Quantitative analysis of three-dimensional deformity indexes of the first metatarsal bone after osteotomy and orthosis for hallux valgus deformity / 中国组织工程研究

BACKGROUND:The displacement change parameters of the bone structure of the first metatarsal bone at the two-dimensional level of hallux valgus deformity are of great significance for clinical diagnosis and treatment,while the quantitative analysis of the three-dimensional deformity index may have some influences on the postoperative efficacy. OBJECTIVE:To explore the quantitative change of the three-dimensional deformity index of the first metatarsal bone after routine osteotomy and orthosis for hallux valgus deformity and to provide reference for clinical work. METHODS:100 patients with hallux valgus deformity(foot)in Hengshui People's Hospital from October 2020 to April 2023 were selected and all of them underwent conventional osteotomy and orthosis.Foot function was assessed by the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale 6 months after surgery.Anterolateral X-rays of the foot in weight-bearing position and CT images in simulated weight-bearing position were taken before surgery and 6 months after surgery.The three-dimensional deformity indexes of the first metatarsal bone before and after surgery were quantitatively analyzed in patients with different ages,genders and therapeutic effects,including first-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotation α angle.The value of the difference of three-dimensional deformity indexes of the first metatarsal bone before and after operation in evaluating the curative effect was analyzed. RESULTS AND CONCLUSION:(1)Six months after operation,the American Orthopedic Foot and Ankle Society score was 75-98(88.25±4.14)points,among which 56 cases were excellent,28 cases were good,14 cases were average,and 2 cases were poor.The excellent and good rate was 84%(84/100).(2)Compared with the preoperative results,first-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotation α angle were significantly improved in patients of different ages and genders 6 months after surgery(P<0.05).First-second intermetatarsal angle,hallux valgus angle,distal metatarsal articular angle,tibial sesamaid position,and first metatarsal rotation α angle were all lower in patients with good curative effect 6 months after surgery than those with poor curative effect,and the difference before and after surgery was greater than those with poor curative effect(P<0.05).(3)The area under the curve of the difference evaluation of the first metatarsal three-dimensional deformity index before and after surgery was above 0.7,and the area under the curve of the combined evaluation of all indexes was the largest(0.902),which was significantly greater than the first metatarsal rotation α angle and distal metatarsal articular angle(P<0.05).(4)The quantitative analysis of the three-dimensional deformity index of the first metatarsal in patients with hallux valgus deformity is related to the postoperative effect,which has important guiding significance for improving the accuracy and comprehensiveness of preoperative evaluation and improving the treatment plan.

Early curative effects of robot-assisted total knee arthroplasty for valgus knee / 中华创伤骨科杂志

Objective:To investigate the early curative effects of robot-assisted total knee arthroplasty (TKA) in the treatment of valgus knee.Methods:A retrospective study was conducted to analyze the data of 40 patients with valgus knee who had been treated by TKA at Department of Orthopaedics, The 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January to December 2021. The patients were divided into 2 groups according to whether a robot had been used or not for TKA. In the observation group of 15 cases for which TKA was assisted by a robot, there were 4 males and 11 females with an age of (65.5±6.2) years, and the disease course was 42 (36, 54) months; in the control group of 25 cases for which conventional TKA was performed, there were 8 males and 17 females with an age of (65.8±7.5) years, and the disease course was 42 (36, 60) months. Surgical time, hemoglobin decrease, and knee joint range of motion, American Knee Society Score (KSS), hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) at 12 months after surgery were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The surgical time in the observation group was (148.0±21.2) min, significantly longer than that in the control group [(115.2±7.1) min], and the hemoglobin decreased by (11.8±1.1) g/L in the observation group, significantly less than that in the control group [(18.1±1.8) g/L] ( P<0.05). The observation group and the control group were followed up for 13 (13, 14) and 13 (13, 14) months after surgery, respectively, showing no statistically significant difference ( P>0.05). At 12 months after surgery, the KSS knee score, KSS functional score, and knee range of motion in the observation group were (86.1±4.6) points, (86.9±3.1) points, and 115.7°±5.0°, significantly larger than those in the control group [(82.2±3.5) points, (82.8±0.9) points, and 108.2°±5.0°] ( P<0.05). Reexamination of full-length radiographs of both lower limbs in all patients showed good positions of the prostheses and no such adverse events as loosening or sinking at 12 months after surgery. The HKA (178.5°±1.2°) and LDFA (89.1°±0.7°) at 12 months after surgery in the observation group were significantly larger than those in the control group (176.6°±1.5°, 88.2°±8.2°) ( P<0.05); there was no statistically significant difference in MPTA between the 2 groups ( P>0.05). Conclusions:In the treatment of valgus knee, robot-assisted TKA can correct joint deformity, and achieve precise osteotomy and functional alignment of lower limbs, leading to better early curative effects than conventional TKA.

