Axis Of Limb Research Articles

Limb Axis Disorder During Leg Length Discrepancy Treatment with Temporary Epiphysiodesis Using Eight-Plate Implants

Background: A common problem in pediatric orthopedics is leg length discrepancy (LLD). In adulthood, this may result in overload and degenerative changes in the lumbar spine, hip, and knee joints of the longer limb, and the fixed equinus position of the foot of the shorter limb. Surgical treatment using temporary epiphysiodesis with eight-plate implants is a minimally invasive, safe, and patient-tolerated procedure in LLD. However, publications mainly describe the effects of treatment in the form of achieved equalization and there is little information about the occurrence of secondary deformations. Our study aimed to determine the effect of temporary growth plate blocking on the final axis after treatment. Methods: The study was based on an analysis of radiographs recorded from 2010 to 2019 and an assessment of parameters such as MAD (mechanical axis deviation), mMPTA (mechanical medial proximal tibial angle), and M/at (mechanical axis of the tibia). Results: Twenty-four girls and thirty-six boys treated with eight-plate implants were included in the investigation. The duration of the treatment was 18 months (group I), 30 months (group II), and 42 months (group III). Our study revealed that the most significant differences were observed in the MAD parameter. MAD changed in a statistically significant manner across all investigated groups, for both girls and boys, regardless of the treatment duration. Conclusions: The treatment of LLD with epiphysiodesis using eight-plate implants influences both the anatomical axis of the bones and the mechanical axis of the limb.

Long-term result of unicompartmental knee arthroplasty in knee osteoarthritis secondary to chondrodysplasia

Background. In determining the indications for unicondylar endoprosthesis of the knee joint the literature practically does not cover the results of such interventions in knee osteoarthritis in patients with chondrodysplasia. The purpose of our report was to publish our observation of the long-term results of unicondylar endoprosthesis of the knee joint in a patient with knee osteoarthritis due to chondrodysplasia. Material and methods. We operated on a patient with chondrodysplasia who came to the clinic at the age of 28 with complaints of pain in the right knee joint during walking, “clicking” and joint swelling. The radiological and magnetic resonance examination results of the right knee determined the presence of an area of aseptic necrosis of the medial femoral condyle. Considering the concordance of lower limb axis disorders, it was decided to perform unicondylar arthroplasty with preservation of the preoperative varus deformity to maintain the motor stereotype's compensation state. Results. In the postoperative period, there were no complications in wound healing, the rate of recovery of movements corresponded to similar indicators in patients with knee osteoarthritis of other etiologies after similar interventions, and the patient was discharged from the hospital on the sixth day after surgery with the preoperative range of motion in the operated joint. At the examination 10 years after the operation there were no complaints from the operated knee joint, the movements in the operated joint remained in the same range, and the patient moved without additional support with full load on the operated limb. Conclusions. Our results indicate the appropriateness of unicompartmental knee arthroplasty in patients with knee osteoarthritis secondary to.

Aseptic failure of total hip arthroplasty as an early complication requiring revision surgery: a comprehensive literature review

Background: The undertaking of hip joint endoprosthesis surgery carries the inherent risk of complications. During the perioperative and early postoperative phases, septic complications take precedence, notably those associated with infection. Conversely, aseptic complications encompass issues unrelated to infection. Accurate risk stratification for complications following hip prosthesis implantation should be grounded in research adhering to the principles of Evidence-Based Medicine.Aim of the study: This paper aimed to present a critical literature review Material and methods: The literature review was conducted using international medical databases such as PubMed, Scopus, and PEDro. The review was based on criteria that included clinical studies and full-text publications published in English. The search period covered the last decade, spanning from 2014 to 2024.Results: The review highlights aseptic loosening and dislocation as the predominant causes of early THA failures. Addressing these complications requires a multifaceted approach, including patient education, meticulous surgical techniques, and robust postoperative rehabilitation programs. Future research should focus on improving implant materials and techniques to further reduce the incidence of aseptic failures. Dislocation and loosening of the hip joint prosthesis are direct reasons for qualifying the patient for revision surgery and reconstruction of the damaged prosthesis components. Individual biomechanical characteristics of the patient, genetic predispositions, obesity, or improper positioning of the prosthesis in relation to the limb axis are also potential risk factors for dislocation.Conclusions: Aseptic complications remain a significant challenge in THA. By understanding the causes and implementing effective preventative strategies, the incidence of early failures can be reduced, improving patient outcomes and prosthesis longevity. The gradual introduction of a well-planned and individualized rehabilitation program, along with the patient's adherence to treatment recommendations, is crucial for minimizing the risk of mechanical damage.

