Purpose: To describe the indications for, and surgical technique of, tibial condylar valgus osteotomy (TCVO). Indications: TCVO is commonly performed in patients with middle-to-end-stage medial unicompartmental osteoarthritis. Among the most important TCVO indication criteria are the types of tibial plateau shape. The convextype (also called "pagoda-type"), with over a 5°joint line convergence angle on the standing X-ray, meets the indication criteria for TCVO. Surgical technique: An L-shaped osteotomy is performed from the medial side of the proximal tibia to the lateral beak of the intercondylar eminence. The apex of the L-shaped osteotomy line is on the medial border of the patellar tendon insertion. Surgeons should note the direction of the chisel (during the osteotomy) to the intercondylar eminence following fluoroscopic guidance. The posterior cortical bone is cut under a lateral view observation, and the crossed-leg position is adopted to prevent injury to the popliteal blood vessels. The spreader should be positioned at the posterior cortical bone to avoid increasing the tibial slope. The locking plate reliably stabilizes the osteotomy and helps shorten the period of postoperative rehabilitation. Conclusions: TCVO adjusts varus deformity alongside joint congruity. Accurate identification of indications and a detailed surgical plan would ensure effective correction and proper alignment. Additional osteotomies are recommended in case of under-correction of the varus limb deformity. TCVO is an effective intervention in patients with advanced knee osteoarthritis and lateral joint laxity with the pagoda-type tibial plateau shape.
ObjectivesBecause there have been no standard methods to determine pre-operatively
the thickness of resection of the proximal tibia in unicompartmental
knee arthroplasty (UKA), information about the relationship between
the change of limb alignment and the joint line elevation would
be useful for pre-operative planning. The purpose of this study
was to clarify the correlation between the change of limb alignment
and the change of joint line height at the medial compartment after
UKA.MethodsA consecutive series of 42 medial UKAs was reviewed retrospectively.
These patients were assessed radiographically both pre- and post-operatively
with standing anteroposterior radiographs. The thickness of bone
resection at the proximal tibia and the distal femur was measured
radiographically. The relationship between the change of femorotibial
angle (δFTA) and the change of joint line height, was analysed.ResultsThe mean pre- and post-operative FTA was 180.5° (172.2° to 184.8°)
and 175.0° (168.5° to 178.9°), respectively. The mean δFTA was 5.5°
(2.3° to 10.1°). The joint line elevation of the tibia (JLET) was
4.4 mm (2.1 to 7.8). The δFTA was correlated with the JLET (correlation
coefficient 0.494, p = 0.0009).ConclusionsThis study indicated that there is a significant correlation
between the change of limb alignment and joint line elevation. This
observation suggests that it is possible to know the requirement
of elevation of the joint line to obtain the desired correction
of limb alignment, and to predict the requirement of bone resection
of the proximal tibia pre-operatively.Cite this article: Bone Joint Res 2015;4:128–133
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.