Surgical technique of lateral unicompartmental knee arthroplasty and discussion of the maximum correction value in the treatment of knee valgus deformity / 中国修复重建外科杂志

OBJECTIVE@#To investigate the surgical technique and the short-term effectivenss of lateral unicompartmental knee arthroplasty (LUKA) through lateral approach in the treatment of valgus knee and to calculate the maximum value of the theoretical correction of knee valgus deformity.@*METHODS@#A retrospective analysis was performed on 16 patients (20 knees) who underwent LUKA and met the selection criteria between April 2021 and July 2022. There were 2 males and 14 females, aged 57-85 years (mean, 71.5 years). The disease duration ranged from 1 to 18 years, with an average of 11.9 years. Knee valgus was staged according to Ranawat classification, there were 6 knees of type Ⅰ, 13 knees of type Ⅱ, and 1 knee of type Ⅲ. All patients were assigned the expected correction value of genu valgus deformity by preoperative planning, including the correction value of lateral approach, intra-articular correction value, and residual knee valgus deformity value. The actual postoperative corrected values of the above indicators were recorded and the theoretical maximum correctable knee valgus deformity values were extrapolated. The operation time, intraoperative blood loss, incision length, hospital stay, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), joint line convergence angle (JLCA), posterior tibial slope (PTS), range of motion (ROM), Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were also recorded for effectiveness evaluation.@*RESULTS@#The patients' incision length averaged 13.83 cm, operation time averaged 85.8 minutes, intraoperative blood loss averaged 74.9 mL, and hospital stay averaged 6.7 days. None of the patients suffered any significant intraoperative neurological or vascular injuries. All patients were followed up 10-27 months, with a mean of 17.9 months. One patient with bilateral knee valgus deformities had intra-articular infection in the left knee at 1 month after operation and the remaining patients had no complication such as prosthesis loosening, dislocation, and infection. The ROM, HSS score, and WOMAC score of knee joint significantly improved at each time point after operation when compared to those before operation, and the indicators further improved with time after operation, the differences were all significant ( P<0.05). Imaging measurement showed that HKA, mLDFA, JLCA, and PTS significantly improved at 3 days after operation ( P<0.05) except for mMPTA ( P>0.05). Postoperative evaluation of the knee valgus deformity correction values showed that the actual intra-articular correction values ranged from 0.54° to 10.97°, with a mean of 3.84°. The postoperative residual knee valgus deformity values ranged from 0.42° to 5.30°, with a mean of 3.59°. The actual correction values of lateral approach ranged from 0.21° to 12.73°, with a mean of 4.26°.@*CONCLUSION@#LUKA through lateral approach for knee valgus deformity can achieve good early effectiveness. Preoperative planning can help surgeons rationally allocate the correction value of knee valgus deformity, provide corresponding treatment strategies, and the maximum theoretical correction value of knee valgus deformity can reach 25°.

