Bildgebung und präoperative Planung bei perigenikulären Osteotomien

Pape, Dietrich; Hoffmann, Alexander; Seil, Romain

doi:10.1007/s00064-017-0496-6

Cited by 8 publications

(3 citation statements)

References 46 publications

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“…6 Correction of malunion is predominantly achieved through careful preoperative planning and careful intraoperative assessment of the MAD to ensure precise execution of the preoperative plan. 7,8 Intraoperative assessment of the MAD has been shown to be beneficial in achieving a precise coronal plane correction particularly when good preoperative planning is accompanied. 9…”

Section: Introductionmentioning

confidence: 99%

Extra-articular Osteotomy for the Management of Intra-articular Tibial Plateau Valgus Malunion

Page,

Greenstein,

Sheridan

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: To report a case series of extra-articular osteotomies for the management of intra-articular tibial plateau malunions and to assess the ability to correct deformity and improve knee range of motion (ROM). METHODS: Design: Retrospective case series Setting: Academic, tertiary, referral center. Patient Selection Criteria: Adult patients with tibial plateau fracture malunion treated with extra-articular osteotomy of the femur and/or tibia between 2014-2023. Outcome Measures and Comparison: Mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), lateral distal femoral angle (LDFA), and posterior proximal tibia angle (PPTA) correction; knee ROM, and time to weight bearing. RESULTS: There were 7 patients included, 6 (85.7%) were female and 1 (14.3%) were male. The median age was 43.5 years (IQR 38.5-51, range 32-62). Four (57.1%) patients were treated with a high tibial osteotomy (HTO) and 3 (42.9%) patients were treated with an HTO and distal femoral osteotomy (DFO). One patient had concomitant supramalleolar osteotomy with HTO to address distal tibia procurvatum and valgus. Four were treated with hexapod frames and 3 were treated with plates and screws. Median follow-up was 22.5 months (IQR 10.5-107 months, range 7-148 months). Surgical intervention corrected median radiographic measures of valgus malalignment pre-operatively relative to post-operative values. This included MAD (42.5mm to 0mm), valgus angle (12.5° to 1.5°), MPTA (95° to 88.0°), and LDFA 86.0° to 87.3°). Surgical intervention increased maximal knee range of motion pre- to post-operatively. Median time to full weight bearing was 81.5 days (IQR 46-57 days, range 41-184 days Two patients were converted to total knee arthroplasty after 5 and 10 years following HTO with hexapod frame. CONCLUSIONS: Extra-articular osteotomy is an effective treatment for addressing intra-articular malunion after tibia plateau fractures. It is effective in correcting the MAD, valgus deformity, MPTA, LDFA, PPTA, and improving knee ROM (measured through knee extension and flexion). LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Introductionmentioning

confidence: 99%

Extra-articular Osteotomy for the Management of Intra-articular Tibial Plateau Valgus Malunion

Page,

Greenstein,

Sheridan

et al. 2024

Journal of Orthopaedic Trauma

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“…11 There is general agreement that it is difficult to achieve accurate preoperative correction with conventional radiography alone. [12][13][14] According to some authors, CAS and PSI increase the precision of osteotomy. Other scholars believe that CAS cannot sufficiently control the degree of the desired correction.…”

Section: Introductionmentioning

confidence: 99%

Is Patient‐Specific Instrumentation Accurate and Necessary for Open‐Wedge High Tibial Osteotomy? A Meta‐Analysis

Pang

Jiang

et al. 2022

Orthopaedic Surgery

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The purpose of this meta‐analysis was to identify if patient‐specific instrumentation (PSI) could increase the accuracy of the correction in high tibial osteotomy (HTO) and to explore the assessment indices and the necessity of using a PSI in HTO. A systematic search was carried out using online databases. A total of 466 patients were included in 11 papers that matched the inclusion criteria. To evaluate the accuracy of PSI‐assisted HTO, the weight bearing line ratio (WBL%), hip‐knee‐ankle angle (HKA), mechanical medial proximal tibial angle (mMPTA), and posterior tibial slope angle (PTSA) were measured preoperatively and postoperatively and compared to the designed target values. Statistical analysis was performed after strict data extraction with Review Manager (version 5.4). Significant differences were detected in WBL% (MD = −36.41; 95% CI: −42.30 to −30.53; p < 0.00001), HKA (MD = −9.95; 95% CI: –11.65 to –8.25; p < 0.00001), and mMPTA (MD = –8.40; 95% CI:−10.27 to −6.53; p < 0.00001) but not in PTSA (MD = 0.34; 95% CI: −0.59 to 1.27; p = 0.47) between preoperative and postoperative measurements. There was no significant difference between the designed target values and the postoperative correction values of HKA (MD = 0.14; 95% CI: −0.19 to 0.47; p = 0.41) or mMPTA (MD = 0.11; 95% CI −0.34 to 0.55; p = 0.64). The data show that 3D‐based planning of PSI for HTO is both accurate and safe. WBL%, HKA, and mMPTA were the optimal evaluation indicators of coronal plane correction. Sagittal correction is best evaluated by the PTSA. The present study reports that PSI is accurate but not necessary in typical HTO.