Simultaneous tibial osteotomy and total knee arthroplasty in posttraumatic and obese patient: a case report

Deforming osteoarthritis of the knee joint alters the mechanical axis of the lower limb. This, combined with extra articular deformity of the tibia or femur leads to serious dysfunction of the limb and great disability for the patient. These rare cases present great challenge for the orthopedic surgeon. Most of the cases with mild to moderate deformities can be successfully managed by adjusting intra articular resections, but in those with severe extra articular deformity, an extra articular correctional osteotomy may be required in order to achieve good flexion-extension balance of the knee. We report a case of total knee replacement performed together with correctional osteotomy of the tibia due to extra articular deformity of about 20 degree varus.

A Novel Minimally Invasive Surgical Technique for Eight-Plate Hemiepiphysiodesis: Description and Evaluation.

Background: Temporary hemiepiphysiodesis with tension band plates or eight-plates is a common surgical procedure to treat malalignment of the lower limb axis in skeletally immature patients. The objective of this study was to compare a new minimally invasive surgical procedure with the conventional procedure and evaluate its safety and effectiveness in order to reduce the risk of hypertrophic scarring, which may cause functional impairment as well as cosmetic issues. Methods: Sixty-five growth plates of either the femur or the tibia were evaluated in 33 patients treated for genu valgum or varum between 2010 and 2017. Each growth plate was considered an individual case. The modified procedure was used in 17 cases and the conventional procedure in 48 cases. The modified surgical procedure is characterized by an 8 mm incision and preparation of the epi-periosteal layer, in which the eight-plate is positioned via a guide-wire. Positioning and implantation are controlled via fluoroscopy. Skin incision length, duration of surgery, revision rate, achievement of a defined correction goal, and correction rate were analyzed. Results: Using the minimally invasive procedure, the mean skin incision length (23.94 ± 10.18 mm vs. 8.75 ± 2.14 mm, p < 0.001) could be significantly reduced. No significant difference was found in regard to the duration of surgery, revision rate, achievement of the correction goal or correction rate. Conclusions: The minimally invasive procedure results in a reduction in incision length without significant impact on the duration of surgery, revision rate, achievement of correction goal or correction rate. Consequently, the modified procedure can be regarded as equally as effective and safe as the conventional procedure.

DEIT-Based Bone Position and Orientation Estimation for Robotic Support in Total Knee Arthroplasty-A Computational Feasibility Study.

Total knee arthroplasty (TKA) is a well-established and successful treatment option for patients with end-stage osteoarthritis of the knee, providing high patient satisfaction. Robotic systems have been widely adopted to perform TKA in orthopaedic centres. The exact spatial positions of the femur and tibia are usually determined through pinned trackers, providing the surgeon with an exact illustration of the axis of the lower limb. The drilling of holes required for mounting the trackers creates weak spots, causing adverse events such as bone fracture. In the presented computational feasibility study, time differential electrical impedance tomography is used to locate the femur positions, thereby the difference in conductivity distribution between two distinct states s0 and s1 of the measured object is reconstructed. The overall approach was tested by simulating five different configurations of thigh shape and considered tissue conductivity distributions. For the cylinder models used for verification and reference, the reconstructed position deviated by about ≈1 mm from the actual bone centre. In case of models mimicking a realistic cross section of the femur position deviated between 7.9 mm 24.8 mm. For all models, the bone axis was off by about φ=1.50° from its actual position.

Personalized total knee arthroplasty in patients with extra-articular deformities.