Evans lateral lengthening calcaneal osteotomy in treatment of talocalcaneal coalition with hindfoot valgus deformity / 中国修复重建外科杂志

Objective: To investigate the effectiveness of the Evans lateral lengthening calcaneal osteotomy (E-LLCOT) in treatment of talocalcaneal coalition (TCC) with hindfoot valgus deformity. Methods: Between January 2014 and October 2017, 10 patients (13 feet) of TCC with hindfoot valgus deformities underwent E-LLCOTs. There were 6 males (8 feet) and 4 females (5 feet) with an age of 13-18 years (mean, 15.8 years). The disease duration was 10-14 months (mean, 11.5 months). The foot deformity was characterized by hindfoot valgus, forefoot abduction, and collapse of the medial arch. Pain site was the tarsal sinus in 4 feet, TCC in 5 feet, and ankle joint in 4 feet. There were tightness of the gastrocnemius in 3 cases (4 feet) and Achilles tendon in 7 cases (9 feet) on Silverskiold test. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 46.54±9.08 and visual analogue scale (VAS) score was 6.54±0.88 after walking 1 kilometer. The AOFAS ankle-hindfoot score and VAS score were adopted to evaluate the postoperative function of the foot. The talar-first metatarsal angle (T1MT), talonavicular coverage angle (TCA), talar-horizontal angle (TH), calcaneal pitch angle (CP), and heel valgus angle (HV) were measured after operation. Results: All incisions healed by first intention. All patients were followed up 12-30 months (mean, 18 months). At last follow-up, the AOFAS ankle-hindfoot score and VAS score were 90.70±6.75 and 1.85±0.90, respectively, showing significant differences when compared with preoperative scores ( t=-23.380, P=0.000; t=35.218, P=0.000). X-ray films showed that the osteotomy healed at 2-4 months (mean, 3 months) after operation. At last follow-up, the T1MT, TCA, TH, and HV were significantly lower than preoperative ones ( P<0.05), and the CP was significantly higher than preoperative one ( P<0.05). During the follow-up, the pain did not relieve obviously in 1 patient (1 foot), and the cutaneous branch of the sural nerve injured in 1 patient (1 foot). Conclusion: For TCC with severe hindfoot valgus deformity, E-LLCOT can effectively correct deformity and relieve pain.

Femoral supracondylar osteotomy for the treatment of valgus knee osteoarthritis in young and middle-aged patients / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of open supracondylar osteotomy of the femoral condyle for the treatment of valgus knee osteoarthritis.</p><p><b>METHODS</b>From April 2008 to June 2015, 21 patients with valgus knee osteoarthritis underwent an open wedge femoral supracondylar osteotomy using the distal femur dissection plates combined with autologous iliac bone graft for the bone defect. There were 8 males (8 knees) and 13 females (15 knees), ranging in age from 30 to 54 years old, with a mean age of 41.2 years old. All the patients had valgus deformity and knee joint pain in the lateral compartment. The average tibiofemoral angle was (162.0±2.6)° which was measured on the image of preoperative lower extremity weight-bearing X-ray. Clinical outcomes were comprehensively assessed according to the bone healing time, postoperative complications, progress of knee osteoarthritis after operation, the Hospital for Special Surgery rating system (HSS), and tibiofemoral angle before and after operation.</p><p><b>RESULTS</b>All 21 patients were followed up, the valgus deformity of knee joint was corrected in all patients after operation. No obvious delayed union or nonunion were found, and no serious complications were found. The HSS knee score was improved from the preoperative 57.3±3.1 to the final follow-up time 88.6±2.7. Tibiofemoral angle was improved to the postoperative(176.0±1.4)°.</p><p><b>CONCLUSIONS</b>Open wedge femoral supracondylar osteotomy has a clear surgical approach, and it is easy to control the bone mass of osteotomy and can effectively correct the valgus deformity and improve the function of knee joint using this method. It is an effective method for the treatment of valgus knee osteoarthritis in young and middle-aged patients.</p>

