Intra- and Extra-Articular Deformity of Lower Limb: Tibial Condylar Valgus Osteotomy (TCVO) and Distal Tibial Oblique Osteotomy (DTOO) for Reconstruction of Joint Congruency.

Y Watanabe,K Kinugasa,T Teramoto,N Takenaka,T Matsushita

doi:10.1155/2019/8605674

Y Watanabe, K Kinugasa + Show 3 more

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https://doi.org/10.1155/2019/8605674

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Abstract

Osteotomies are the established surgical procedure for the deformity of the lower limb induced by osteoarthritis (OA) of the knee and ankle. Closed-wedge (CW) and open-wedge (OW) high tibial osteotomy (HTO) are extra-articular surgery, which aim to shift the mechanical axis from medial to slightly lateral and reduce the overload in the medial compartment of the varus deformed knee by extra-articular correction. However, varus deformity of the knee with the teeter effect, which could be accompanied with subluxation and thrust due to the medial-lateral soft tissue imbalance, is not resolved only by the shift of mechanical axis. The depression of the medial tibia plateau, so-called pagoda deformity, is the intra-articular deformity, which could potentially cause the teeter effect and involves intra-articular incongruency. In such case, the osteotomy with novel concept should be developed to overcome the issues, both the imbalance of soft tissue and intra-articular deformity. Tibial condylar valgus osteotomy (TCVO) is an intra-articular osteotomy, which improves the joint congruency of the medial-compartment knee OA with subluxation and/or intra-articular deformity and also provides better joint stability. A similar argument is raised in the treatment of the ankle OA. Low tibial osteotomy (LTO) is an extra-articular surgery to correct malalignment of lower leg. Distal tibial oblique osteotomy (DTOO) is a novel surgery to improve the bony congruency of the ankle OA. In DTOO, the distal tibia is cut obliquely from the proximal medial to the distal lateral in the coronal plane and towards the center of the tibiofibular joint to improve the bony congruency of the ankle joint. Tibial condylar valgus osteotomy (TCVO) and distal tibial oblique osteotomy (DTOO) can correct intra-articular deformity of knee and ankle, respectively. The rationale and indication of TCVO and DTOO for the treatment of the lower limb by reconstructing the joint congruency are discussed.

Highlights

Deformity of the lower limb induced by osteoarthritis of the knee or ankle causes the adverse effect on daily living due to gait disturbance, which could cause abnormal posture, as well as local problem such as pain
Osteotomies are effective in managing malalignment of knee and ankle arthrosis, determination regarding the type of osteotomy should be based on the pathology in each patient
Traditional High tibial osteotomy (HTO) should be an optimal strategy to overcome the malalignment in OA of the knee; the excessed medial-lateral soft tissue imbalance and intra-articular deformity are not solved by this surgical procedure

Summary

Introduction

Deformity of the lower limb induced by osteoarthritis of the knee or ankle causes the adverse effect on daily living due to gait disturbance, which could cause abnormal posture, as well as local problem such as pain. Medial open-wedge high tibial valgus osteotomy (OWHTO) has been developed for the correction of the varus deformed knee and extensively spread by the improvement in surgical technique, fixation devices, and patient selection with fewer complications [4,5,6,7]. High tibial valgus osteotomy is an established surgical procedure to correct varus malalignment in patients with medial-compartment OA of the knee; the deformity center of the malalignment of lower limb varies in each case. The depression of the medial tibia plateau, so-called pagoda deformity, is the intra-articular deformity, which could cause intra-articular incongruency and the teeter effect In such case, the osteotomy with novel concept should be developed to overcome the issues, both the imbalance of soft tissue and intra-articular deformity; otherwise the relief of the pain and disability would not be achieved. Tibial condylar valgus osteotomy (TCVO) and distal tibial oblique osteotomy (DTOO) can correct intraarticular deformity of knee and ankle, respectively

Extra-Articular Deformity and Lower Limb Alignment

Intra-Articular Deformity and Joint Congruency

Discussion