Over the years, with a better understanding of knee anatomy and biomechanics, superior implant designs, advanced surgical techniques, and the availability of precision tools such as robotics and navigation, a more personalized approach to total knee arthroplasty (TKA) has emerged. In the presence of extra-articular deformities, performing personalized TKA can be more challenging and specific considerations are required, since one has to deal with an acquired pathological anatomy. Performing personalized TKA surgery in patients with extra-articular deformities, the surgeon can: (1) resurface the joint, omitting the extra-articular deformity; (2) partially compensate the extra-articular deformity with intra-articular correction (hybrid technique), or (3) correct the extra-articular deformity combined with a joint resurfacing TKA (single stage or two-stage procedure). Omitting the acquired lower limb malalignment by resurfacing the knee has the advantages of respecting the joint surface anatomy and preserving soft tissue laxities. On the other hand, it maintains pathological joint load and lower limb kinematics with potentially detrimental outcomes. The hybrid technique can be performed in most cases. It circumvents complications associated with osteotomies and brings lower limb axes closer to native alignment. On the other hand, it creates some intra-articular imbalances, which may require soft tissue releases and/or constrained implants. Correcting the extra-articular deformity (through an osteotomy) in conjunction with joint resurfacing TKA represents the only true kinematic alignment technique, as it aims to reproduce native knee laxity and overall lower limb axis.

TBX3 is essential for establishment of the posterior boundary of anterior genes and upregulation of posterior genes together with HAND2 during the onset of limb bud development.

During limb bud formation, axis polarities are established as evidenced by the spatially restricted expression of key regulator genes. In particular, the mutually antagonistic interaction between the GLI3 repressor and HAND2 results in distinct and non-overlapping anterior-distal Gli3 and posterior Hand2 expression domains. This is a hallmark of the establishment of antero-posterior limb axis polarity, together with spatially restricted expression of homeodomain and other transcriptional regulators. Here, we show that TBX3 is required for establishment of the posterior expression boundary of anterior genes in mouse limb buds. ChIP-seq and differential gene expression analysis of wild-type and mutant limb buds identifies TBX3-specific and shared TBX3-HAND2 target genes. High sensitivity fluorescent whole-mount in situ hybridisation shows that the posterior expression boundaries of anterior genes are positioned by TBX3-mediated repression, which excludes anterior genes such as Gli3, Alx4, Hand1 and Irx3/5 from the posterior limb bud mesenchyme. This exclusion delineates the posterior mesenchymal territory competent to establish the Shh-expressing limb bud organiser. In turn, HAND2 is required for Shh activation and cooperates with TBX3 to upregulate shared posterior identity target genes in early limb buds.

Temporary hemi-epiphysiodesis with tension band plates in skeletally immature patients with genu valgum: Faster correction in patients with more than 2 years of expected time of growth remaining.

Hemi-epiphysiodesis procedures in skeletally immature patients are commonly done to correct genu valgum over time. This study seeks to demonstrate the average rate of deformity correction for genu valgum using hinged tension band plates, while examining different age groups and sex-related differences. A retrospective chart review of patients who underwent hemi-epiphysiodesis with hinged tension band plates for valgus knee deformity from 2012 to 2022 by one pediatric orthopaedic surgeon was performed. Expected time of growth remaining was calculated as the difference between age of skeletal maturity and bone age at time of surgery. The mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, mechanical femoral tibia angle, screw divergence angle, and hinge angle were measured immediately after implant placement and prior to implant removal. 54 skeletally immature patients were treated for pathologic genu valgum. The mean age at time of surgery was 12.5 ± 1.9 years. The radiographic measurement of the valgus deformity between the beginning and end of treatment showed significant correction (p = 0.002). The lower limb axis of the younger cohort corrected significantly faster (7.5 ± 4.6°/year) than the older cohort (5.3 ± 2.8°/year) (p = 0.030). The mechanical lateral distal femoral angle correction rate was also significantly different between the two cohorts (7.0 ± 4.7°/year vs. 4.8 ± 2.8°/year, respectively (p = 0.002)). The group with greater expected time of growth remaining demonstrated a significantly faster rate of correction than the group with less than 2 years of growth remaining (p < 0.001). This study reaffirms the finding that timing is essential when performing temporary hemi-epiphysiodesis for valgus knee deformity in skeletally immature patients.