Clinical effect of total knee arthroplasty for severe knee valgus deformity / 局解手术学杂志

Objective To research the clinical effect and operation way of total knee arthroplasty for severe knee valgus deformity. Methods From March 2011 to September 2013, 17 cases (23 knees) with severe knee valgus deformity were selected as the research ob-ject. Metered the tibial angle and checked the activity of knee joint of all the patients before operation. All patients were scored with HSS knee scoring system. Through the selection of lateral parapatellar approach, targeted osteotomy, selective lateral soft tissuelax, patients were given total knee arthroplasty for the treatment of severe knee valgus deformity. The femoral and tibial angle of patients was measured again after the operation. All patients were reexamined after 6 months which included checking the activity of knee joint, evaluating the therapeutic effect of patients with HSS knee scoring system. Results All patients were reexamined in our hospital 6 months after surgery, the degree of femoral and tibial angle decreased from (28. 4 ± 4. 9)° to (5. 2 ± 2. 3)°; knee joint range of motion increased from (65. 4 ± 16. 7)° to (106. 7 ± 27. 3)°;HSS score increased from (38. 46 ± 3. 75) point to (87. 41 ± 4. 77) point. Postoperative indexes were significantly im-proved compared with preoperative indexes, and the differences were of statistical significance (P<0. 05). Conclusion The curative effect is remarkable for patients with severe knee valgus deformity using patellar medial approach, standard osteotomy combined with selective soft tissue release, and total knee arthroplasty. And the knee valgus deformity of patients was corrected and the quality of life has been signifi-cantly improved.

Treatment of Fused Knee Flexion and Valgus Deformity Using Gradual Correction with Ilizarov Frame / 대한정형외과학회잡지

Various surgical methods including soft tissue procedures and bone procedures are commonly used to treat knee flexion and contracture deformity. However, several complications such as, neurovascular injury and skin necrosis were reported because of rapid correction. We aim to report good results from gradual correction using Ilizarov following supracondylar osteotomy in a 24-year-old man suffering from fused knee flexion and valgus deformity, a complication developed by septic arthritis.

Ankle Deformity Secondary to Acquired Fibular Segmental Defect in Children

BACKGROUND: The authors report the long-term effect of acquired pseudoarthrosis of the fibula on ankle development in children during skeletal growth, and the results of a long-term follow-up of Langenskiold's supramalleolar synostosis to correct an ankle deformity induced by an acquired fibular segmental defect in children. METHODS: Since 1980, 19 children with acquired pseudoarthrosis of the fibula were treated and followed up for an average of 11 years. Pseudoarthrosis was the result of a fibulectomy for tumor surgery, osteomyelitis of the fibula and traumatic segmental loss of the fibula in 10, 6, and 3 cases, respectively. Initially, a Langenskiold's operation (in 4 cases) and fusion of the lateral malleolus to the distal tibial epiphysis (in 1 case) were performed, whereas only skeletal growth was monitored in the other 14 cases. After a mean follow-up of 11 years, the valgus deformity and external tibial torsion of the ankle joint associated with proximal migration of the lateral malleolus needed to be treated with a supramallolar osteotomy in 12 cases (63%). These ankle deformities were evaluated using the serial radiographs and limb length scintigraphs. RESULTS: In all cases, early closure of the lateral part of the distal tibial physis, upward migration of the lateral malleolus, unstable valgus deformity and external tibial torsion of the ankle joint developed during a mean follow-up of 11 years (range, 5 to 21 years). The mean valgus deformity and external tibial torsion of the ankle at the final follow-up were 15.2degrees (range, 5degrees to 35degrees) and 10degrees (range, 5degrees to 12degrees), respectively. In 12 cases (12/19, 63%), a supramalleolar corrective osteotomy was performed but three children had a recurrence requiring an additional supramalleolar corrective osteotomy 2-4 times. CONCLUSIONS: A valgus deformity and external tibial torsion are inevitable after acquired pseudoarthrosis of the fibula in children. Both Langenskiold supramalleolar synostosis to prevent these ankle deformities and supramalleolar corrective osteotomy to correct them in children are effective initially. However, both procedures cannot maintain the permanent ankle stability during skeletal maturity. Therefore any type of prophylactic surgery should be carried out before epiphyseal closure of the distal tibia occurs, but the possibility of a recurrence of the ankle deformities and the need for final corrective surgery after skeletal maturity should be considered.