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“…To achieve the best results whilst performing these osteotomies, an ultimate care should be given in terms of accurate pre‐operative planning and during the intraoperative execution to obtain precise correction of the deformity with a low complication rate, and hence the best clinical outcome [4]. Therefore, a certain degree of experience is often required to precisely reach the pre‐operative planning target postoperatively using the conventional free hand (FH) technique which depends only on standard X‐rays and intraoperative fluoroscopy [27]. Some authors argued that reaching the target pre‐operative correction is always difficult with frequent under and over correction whilst using the conventional FH technique [12].…”

Section: Introductionmentioning

confidence: 99%

No benefits of knee osteotomy patient’s specific instrumentation in experienced surgeon hands

Abdelhameed

Yang

AlMaeen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To compare the clinical and radiological outcomes of patient-speciic instrumentation (PSI) with the conventional free hand (FH) technique in performing coronal plane corrective knee osteotomies in terms of limb alignment and functional scores. The hypothesis is that conventional FH technique in experienced hands with proper pre-operative planning is as precise as PSI. Methods Patients who underwent coronal plane corrective knee osteotomies with either PSI or FH technique between 2017 and 2019 by the same senior surgeon and have a minimum of 2 years follow-up period were included in this study. A total of 91 knees (84 patients) with mean age of 42.9 ± 12.5 years who had a pre-and post-operative complete weight-bearing radiographic work-up (50 of them were performed with the FH technique and 41 by means of PSI) were included for comparison. The data were retrospectively reviewed both radiologically and clinically using the Knee Injury and Osteoarthritis Outcome Score (KOOS) sub-scores. All cases in both groups were evaluated for the following measurements: hip-knee-ankle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), and joint line convergence angle (JLCA) both preoperatively and postoperatively. In addition, FH and PSI osteotomy cases were also compared for their precision in achieving the target correction that was planned preoperatively. All cases were also evaluated clinically preoperatively and at 2-year follow-up using KOOS sub-scores and the two groups were compared. ResultsThe mean HKA precision was 1.5 ± 0.9 in FH group and 1.3 ± 0.7 in PSI (P value = n.s.), the mean MPTA precision was 1.6 ± 1.6 in FH group and 2.1 ± 1.2 in PSI (P value = n.s.), the mean m-LDFA precision was 1.9 ± 1.7 in FH group and 1.4 ± 1.3 in PSI (P value = n.s.), and the mean JLCA precision in the FH group was 1.5 ± 1.2 and 1.7 ± 1.2 in PSI (P value = n.s.). For all the radiographic parameters, there were no statistically signiicant diferences between the target correction and the obtained correction in both groups. Moreover, PSI and FH techniques were comparable in terms of clinical outcomes and no signiicant diference was found between the two groups in any of the 2-year follow-up KOOS sub-scores. Conclusion Conventional FH method in the hands of experienced surgeons is as precise as PSI in reliably achieving the planned correction in diferent coronal plane knee corrective osteotomies. Moreover, there was also no diference between both methods in the 2-year clinical outcome scores.

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Bildgebung und präoperative Planung bei perigenikulären Osteotomien

Cited by 8 publications

References 46 publications

Extra-articular Osteotomy for the Management of Intra-articular Tibial Plateau Valgus Malunion

Extra-articular Osteotomy for the Management of Intra-articular Tibial Plateau Valgus Malunion

Is Patient‐Specific Instrumentation Accurate and Necessary for Open‐Wedge High Tibial Osteotomy? A Meta‐Analysis

No benefits of knee osteotomy patient’s specific instrumentation in experienced surgeon hands

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