A Bibliometric study of the top 100 most-cited papers in high tibial osteotomy.

High tibial osteotomy (HTO) is a well-established surgical procedure employed to treat medial compartment knee osteoarthritis by modifying the mechanical axis of the lower limb, thereby reducing the load on the affected joint. It has gained increased attention in recent years, resulting in numerous research advancements in this field. The top 100 most-cited papers on HTO, published between 1970 and 2023, were identified by searching the Web of Science Core Collection database. Data, including the title, author, keywords, journal, publication year, country, and institution, were extracted. Subsequently, a bibliometric analysis was performed. The 100 papers collectively garnered a total of 15833 citations, with a median of 122 and an average of 158.33 citations per article. Since the onset of the 21st century, there has been a significant increase in the number of publications and citations. Lobenhoffer authored the most published papers. The majority of papers originated from the USA. Hannover Medical School produced the most papers. Analysis of keywords in the articles revealed several research hotspots, including open-wedge osteotomy, biomechanical study, tibial slope, patellar height, Puddu plate, TomoFix plate, stability, complications, and accuracy. This study offers bibliometric insights into HTO, underscoring that the USA is a prominent leader in this field. HTO has garnered increasing attention since the onset of the 21st century and is expected to remain a significant research area in the future. Concurrently, the authors advise focusing on potential research hotspots, such as the navigation system, to augment the accuracy of the correction.

Study of the biocompatibility of porous 3D-TiNi implants in vivo

Introduction. Porous TiNi alloys are widely used in medicine as osteoreplacement implants due to their unique properties of superelasticity and biocompatibility, but their clinical use is severely limited by time-consuming manual fabrication and the inability to create precise geometries. Reconstructive surgery for the replacement of bone defects requires biocompatible endoprostheses of individual shape and complex geometry. The use of porous 3D-TiNi implants can be a solution to many problems in traumatology and bone oncology.Aim: To evaluate the possibility of using porous 3D-TiNi implants in osteoplastic surgery based on a study of the structure and biocompatibility of the material under in vivo conditions.Material and Methods. Porous samples in the form of cones and a single implant for maxillofacial surgery were prepared from TiNi powder by selective laser melting. To print an individual implant for maxillofacial surgery, the personal data of the patient at the Oncology Research Institute were used. The macrostructure, elemental and phase composition of porous titanium nickelide samples were investigated using scanning microscopy and X-ray diffraction analysis. The biocompatibility of porous cone-shaped samples was evaluated in vivo using guinea pigs whose condition was analysed by CT scanning.Results. Structural studies of porous titanium nickelide samples showed that selective laser melting can be used to obtain a continuous porous structure with strong contact bridges between particles of a three-phase powder. In vivo testing of the cone-shaped implants showed no local inflammatory changes, rejection or deformation of the hind limb axes of the experimental animals. The basic feasibility of fabricating a custom implant of complex geometry from TiNi powder using selective laser melting according to a patient’s MSCT data was demonstrated.Conclusions. Porous 3D-TiNi implants obtained by selective laser melting showed high biocompatibility under in vivo conditions. An experimental study confirmed the efficacy and ease of use of 3D TiNi implants, their excellent self-fixation in bone tissue, and bone tissue augmentation at the interface with the implant. The macrostructure, chemical and phase composition of the implant material was found to be close to traditional porous TiNi alloys. It was shown that the method of selective laser melting makes it possible to create complex geometric defects in bone tissue from TiNi.