Total Knee Arthroplasty for Treating Valgus and Varus in the Knees of One Person

PURPOSE: We have performed total knee arthroplasty for treating valgus and varus in the knees of one person. We investigated the clinical characteristics of these patients and the relationship between the kind of deformity and the postoperative result. MATERIALS AND METHODS: From March 2002 to May 2005, fourteen patients who had simultaneous varus and valgus knee deformities underwent total knee arthroplasties and they were followed for more than 12 months, and these were the subjects of our study. The average age was 64.6.years and the average follow-up period was 18.4 months. Follow-up imaging assessments were done and the clinical outcomes were evaluated using the HSS score at the last follow-up. RESULTS: Nine cases had more pain in the varus knee preoperatively and two cases had more pain in the valgus knee preoperatively. In 8 cases, degenerative scoliosises were associated with the knee deformity and among these cases, seven cases had vlagus deformities in the right knees. In two cases, hip deformities were noted in the ipsilateral side of the valgus deformity. The preoperative mean valgus angle and varus angle was 10.5 degrees and 7.8 degrees, respectively. The postoperative valgus and varus angle improved to 6.8 and 6.0 degree, respectively. The HSS score improved from 64.7 to 86.0 points for the valgus deformities and from 61.5 to 86.9 points for the varus deformities. Postoperative patellar clunk syndrome was identified in one valgus knee and arthroscopic resection was then performed. The knee had completely recovered on the last follow-up. CONCLUSION: Simultaneous or staged total knee arthroplasties in patients with simultaneous varus and contralateral valgus knee deformities achieved satisfactory outcomes with regard to the objective orthopedic criteria as well as the overall patient satisfaction in terms of pain relief and function. We found that scoliosis and ipsilateral hip deformities concurred with knee deformities, and this indicated that hip deformity and scoliosis are related with knee deformities. We found no significant difference between the kind of deformity and the postoperative result, yet a prospective study with more cases and longer follow-up is recommended in the future to reaffirm our findings.

Corrective Dome Osteotomy for Cubitus Varus and Valgus Deformity / 대한정형외과학회잡지

Purpose: To examine the clinical results of a corrective dome osteotomy for a cubitus varus and valgus deformity. Materials and Methods: Between January 1998 and April 2005, nineteen patients with a cubitus varus or valgus deformity were treated with a corrective dome osteotomy. The mean age of the patients was 29.5 years and the mean follow-up period was 39 months (range, 15 to 95 months). A dome osteotomy was performed along the circle centered approximately 1 cm distally from the olecrenon tip. Internal fixation was performed with multiple K-wires or plates. Results: Bony union was achieved in 18 cases. In the cubitus varus group, the carrying angle was corrected from a mean varus of 17.9o to a mean valgus of 5.9o. The lateral prominence angle (LPI) was corrected from a mean of 15.6% to a mean of -7.6%. In the cubitus valgus group, the carrying angle was corrected from a mean valgus of 36o to 6.7o. The LPI was corrected from a mean -31% to -1.3%. On the functional assessment, 12, 5 and 2 cases showed excellent, good and fair outcomes, respectively. Conclusion: Corrective dome osteotomy for a cubitus varus or valgus deformity is an excellent cosmetic procedure through which a correctional angle can be achieved easily without shortening the humeral length.

