Degree Of Valgus Deformity Research Articles

Is lateral femoral condyle hypoplasia a feature of genu valgum? A morphological computed tomography study of 200 knees

BackgroundYoung surgeons are taught that genu valgum deformity is associated with hypoplasia of the lateral femoral condyle, despite the absence of supporting evidence. The objective of this study was to determine whether the lateral condyle was hypoplastic in genu valgum, by assessing the morphological features of the distal femur and their variations according to the severity of the coronal deformity. HypothesisThe lateral femoral condyle is not hypoplastic in genu valgum deformity. Material and methodsThe 200 included patients treated by unilateral total knee arthroplasty were divided into five groups based on their preoperative hip-knee-ankle (HKA) angle. The HKA angle, valgus cut angle (VCA), and anatomical lateral distal femoral angle (aLDFA) were measured on long-leg radiographs. Computed tomography images were then used to measure the medial and lateral anterior-posterior condylar lengths (mAPCL and lAPCL) and condylar thicknesses (mCT and lCT), distal femoral torsion (DFT), medial and lateral posterior condylar heights (mPCH and lPCH), and medial and lateral condylar volumes (mCV and lCV). ResultsNo significant differences were demonstrated across the five mechanical-axis groups for mAPCL, lAPCL, mCT, lCT, mPCH, or lPCH. The groups differed significantly regarding the VCA (p<0.0001), aLDFA (p<0.0001), DFT (p<0.0001), and mCV/lCV ratio (p<0.0001). VCA and aLDFA were smaller when the valgus exceeded 10°. DFT was similar in all varus knees (2.2°–2.6°) but significantly greater for knees with moderate (4.0°) or severe (6.2°) valgus. Finally, lCV was greater than mCV in valgus knees compared to varus knees. ConclusionThe presence of lateral condyle hypoplasia in knees with genu valgum seems open to question. Apparent hypoplasia noted during the standard physical examination may be chiefly ascribable to distal valgus of the femoral epiphysis in the coronal plane and, with the knee flexed, to distal epiphyseal torsion, whose severity increases with the degree of valgus deformity. These considerations should be taken into account when performing distal femoral cuts for TKA, to ensure the restoration of normal anatomy in patients with genu valgus. Level of evidenceIV.

High femoral anteversion in osteoarthritic knees, particularly for severe valgus deformity

ObjectiveIncreased femoral anteversion (FA) has been correlated with less varus deformities in osteoarthritic (OA) knees, but the relationship between FA and the degree of valgus deformity in osteoarthritic (OA) knees is still largely unknown. We aimed to thoroughly analyze the distribution of FA in relation to varus or valgus deformities of the lower extremity in OA knees, and to further clarify the relationship between FA and trochlear morphology.Methods235 lower extremities with OA knees were divided into five groups according to the mechanical tibiofemoral angle: excessive valgus (< − 10°), moderate valgus (− 10° to − 3°), neutral (− 3° to 3°), moderate varus (3° to 10°), and excessive varus (> 10°). FA (measured using the posterior condylar axis [pFA] and the transepicondylar axis [tFA]) was measured, and the relationships of FA to the mechanical tibiofemoral angle and femoral trochlear morphology were identified.ResultsExcessive FA (pFA ≥ 20°) was observed in 30.2% of all patients and in 58.8% of patients in the excessive valgus group. pFA showed a strong correlation with mechanical tibiofemoral angle (p = 0.018). Both the pFA and the tFA of patients in the excessive valgus group were greater than those in other four groups (all p ≤ 0.037). There were significant correlations between tFA and trochlear parameters, including the sulcus angle (SA), lateral trochlear slope (LTS), and medial trochlear slope (MTS) (all p ≤ 0.028).ConclusionHigh FA is prevalent, particularly in severe valgus knees, and FA is significantly related to the femoral trochlear morphology in OA knees. With the aim of improving the patellofemoral prognosis and complications, high FA should be considered during total knee arthroplasty.

Severity of valgus knee osteoarthritis has no effect on clinical outcomes after total knee arthroplasty.

Advanced valgus osteoarthritis (OA) is one of the most challenging indications for total knee arthroplasty (TKA). There is no information in the literature about the optimal timing of surgery. The current study investigates the impact of the preoperative deformity and degree of arthritis on postoperative outcome after TKA. The study evaluated 133 knees in 107 patients with valgus OA that failed nonoperative treatment with a minimum 2-year follow-up. Mechanical alignment, Kellgren and Lawrence (K/L) score, and minimal joint space width (minJSW) were measured on AP- and hip-to-ankle radiographs. All knees had advanced OA (i.e., K/L grades 3 or 4 and less than 50% minJSW). Pre- and postoperative WOMAC, VR-12, UCLA, VAS, ROM were recorded. There was no difference in clinical outcome (WOMAC, UCLA, VR-12, VAS or ROM) between patients with different degrees of valgus deformities (< 5.0deg., 5.0-9.9deg., 10.0-14.9deg., ≥ 15.0deg.). There was also no correlation between K/L score or minimal joint space width and any of the outcome parameters. The degree of valgus deformity and the grade of osteoarthritis do not predict the outcome of TKA in patients with valgus OA. Since the risk of complication and the need for implant constraint increases with increasing deformity and instability of the knee, surgery appears to be justified in patients with advanced OA that failed nonoperative treatment, regardless of the degree of deformity.