Biofeedback training for the analysis of gait stereotypes in patients with gonarthrosis

BACKGROUND: The justification of the treatment techniques for patients with gonarthrosis requires the use of modern methods for assessing walking stereotypes.&#x0D; AIM: This study aimed to evaluate the biomechanical and podometric gait parameters of patients with gonarthrosis using the C-Mill multifunctional complex with biofeedback.&#x0D; MATERIALS AND METHODS: The study included 55 patients who were divided into the following groups: main group (n=35) of patients who had gait disturbances, diagnosed with stage III–IV primary gonarthrosis with varus deformation of the limb axis according to ICD-10, and underwent total knee replacement and control group (n=20) of patients diagnosed with stage I primary gonarthrosis. The average age of patients was 58.7 years in the main group and 47.5 years in the control group.&#x0D; RESULTS: In the main group, the decrease in average walking speed was accompanied by decreases in stride length and step frequency (р 0.05). In the stance phase, which is characterized by the contact of the foot of the affected and contralateral lower extremities with the platform surface, the durations of the double stance phase of both extremities in the main group were longer than those in the control group (p 0.05), indicating gait asymmetry and redistribution of excess load on the contralateral lower extremity, which is clinically manifested by lameness. In the main group, gait was characterized by a decrease in voluntary speed, step frequency, and gait pattern changes in various planes, confirming severe clinical and functional disorders in the lower limbs.&#x0D; CONCLUSION: The study of the walking stereotype in patients using the C-Mill multifunctional complex with biofeedback can be used to substantiate treatment techniques, followed by drawing up an individual medical rehabilitation plan to restore lower limb functions in the postoperative period, fully monitor treatment dynamics, prevent falls, and improve the quality of life of patients.

Salvage Algorithm for Deep Surgical Site Infections after HTO with Unstable Bone Situation Using a Hexapod System - Primary Results.

The incidence of deep surgical site infections following high tibial osteotomy (HTO) ranges between 0.4 to 4.7%. It is a severe complication with a high risk for poor clinical outcome. The aim of this study was to proof that a salvage algorithm for infected HTO with unstable bone situation leads to an infection-free status and bone union of the osteotomy and that correct limb alignment can be restored with good knee function.The study included seven patients with peri-implant infections following HTO. Infections occurred 83±58.9 days (range: 24-191) after HTO. All patients underwent the "RESTORE" algorithm: patients received (1) REmoval of the HTO hardware and extensive debridement; (2) the osteotomy was STabilized with a hexapod external fixator (Taylor Spatial Frame, TSF); (3) the osteotomy gap was Opened; and (4) the alignment was REconstructed using the TSF, aiming for the intended limb alignment of the initial HTO. Patient-reported outcomes were assessed 22-36 months after removal of the TSF.After 24 weeks (range: 11-35), an infection-free status and bone healing were achieved. In all cases, the limb was saved, and the previously targeted mechanical axis of the lower limb was restored. All patients reached full extension of the knee joint and at least 110° of flexion. For KOOS: Symptoms 67.86±18.1, Pain 73.41±16.58, ADL 78.99±21.32, Sports 52.14±25.96, and QoL 41.96±24.66. OKS 35.71±8.8, SF-12 Physical Health 38.89±10.3, and SF-12 Mental Health 46.86±13.76.The "RESTORE" algorithm is a safe and effective salvage procedure. The concept allows for saving the limb and obtaining the previously planned limb alignment. Patient-reported outcome measures showed slightly lowered values than healthy samples, but substantially better values than patients awaiting HTO. Due to the possibility of initial full weight-bearing, the risk of higher morbidity caused by immobilization is minimized.

Increased medial talar tilt may incite ankle pain and predispose ankle osteoarthritis after correction of severity of knee varus deformity among patients undergoing bilateral total knee arthroplasty: a prospective observation