Total Knee Arthroplasty in the Valgus Knee / 대한정형외과학회잡지

PURPOSE: To analyze the clinical and radiographic results after total knee arthroplasty (TKA) in the valgus knee. MATERIALS AND METHODS: Thirty six knees in 27 patients with a valgus alignment of more than 10 degrees of femorotibial angle underwent TKA. The average follow-up period was 7 years 2 months (1 year to 14 years 5 months). 18 (50%) knees were implanted with a cruciate retaining prosthesis, 17 (47.2%) knees with a posterior stabilized prosthesis, and one (2.8%) knee with a constrained condylar prosthesis. In knees with a preoperative 15 degrees or greater femorotibial angle, the posterior stabilized prostheses were necessary in 85%. Medial parapatellar approach was used in 27 knees with a preoperative valgus 20 degrees or lesser femorotibial angle. With 20 to 29 degrees valgus, medial parapatellar approach was used in 5 knees and lateral parapatellar approach in 2 knees. With 30 degrees or greater valgus, lateral parapatellar approach was used in 2 knees. RESULTS: The mean postoperative Hospital for Special Surgery knee scores were 89.5 points. Postoperative range of motion averaged 114.4 degrees. Postoperative alignment averaged 6.5 degrees valgus. Radiolucent line or loosening was not seen in any knee. There were 2 deep infection in patients whose preoperative femorotibial angle was greater than valgus 20 degrees using lateral parapatellar approach. CONCLUSION: Clinical and functional results after TKA in valgus knee were similar to those in varus. But, prevention of deep infection in patients with marked valgus angle was important, especially using lateral parapatellar approach. Cruciate retaining, posterior stabilized and constrained condylar prostheses were used in our cases. A more constrained prosthesis was frequently used in more significant valgus deformity. Both medial and lateral parapatellar approaches were used in our cases. But, in severe valgus knee more than 30 degrees, lateral parapatellar approach was necessary.

Joelho valgo em cães de pequeno porte - relato de dois casos / Valgus deformity of the stifle joint in small dogs-report of two cases

O joelho valgo é observado primariamente em cães de raças gigantes como resultado da disparidade do crescimento da porção lateral e medial da epífise distal do fêmur, apesar da porção proximal da tíbia poder estar envolvida. As formas de tratamento são: epifisiodese, transecção periosteal invertida em ôTö ou osteotomia corretiva. Descreve-se dois casos de joelho valgo em cães jovens de pequeno porte. À palpação observou-se crepitação e diferentes graus de luxação patelar. O exame radiográfico revelou desvio longitudinal da tíbia com moderado estreitamento do espaço intra-articular medial. O tratamento padrão para ambos os casos foi a ostectomia cuneiforme varizante, seguida de fixação com placa e parafusos. Após a cirurgia, observou-se deambulação normal com remissão dos sinais clínicos, apesar da manutenção da luxação patelar. O relato destes casos prende-se à raridade de tal condição ortopédica em cães de pequeno porte, atentando-se ao fato de que tal afecção pode ser confundida clinicamente com a luxação de patela, a qual não seria corretamente tratada com técnicas tradicionais para estabilização articular.

Valgus Deformity after Non-displaced Fracutre of the Proximal Tibia in Children / 대한정형외과학회잡지

Tibia valga has been described as a consequence of non-displaced fractures of the proximal metaphysis of the tibia in children. There has been considerable speculation about the cause of this deformity. Four cases of estabilished valgus deformity following injury to the proximal tibia metaphysis in children are presented. In one case of them, it was showed that an infolding of a portion of the periosteum of the tibiain medial opening of this fracture. It was treated by surgical clearence of the infolding periosteum and varus osteotomy with slight over-correction and partial fibulectomy. The recurrence of valgus deformity was absent during post operative one year. In another case, roentgenogram showed an asymmetrical growth arrest line of the pmximal tibia. The presence of asymmetrical growth arrest lines in the pmximal metaphysis of the tibia demonstrates that the valgus deformity in this patient was caused by overgrowth of the medial portion of the proximal tibial epiphyseal plate. In the remainder, we observed the deformity developed without any specific cause.