Complications, Additional Surgery, and Joint Survival Analysis After Medial Open-Wedge High Tibial Osteotomy.

The reported incidence of complications following medial open-wedge high tibial osteotomy (MOWHTO) varies. The authors sought to assess the complications, additional surgeries, and joint survival following MOWHTO in patients with isolated medial compartment arthrosis during a mean follow-up of 10 years. This retrospective study involved patients implanted with spacer plates, angle adjustable plates, or inverse L-type plates with wedges between 2000 and 2010. A total of 504 knees from 441 patients were examined. Mean age of the study population was 52.6±7.0 years, with 56 (11.1%) knees from men and 448 (88.9%) from women. The 10-year Kaplan-Meier joint survival rate was 94.8%. Overall complication rate for MOWHTO was 63.7%, with complications in 20.3% of treated knees requiring additional surgery. In this population, although the overall complication rate and the need for additional surgery were high, the need for additional surgery resulting from serious complications was low (2.6%). The high joint survival rate and low rate of additional surgery for serious complications indicate that MOWHTO can be safely applied in patients with isolated medial gonarthrosis. [Orthopedics. 2020;43(5):303-314.].

Evaluation of the Association Between Plantar Fasciitis and Hallux Valgus.

BACKGROUND: The windlass mechanism, first described by John Hicks in 1954, defines the anatomical and biomechanical relationship between the hallux and the plantar fascia. Hallux valgus (HV) and plantar fasciitis are the most common foot disorders, and, to date, no study has evaluated the relationship between these disorders. The purpose of this study was to determine the incidence of and factors associated with plantar fasciitis in patients with HV deformity. METHODS: In this prospective observational study, 486 patients with HV were divided into three groups according to stage of HV deformity. Patient sex, age, and body mass index were recorded. Presence of accompanying plantar fasciitis and heel spur was investigated by physical and radiographic examination. First metatarsophalangeal joint dorsiflexion of the affected side was measured. Patients with or without plantar fasciitis were also compared to evaluate factors associated with plantar fasciitis. RESULTS: Mean age and body mass index of the patients were significantly different among the three HV groups. The incidence of plantar fasciitis and heel spur significantly increased in correlation with the severity of HV deformity. Increased age and HV stage and decreased first metatarsophalangeal joint dorsiflexion were significantly associated with presence of plantar fasciitis in HV. CONCLUSIONS: In this study, the incidence of plantar fasciitis was significantly increased in correlation with the severity of HV deformity. Significant association was found between plantar fasciitis and HV, which are anatomically and biomechanically related to each other by the windlass mechanism.

Mid-term survivals of cemented calcar-replacement bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients.

BACKGROUND: The literature has limited evidence regarding the mid-term survivals of cemented calcar-replacement bipolar hemiarthroplasty (HA) in elderly patients with unstable intertrochanteric (IT) fracture. The purpose of the present study was to evaluate clinical and radiological outcomes of cemented calcar-replacement bipolar HA for unstable IT fractures in elderly patients. METHODS: One hundred and twenty-two patients with the mean age of 80.6 years were enrolled in this retrospective study after they met the selection criteria. Demographics, main clinical characteristics, and operative data were recorded for all patients. Functional outcomes were assessed according to Koval's categories. Clinical and radiological evaluations were performed. Kaplan-Meier survival analysis was used to construct the cumulative survival rate. The mean follow-up time was 25.7 ±â€¯2.9 months (ranges 0-72 months). RESULTS: Based on Koval's categories, 3 or 4-level decrease was detected in 21 patients (17%). Three patients (2 periprosthetic infections, 1 periprosthetic fracture) underwent reoperation during follow-up. No patient underwent revision of bipolar HA prosthesis. Femoral stem loosening and stem subsidence was the most common complication, observed in 22 patients (18%), followed by acetabular erosion that was seen in 12 patients (9.8%). The mean cumulative survival rate of prosthesis was 56.5% (95% confidence interval: 51.3-61.6). CONCLUSION: Based on the results of our study, cemented calcar-replacement HA is an appropriate treatment option in elderly patients with unstable IT fractures owing to the advantages of satisfactory functional outcomes and lower reoperation rates. However, orthopedic surgeons should consider the low survival rates of cemented calcar-replacement HA prosthesis because of the increased femoral loosening in osteoporotic elderly patients.

Greater Trochanter Apophysiodesis in Legg-Calve-Perthes Disease: Which Implant to Choose?

BACKGROUND: Greater trochanter apophysiodesis (GTA) is relatively minimal invasive technique for the treatment of trochanteric overgrowth. Various types of implants can be used in each procedure. The purpose of this study was to compare outcomes of three different types of implants that were used in treatment of trochanteric overgrowth in Legg-Calve-Perthes disease. MATERIALS AND METHODS: We retrospectively studied radiological results of three implants (screw, screw washer, and EP) on inhibiting trochanteric growth in 32 patients. Articulo-trochanteric and trochanter-trochanter distances (TTDs) were measured on radiographs. Embedding of implant evaluated on final radiographs. RESULTS: The mean of age at the surgery was 10 ± 2.3 years, and the mean of follow up period was 50.0 ± 16.7 months. In all groups, articulo-trochanteric distance was decreased on final radiographs. In screw and screw washer group, increase of TTD was not statistically significant (P < 0.05). Twelve, one, and two implants were embedded, respectively, in screw, screw washer, and EP groups. Two patients in EP group had revision surgery due to loosening. CONCLUSIONS: In this study group, GTA using screw and screw washer methods could slow down but did not restore trochanteric overgrowth. We suggest using washer to reduce embedding of the screw.

Changes in Hip, Knee, and Ankle Coronal Alignments After Total Hip Arthroplasty With Transverse Femoral Shortening Osteotomy for Unilateral Crowe Type IV Developmental Dysplasia of the Hip.

BACKGROUND: To investigate changes in lower extremity coronal alignment in patients with unilateral Crowe type IV developmental dysplasia of the hip who underwent total hip arthroplasty with transverse femoral shortening osteotomy. METHODS: We reviewed the preoperative and 1-year postoperative full-length lower extremity radiographs of 25 patients. Femoral offset (FO), mechanical hip-knee-ankle angle, anatomical axis, mechanical axis deviation (MAD), mechanical lateral proximal femoral angle, anatomical medial proximal femoral angle, mechanical lateral distal femoral angle, anatomical lateral distal femoral angle, knee joint line congruency angle, mechanical medial proximal tibial angle, mechanical lateral distal tibial angle, ankle joint line orientation angle, tibial plafond talus angle, extremity length, and pelvic obliquity were measured on both the operative and nonoperative sides. RESULTS: Postoperatively, there were significant changes in FO (P = .001), hip-knee-ankle angle (P = .004), MAD (P = .016), mechanical lateral proximal femoral angle (P = .001), anatomical medial proximal femoral angle (P = .012), mechanical lateral distal femoral angle (P = .043), and ankle joint line orientation angle (P = .012) on the operative side. Only MAD (P = .035) changed significantly on the nonoperative side. CONCLUSION: Modification of FO and reconstruction of hip joint anatomy led to neutralization of knee and ankle valgus alignment. Effects on the nonoperative side were minimal.