PurposePatients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This study aims to investigate whether any ankle clinical-radiographical changes occur as a result of bilateral mechanical TKA in patients with bilateral Osteoarthritis knee at a minimum follow-up of 6 months.MethodsThe prospective observational study included 61 patients (122 knees) undergoing simultaneous bilateral TKA (mechanical alignment). Tibio-talar angle(TTA), tibial Anterior Surface angle (TAS), lateral distal tibial angle (LDTA), talar-tilt angle (TT), anatomical talocrural angle (aTC), ground surface and distal tibial plafond angle (GP), ground surface and an upper surface of talus angle (GT)and tibial plateau and tibial plafond angle (PP) were measured on long-film radiographs to look for changes in the ankle, whereas functional assessment was done using American Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Forgotten Joint (FJS-12) scores. Patients were sub-grouped based on the Hip-Knee-Ankle (HKA) axis, and the effect of the severity of knee varus on the ankles after TKA was also analyzed. The minimum follow-up was 6 months.ResultsA significant decrease in the tibial plateau-tibial plafond (PP), ground-tibial plafond (GP), and ground-talar dome (GT) angles was noted after TKA (p-value < 0.05). Postoperative functional parameters were comparable to the preoperative status except for FADI, which significantly improved (p-value-0.03). Sub-group analysis based on the severity of knee varus (HKA) revealed GT to be most significantly reduced (p-value-0.036), while the talar tilt (TT) increased (p-value-0.044). Functional outcomes of the ankles clinically improved with the correction of severe knee varus after TKA. At a mean follow-up of 13.2 months post-TKA, 7 out of 61 (11.4%) patients complained of post-TKA ipsilateral ankle pain.ConclusionMechanically aligned bilateral TKA in severe varus deformity of the knee significantly decreases the GT angle but increases the varus tilt of the talus with lateral talar incongruency and under-coverage. Although the acute correction of severe knee varus deformity aligns the tibia more neutrally, resulting in an overall clinically evident improvement in ankle functional outcome, the increased varus talar tilt remains a deep concern.Level of EvidenceProspective, observational, comparative study Level II.

Experience in the lower extremities trophic ulcers treatment in patient with combined pathologies: varicose veins and rheumatoid arthritis

Varicose veins of the lower extremities is one of the most common diseases on Earth and its combination with other diseases is inevitable. The combination of diseases aggravates the course of each other. Rheumatoid arthritis worsens the course of varicose veins with trophic disorders – both independently – an increase in pro-inflammatory factors, a change in microcirculation, deformation of the limb axis with a violation of musculoskeletal function, and treatment of rheumatoid arthritis reduces the immune response of the body reducing the reparative capabilities of the body. Clinical case: a patient with a long course of rheumatoid arthritis and varicose veins. For a long time he used cytostatic drugs with a subsequent transition to hormonal drugs. For about 5 years, he noted the appearance of ulcers on both shins, which took a circular shape, which significantly reduced the quality of life and did not respond to conservative treatment. He repeatedly underwent inpatient treatment with intravenous administration of general restorative and vascular drugs. He was also constantly observed in the polyclinic at the place of residence with the implementation of local treatment of ulcerative surfaces. The patient was successively treated for varicose veins by endovenous laser coagulation of the trunks of large subcutaneous veins. The second stage was performed debridement of the wound surface and skin grafting with a free perforated flap. Between the stages, the appointment of drug therapy according to clinical recommendations. Rheumatoid arthritis and varicose veins aggravate each other, especially trophic manifestations. Treatment of such patients should be carried out by a team ofspecialists of various profiles together. Step-by-step treatment ofsuch patients with careful preparation for each of them shows excellent results. A special place is occupied by the patients’ commitment to treatment.

Management of post-traumatic genu valgus deformity in adolescent by proximal tibial corticotomy with bone lengthening by Ilizarov method: a case report

