Effect of foot rotation on the mechanical axis and correlation between knee and whole leg radiographs

Jeong

BMC Musculoskelet Disord

et al. 2014

BackgroundCodman’s paradox reveals a misunderstanding of geometry in orthopedic practice. Physicians often encounter situations that cannot be understood intuitively during orthopedic interventions such as corrective osteotomy. Occasionally, unexpected angular or rotational deformity occurs during surgery.This study aimed to draw the attention of orthopedic surgeons toward the concepts of orientation and rotation and demonstrate the potential for unexpected deformity after orthopedic interventions. This study focused on three situations: shoulder arthrodesis, femoral varization derotational osteotomy, and femoral derotation osteotomy.MethodsFirst, a shoulder model was generated to calculate unexpected rotational deformity to demonstrate Codman’s paradox. Second, femoral varization derotational osteotomy was simulated using a cylinder model. Third, a reconstructed femoral model was used to calculate unexpected angular or rotational deformity during femoral derotation osteotomy.ResultsUnexpected external rotation was found after forward elevation and abduction of the shoulder joint. In the varization and derotation model, closed-wedge osteotomy and additional derotation resulted in an unexpected extension and valgus deformity, namely, under-correction of coxa valga. After femoral derotational osteotomy, varization and extension of the distal fragment occurred, although the extension was negligible.ConclusionsSurgeons should be aware of unexpected angular deformity after surgical procedure involving bony areas. The degree of deformity differs depending on the context of the surgical procedure. However, this study reveals that notable deformities can be expected during orthopedic procedures such as femoral varization derotational osteotomy.

Section: Discussionmentioning

confidence: 99%

Unexpected angular or rotational deformity after corrective osteotomy

Jeong

BMC Musculoskelet Disord

et al. 2014

“…Ротация большеберцовой кости обуслов-ливает избыточную нагрузку на суставные поверхности надколенника, а также ограни-чивает вращательные движения (боковые) надколенника во фронтальной плоскости, практически не затрагивая поступатель-ных (сгибание/разгибание) [29,37]. Особен-ности влияния ротации большеберцовой кости зависят также от её механизма -ла-теральный или медиальный ротационный компонент.…”

Section: Etiopathogenic Bases For Patellofemoral Arthritis Developmentunclassified

“…В частности, Lee и соавт. докладывали, что наружная ро-тация на 10-15° от нейтральной позиции достоверно увеличивает пик нагрузки ло-кально на большую латеральную фасет-ку [31,37]. При наружной ротации больше-берцовой кости страдает и медиальная су-ставная поверхность надколенника, в том числе и «спящие» фасетки.…”

Section: Etiopathogenic Bases For Patellofemoral Arthritis Developmentunclassified

“…Таким образом, наружная ротация боль-шеберцовой кости даже при минимальных движениях КС до 15° способствует механи-ческой деградации латеральной суставной поверхности надколенника (хондромаля-ции), компрессирует основную медиальную Обзоры и дополнительные фасетки [37,40], непо-средственно влияя на вращательные дви-жения надколенника, создаёт условия для ранней нестабильности КС и пателлофемо-рального синдрома.…”

Section: Etiopathogenic Bases For Patellofemoral Arthritis Developmentunclassified

“…Однако она обусловливает общее формирование биомеханики всей нижней конечности, опосредованно, и на КС [37,40]. В частности, были проанализированы эф-фекты как наружной, так и внутренней ро-тации бедра в пределах 0-20°, что влекло к минимальному увеличению нагрузки на фасетки надколенника.…”

Section: Etiopathogenic Bases For Patellofemoral Arthritis Developmentunclassified

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Etiopathogenic bases for patellofemoral arthritis development

Саид

М²,

Akhtyamov

et al. 2018

Kazan Med J

Patellofemoral arthritis is nowadays an actual issue of traumatology and orthopedics. High prevalence of this pathology around the world (6.9 to 36.1%) is associated with multiple etiological causes, responsible for certain difficulties in diagnosis and complexity of determining an individualized pathogenetic method of treatment. The pathology, often occurring in the young age, is called «delayed or late arthritis», due to the fact that it is often ignored in the early stages of its development. This leads, in the final stages of disease, to manifestation of classic osteoarthritis involving all the structures of the knee joint in the process. The literature review is devoted to the study of etiology, pathogenesis and anatomical features of the development of patellofemoral arthritis. From the clinical point of view, the most important factors, influencing patellofemoral arthritis course, are analyzed. They include mechanisms of the disease, anatomical features of patella, trochlear surface and femoral condyles, which affect the disease course. The article discusses the risk factors of patellofemoral arthritis, such as weakness of vastus muscles of quadriceps femoris, increased knee Q-angle, increased femoral anteversion and tibial rotation, abnormalities of patellar and tibial epicondyles morphology. In addition the study presents some data about dysplasia of the condyles and femoral trochlea and patella, disposition of the patella and dysplasia of the quadriceps. Variations of configuration and position of patella affecting its stability are described and presented. The article also focuses on the influence of internal tibial rotation and femoral anteversion on the development of disease, as well as patellar instability as a multifactorial cause.

Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty

Kokubu,

Kawahara,

Mizu‐Uchi

et al. 2024

J. exp. orthop.

PurposeThis study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient‐reported outcome measures (PROMs).MethodsSeventy‐one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole‐leg and supine knee radiographs using a three‐dimensional‐to‐two‐dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs.ResultsIn the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (>5°) in the supine position but small (<5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (<5°) in the supine position and large (>5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values.ConclusionsThe underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position.Level of EvidenceⅣ, Case series.