Higher revision rate for posterior cruciate-retaining than posterior-stabilized total knee arthroplasty for the treatment of valgus osteoarthritis.

Determining the point at which a valgus deformity requires a more invasive therapy-in this case PS TKA-is surgically challenging. Retaining the posterior cruciate ligament has both advantages and disadvantages. The aim was to evaluate the failure rate and clinical outcomes. 248 patients with valgus gonarthrosis underwent surgical treatment: 167 CR TKA cases and 81 PS TKA cases. The KOOS and the OKS were recorded, and 201 patients (133 CR, 68 PS) were recruited into the retrospective study. The influence of BMI and degree of preoperative valgus deformity on the clinical outcome was determined. The revision rate was documented and analysed. Of 201 patients, 10 required revision surgery owing to instability (10/133 CR, 0/68 PS). Based on the KOOS and the OKS, no significant difference between CR TKA and PS TKA was found. BMI and degree of valgus deformity had no effect on the clinical outcome. No difference in the clinical outcome between the CR and PS TKA patients was found. In the CR group, significantly more patients showed 'excellent' OKS than in the PS group. However, 8.0% of the patients in the CR group and none in the PS group underwent surgery due to instability. A higher rate of dissatisfied patients in the CR group is likely. In our clinic, we no longer perform CR TKA for valgus cases.

The posterior-anterior-flexed view is essential for the evaluation of valgus osteoarthritis. A prospective study on 134 valgus knees

BackgroundRadiographic imaging is an important tool to assess osteoarthritis (OA). Lateral compartment osteoarthritis (valgus OA) usually starts with cartilage degeneration along the posterior aspect of the lateral femoral condyle. There is evidence that the posterior-anterior (PA)-flexed view is more sensitive when diagnosing early stages of valgus OA compared to the anterior-posterior (AP) view. The current paper analyzes the value of the PA-flexed view for patients scheduled for total knee arthroplasty (TKA).MethodsRadiographs of 134 valgus knees were assessed prior to TKA. The minimal joint space width (minJSW) was measured on AP and PA-flexed views. The extent of mechanical deformity was measured on hip to ankle standing films.Results49 (36.6%) AP views showed Kellgren and Lawrence (K/L)-grade 4 osteoarthritis in the lateral compartment, 82 (63.4%) showed grade 3 or less. The PA-flexed view resulted in an increased K/L-grading to grade 4 for 53 knees (62.4%) that were considered grade 3 or less on standard AP-radiographs. There was a significant differences between lateral minJSW on AP and PA-flexed view for patients with up to 10 degrees of mechanical valgus deformity (p < 0.001), as well as 11 to 15 degrees of mechanical deformity (p = 0.021). Only knees with severe deformity of more than 15 degrees did not show a difference in minJSW between PA-flexed view and AP view (p = 0.345).ConclusionsThe PA-flexed view is superior to the standard AP view in quantifying the extent of valgus OA in patients with zero to fifteen degrees of valgus deformity. It is recommended for the initial assessment of patients with valgus osteoarthritis and better documents the extent of osteoarthritis prior to TKA.

Surgical treatment of congenital patellar dislocation in skeletally mature patients: surgical technique and case series.

Congenital patellar dislocation is a rarely encountered condition and is readily treated in childhood to prevent lasting disability, knee pain, decreased range of motion and ambulation problems. This condition is very rarely seen in skeletally mature patients, and the treatment of the condition represents a challenge to the orthopedic surgeon. Patients were treated with soft tissue reconstruction and tibial tubercle transfer with or without a prior medial close-wedge distal femoral osteotomy, depending on the degree of valgus deformity. We, then, searched the database of our orthopedics center for cases of congenital patellar dislocation in skeletally mature patients who were surgically treated. We collected a total of five knees and analyzed the cases according to the type of surgery performed and difference between pre- and postoperative functions. Five knees with congenital patellar dislocation were treated. The mean age of the patients was 29.6years, and mean follow-up time was 4.3years. Mean preoperative range of motion was 65°, and it increased to a mean of 105.5° after surgical treatment. The mean preoperative Kujala score was 29.2 and increased to 67.2 after surgical treatment. Congenital patellar dislocations that are allowed to proceed to adulthood are difficult to treat, and surgical treatment depends on the degree of deformity of the patella and of the knee joint. This study shows that surgical treatment is able to correct the deformity and provide better knee function.