Introduction: Genu Valgus and Varus are the most common lower limb deformities at knee level, seen in childhood. Genu valgus is more common about 10%, where knee/knees turn inward, causing the appearance of the knees to be touching each other while the ankles remain apart. Genu Valgus is a normal physiological process in children’s; it may be pathological due to various causes. Physiological genu valgus is greatest at the age of 3-4 years and spontaneously resolves by the age of 7 years. When valgus deformity is persistent or worsening after 7 years of age is called pathological genu valgus. Cosmetic abnormality is common complaint. Abnormal circumduction gait, knees touching on medial aspect and LLD found on examination. Plan x-ray A/P view in standing position of full both lower limbs with pelvis provides diagnosis and treatment plan information. Case presentation: A 15 years old girl came with the complaints of abnormal walking due to right knee bending inwards, also during standing position. She was perceived pain in right knee during walking and longtime standing position. She has H/O- fractured proximal tibia (Rt.) more than 6 months ago due to trauma and treated by plaster. Plaster removed after 3 months. One month later she developed pain in knee joint during walking and right knee gradually bend inwards. O/E- Bil genu valgus right &gt; left. Clinically, right knee -300 and left knee -100 There was 1.5 cm shortening of right lower limb than left. Both right and left lower limb with pelvis full radiograph was done. In x-ray both femurs and knee joints were normal. In radiograph, the medial and lateral surface of right tibia with fibula bends medially. Left tibial surfaces and fibula appears almost normal. The right tibia at the point of 14 cm from upper end there was maximum angulation point. The degree of genu valgus was evaluated by CORA method and treatment plan set accordingly. There was 300 medial bending of right tibial shaft and about 100 of left tibial shaft. The patient was diagnosed as post traumatic unilateral right tibial genu valgus following proximal tibia fracture. The patient was treated by proximal tibial corticotomy with Ilizarov frame. Aim: The aim of the treatment is restoration of normal mechanical axis. Objective: To assess the effectiveness and outcomes of the treatment method. Result: After complete union and consolidation, substantial evidence was checked and confirmed by both clinical and radiological. There was no abnormal gait and pain during walking. Mechanical axis of right lower limb was restored as normal. The final outcome is excellent. Conclusion: Genu valgus is common in children and observation is the first line of treatment. Physiological variant treated conservatively. Pathological genu valgus needs management according the cause. When surgical correction is indicated, corrective osteotomy usually done but there is so many complications and needed repeated surgery. In post-traumatic proximal tibial genu valgus effectively corrected by Ilizarov with corticotomy, which minimize complications, Due to early mobilization and decrease hospital stay time, resulting cost effective and found excellent final outcome.

Clinical evaluation and accuracy of mechanical axis alignment in robotic total knee arthroplasty

The first experience in robotic total knee arthroplasty (RoTKA) has been obtained resulting in the questions about clinical efficiency and accuracy of lower limb alignment.Objective To clarify clinical evaluation and accuracy of alignment of the mechanical axis of the lower limb in RoTKA.Materials and methods Twenty-nine patients with osteoarthritis of the knee of Kellgren-Lawrence stage 3-4 underwent RoTKA. The knee joint was assessed with VAS, WOMAC, FJS-12; the range of motion was measured. The changes in the axis of the lower limb were evaluated on the full limb length radiographs.Results Pain before the surgery according to VAS was 5.8 ± 1.5 points, on the first day after the surgery it was 8.5 ± 1.4, on day 3 – 5.9 ± 1.2, on day 12 – 2.9 ± 1.1. The range of motion on the first day after the surgery was 99.5° ± 1.4°, three months later – 115.1° ± 1.1°, six months later – 125.6 ± 1.5°, one year later– 127.5 ± 1.6°. The WOMAC score before the surgery was 32.7 ± 3.3, after the surgery 25.1 ± 2.1, three months later 7.3 ± 1.3, six months later 2.8 ± 0.2, and after one year – 1.3 ± 0.5. The FJS-12 score 3 months after the surgery was 68.2 ± 4.1, after 6 months 80.3 ± 2.9, after one year 94.0 ± 2.1. The analysis of postoperative full length roentgenograms in 72 % of cases (n = 21) did not reveal any deviation of the mechanical axis from the planned one and in 28 % of cases (n = 8) the deviation of the mechanical axis was up to 1° from the planned one.Discussion Neither technical difficulties nor complications inherent to RoTKA were found. According to the results of VAS, WOMAC and FJS‑12 questionnaires, and the assessment of the range of motion, a positive dynamics was observed. According to the results of tele-roentgenograms, there was alignment of the limb axis and the accuracy of the position of the endoprosthesis components.Conclusion The study of this technology has demonstrated safety, accuracy of alignment of the mechanical axis, validity of indications and contraindications, and stable early clinical results.

