formula
    • (1) Normal valgus (5-8 degrees)
    • (2) + amount of varus deformity
    • (3) + “overcorrection factor” of 3 to 5 degrees

= total correction required

(approx. 1 mm / degree)

proximal osteotomies of the tibia19
Proximal Osteotomies of the Tibia
  • Maquet (barrel-vault) osteotomy
    • Inherently stable
    • “extensive” degrees of correction possible
    • Technically difficult
    • Intraarticular fracture
    • Scarring about the patellofemoral mechanism
proximal osteotomies of the tibia21
Proximal Osteotomies of the Tibia
  • Medial opening wedge osteotomy
    • Does not “shorten” the extremity
    • Correct medial laxity
    • Surgery directed to the diseased compartment
    • Corrects up to 15˚
conclusions
conclusions
  • Delays/avoids arthroplasty
  • Refute claims osteotomies compromise arthroplasty
  • Second “wave” of osteotomies coming
slide28
6mos post op

Resumed all adl’s

“knee feels 75% better”