RETRACTED: A randomised prospective study of two different combined internal and external fixation techniques for distal tibia shaft fractures

External fixation combined with limited open reduction and internal fixation (EF + LORIF) is a well-accepted and effective method for distal tibia shaft fractures, but it was also related to complications. The objective of this study was to compare external fixation combined with closed reduction and internal fixation (EF + CRIF) with EF + LORIF in the treatment of distal tibia shaft fractures, and explore the benefits and defects of these two techniques. Fifty-six patients were randomised to operative stabilisation either by an external fixator combined with two closed titanium elastic nails or by external fixation combined with limited open reduction and internal fixation. Pre-operative variables included the patients’ age, sex, the affected side, cause of injury, Tscherne classification of soft tissue injury, fracture pattern, and time from injury to surgery. Peri-operative variables were the operating time and the radiation time. Postoperative variables were wound problems and other complications, union time, time of recovery to work, the functional American Orthopaedic Foot and Ankle surgery (AOFAS) score. There was no significant difference in the mean operating time (72.6 ± 11.5 vs. 78.5 ± 16.4 min, P = 0.125), the time to union (21.2 ± 11.0 vs. 22.5 ± 12.3 weeks, P = 0.678), the time of recovery to work (25.0 ± 14.5 vs. 26.4 ± 13.6 weeks, P = 0.711), pin track infection (3/28 vs. 4/28, P = 1.000), delayed union (2/28 vs. 3/28, P = 1.000), pain (38.3 ± 1.6 vs. 38.7 ± 1.5, P = 0.339), function (44.4 ± 6.0 vs. 45.0 ± 5.5, P = 0.698), and total AOFAS scores (91.5 ± 7.4 vs. 93.4 ± 6.8, P = 0.322) between the two groups. However, the mean radiation time was longer in the EF + CRIF group than in the EF + LORIF group (2.0 ± 1.2 vs. 0.3 ± 0.1 min, P < 0.01). The EF + CRIF group had no wound complications while the EF + LORIF group had five wound complications, though the difference was not statistically significant (P = 0.052). Acceptable alignment was obtained in 50 patients (22 in EF + CRIF vs. 28 in EF + LORIF, P = 0.023). Two cases with EF + CRIF had a 6 degrees of recurvatum deformity and four had 6–9 degrees of valgus deformity. Our results indicated that both EF + CRIF and EF + LORIF were reliable methods in treatment of distal tibia shaft fractures. EF + CRIF had fewer wound complications and broader indications while EF + LORIF had lower radiation exposure and better alignment.

Bone mineral assessment by dual-energy X-ray absorptiometry in patients with coxarthrosis.

Forty patients with unilateral osteoarthritis of the hip were studied with dual energy X-ray absorptiometry to quantify disuse osteopenia in their affected leg by examining the proximal femur and tibia. Bone loss was assessed as a percentage of the contralateral value which compares bone mineral density of the affected and normal sides. The percentage contralateral value in the femoral neck and Ward's triangle was 113% and 118% respectively, while that in the tibia was 75%. Bone loss in the proximal tibia of the affected leg could be of value in assessing gait since it correlates with the gait parameters on the hip rating scale. By contrast, bone mineral increase in the proximal femur and correlates only with the degree of valgus deformity of the femoral neck.

Dysplasia Epiphysialis Hemimelica

DYSPLASIA EPIPHYSIALIS hemimelica is a rare epiphyseal dysplasia of the extremities which is readily recognizable roentgenographically. I t is the purpose of this communication to review the clinical and roentgen features of this disorder and to add a new case to the literature. This condition was originally reported by Mouchet and Belot in 1926 (l), but was first recognized and described as a definite entity in 1950 by Trevor (2), who collected 10 cases, to which he gave the name tarso-epiphyseal aclasis. Single cases have been published since that time by Ingelrans and Lacheretz (3), Donaldson et al. (4), and D'Angio et al. (5), and in 1956 Fairbank reported 14 additional examples, including 2 involving the upper extremity, which appear to fall into this group (6). Prior to the latter report, it was believed that this anomaly was confined to the lower limbs. Both D'Angio et al. and Fairbank have presented excellent reviews of this subject. The present paper will embody their data and a survey of the entire 29 cases now recorded. Nomenclature And Nature of the Lesion Fairbank considered the name tarsoepiphyseal aclasis open to two objections. First, although the tarsus is a common site of involvement, it is not invariably affected. Second, there is not simple failure of the perichondrium to model the epiphysis (aclasis), but rather a true dysplasia of the epiphysis itself. The condition is in general confined to the lateral or medial half of the single limb. For these reasons, the name “dysplasia epiphysialis hernimelica” (hemi + µ€»ºs, limb) has been suggested, and this choice appears to be warranted. The disease is an abnormality of the epiphysis which may affect any of the osseous structures of the lower lim.b, and presumably of the upper as well. There is an eccentric cartilaginous overgrowth with resulting asymmetrical enlargement of the involved ossification center. As mentioned previously, an apparent characteristic of the lesion is restriction of the overgrowth to one-half of the affected epiphysis of the long bone; when more than one epiphysis is involved, all the epiphyseal centers affected show overgrowth of either the medial or lateral portions. Case Report D. T., a 3-year-old white girl, was admitted to the University of Missouri Hospital on Nov. 27, 1945, with a history of growing tumors of the left knee and ankle, present since early life. Previous medical history included only the usual childhood diseases. Physical examination showed a healthy child with large masses on the left knee and ankle, arising from the medial aspect of each joint, causing 4.5 degrees of valgus deformity. Roentgen examination showed marked overgrowth of the medial aspects of the distal femoral and tibial epiphyses, producing the above described deformities.