Nonossifying fibroma of the lower femur with genu valgum: a case report

BackgroundNonossifying fibroma is common in children and adolescents, and nonossifying fibroma with genu valgum is rare in the clinic. This article evaluated the effectiveness of treatment in a case of nonossifying fibroma of the lower femur with genu valgum.Case presentationA 16-year-old girl complained of pain in the lower part of her right thigh for one year. She was diagnosed as non ossifying fibroma of the right femur with secondary valgus deformity of the right knee, and was treated in our hospital. We performed curettage, bone grafting and internal fixation,and corrected the valgum deformity at the same time. The patient's incision healed well, the pain was disappeared, and the mechanical axis of lower limbs was corrected. No tumor recurrence was found on X- ray examination one year after operation, and the fracture end was healed. The patient could walk normally, and she was satisfied with her limb function.ConclusionNonossifying fibroma with genu valgum is rare in the clinic. The patient was satisfied with our treatment, which achieved a good curative effect.

Robot-assisted knee arthroplasty: first experience (a prospective randomized study)

Introduction Primary total knee arthroplasty has long been proven effective in the treatment of stage 3–4 knee osteoarthritis. It is well known that this intervention not only improves the quality of life, but also helps to restore the function of the joint and eliminate axial deformities.Purpose To compare early results of total knee arthroplasty using robot-assisted technology with conventional manual technique.Materials and Methods 20 patients diagnosed with stage 3 osteoarthritis of the knee joint and varus deformity of the knee joint axis were included in a prospective randomized study. Patients were divided into 2 representative groups, 10 subjects underwent robot-assisted knee arthroplasty, and the conventional manual technique was used in the other 10 patients. For clinical assessment, functional scales KSS, WOMAC, Lysholm Score were used, postoperative radiographs were evaluated.Results According to clinical functional scales, 10 days after surgery, there was an improvement in performance in the patients of both groups (p &lt; 0.05); the duration of the operation in the patients of both groups did not differ in general; intra-operative blood loss in the group with robot‑assisted arthroplasty was lower; and assessment of postoperative results by radiological imaging showed a better component positioning according to preoperative planning in the robotic group.Discussion When the operation is performed by experienced surgeons, one can expect the correct position of the components and the balance of the ligamentous apparatus in standard arthroplasty. However, the use of robot-assisted technology provides a secure intervention performance even at a hospital where a small number of such operations is performed.Conclusion Despite the high cost and the need for additional consumables, robot-assisted arthroplasty has a number of advantages over classical manual techniques. These advantages include: accurate restoration of the limb axis even in extra-articular deformities, correct position of the endoprosthesis components, reduction of intraoperative blood loss due to closed medullary canals, and safety for patients. However, the role of the surgeon in such operations remains paramount, as it is the surgeon who is responsible for planning the operation, performing it, and achieving soft tissue balance.

Corrective Osteotomies in Severe Non-Idiopathic Lower Limb Alignment Disorders in the Aspect of Future Joint Endoprosthesis-A Perspective Study.

The aim of this study was to retrospectively evaluate the effectiveness of corrective osteotomies in lower limb axis disorders at different levels of non-idiopathic (post traumatic, developmental, post-septic) etiology. A total of 50 patients were divided into three groups: A-thigh segment alignment disorder (24 patients); B-tibia segment alignment disorder (18 patients); C-thigh and tibia segment alignment disorder (8 patients). Radiological evaluation of digital lower limb postural X-ray was performed laterally and for AP, and included mLPFA, mLDFA, MAD, CORA coronal and sagittal plane parameters for the femur segment and mMPTA, mLDTA, MAD, CORA coronal and sagittal plane for the tibia segment. Clinical assessment was based on the LLFI. The mean follow-up was 55.8 months (12-86). Improvements in the radiological parameters and statistical significance were achieved for all measurements in all groups (p < 0.05). The most common plane of deformation was the coronal plane (varus/valgus), followed by the transverse (rotational) and sagittal planes (procurvatum/recurvatum). In this study, we examined 29 post-traumatic deformities and 21 other etiologies. Improvements in the LLFI score performance after corrective osteotomies were observed in all three groups. Corrective osteotomies are a safe and useful but challenging method of preserving joints in cases of post-traumatic, developmental or post-septic lower limb alignment disorders.