Advances in modern osteotomies around the knee : Report on the Association of Sports Traumatology, Arthroscopy, Orthopaedic surgery, Rehabilitation (ASTAOR) Moscow International Osteotomy Congress 2017.

Corrective lower limb osteotomies are innovative and efficient therapeutic procedures for restoring axial alignment and managing unicompartmental knee osteoarthritis. This review presents critical insights into the up-dated clinical knowledge on osteotomies for complex posttraumatic or congenital lower limb deformities with a focus on high tibial osteotomies, including a comprehensive overview of basic principles of osteotomy planning, biomechanical considerations of different implants for osteotomies and insights in specific bone deformity correction techniques. Emphasis is placed on complex cases of lower limb osteotomies associated with ligament and multiaxial instability including pediatric cases, computer-assisted navigation, external fixation for long bone deformity correction and return to sport after such osteotomies. Altogether, these advances in the experimental and clinical knowledge of complex lower limb osteotomies allow generating improved, adapted therapeutic regimens to treat congenital and acquired lower limb deformities.

Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and thirty three patients.

PURPOSE: Nicotine abuse and obesity are well-known factors leading to common post-operative complications. However, their influence on the outcome after high tibial osteotomy is controversial. Thus, the aim of this study was to evaluate their effect on the clinical outcome with particular regard to bone non-union and local complications. METHODS: The functional outcome after open-wedge high tibial osteotomy using the TomoFix® plate was assessed by means of the 12-item Oxford knee score in a multicentre study. In addition the intra- and post-operative complications were determined. RESULTS: Of 533 eligible patients, 386 were interviewed after a mean follow-up of 3.6 years. The median Oxford knee score was 43 points (max. 48 points). Six per cent of these patients experienced at least one local post-operative complication. Patients with a body mass index (BMI) of up to 25 and between 25 and 30 had a higher mean score by 3.5 and 1.8 points, respectively, compared with those having a BMI of more than 30 showing a score of 37.5. No correlation was observed between smoking and the functional outcome. Smoking habits, BMI, the absolute patient weight and the interaction term between smoking and BMI were not significant with reference to the complication rate. CONCLUSIONS: This study reveals favourable mid-term results after high tibial osteotomy in varus osteoarthritis even in patients who smoked and obese patients. The indication in patients with a BMI above 30 should be handled with care due to the slightly inferior outcome, although the complication rate was not increased in these patients.

Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients.

PURPOSE: Open-wedge valgus high tibial osteotomy is a well-established procedure in the management of medial osteoarthritis of the knee. In recent years, improved osteotomy and fixation methods have led to an increased use of this technique. The aim of this study was to identify predictive parameters for the clinical outcome after valgus high tibial osteotomy. METHODS: A multicentre case series involving retrospective capture of baseline data and prospective outcome assessment of patients with knee OA who underwent an osteotomy using Tomofix(®) plate was conducted. Functional outcome was assessed using Oxford 12-item Knee Score. RESULTS: Before surgery, the majority of patients had grade III (52%) and grade IV (33%) lesions according to Outerbridge classification. Three hundred and eighty-six of 533 eligible patients were interviewed for follow-up after an average of 3.6 years. The mean Oxford Knee Score was 43 points. Six per cent experienced at least one local postoperative complication. There was a tendency towards lower score results in patients with a higher preoperative degree of the medial cartilage lesion. No correlation between patient age and the Oxford Knee Score was observed. CONCLUSION: Being male, being operated by an experienced surgeon, having no intake of pain medication at follow-up and having no postoperative complication are positive predictors of the Oxford Knee Score up to 5 years after surgery. This study reveals favourable midterm results after valgus high tibial osteotomy in varus osteoarthritis, even in older patients with high degree of cartilage damage. LEVEL OF EVIDENCE: II.

Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material.

Surgical correction of bowed legs should be performed as early as possible. Overload osteoarthritis, even without significant varus deformity of the knee, is a further indication for open-wedge high-tibial osteotomy. Progression of damage to the joint surfaces due to overloading can be significantly retarded by realigning the extremity with the aim to, at least, reduce overload on the medial compartment to a value close to physiological. Significant improvement to open-wedge high-tibial osteotomy (OWHTO) has been made on two fronts: (a) by the use of a more appropriate surgical technique and (b) by promoting osteogenesis through an angular-stable fixation device with just the correct amount of elasticity. A retrospective study of 53 consecutive cases in which no interposition material was used to fill the wedge, with gap openings between 5 mm and 20 mm, showed that ossification of the gap always progressed from the lateral hinge towards the medial side. Standard radiographs showed 75% of the gap filled in with new bone within 6-18 months. In conclusion, we believe that open-wedge high-tibial osteotomy using the TomoFix plate has proved to be successful in treating unicompartmental gonarthrosis, even without bone grafts or bone-substitute material.

Computer aided ACL reconstruction.

The following article gives a clinical description of computer aided ACL reconstruction using the Praxim Medivision tool. The special feature of this navigation is the existence of the possibility to virtually graft the implantation without first having to attach anchoring channels, which allows potential risks to be recognized and thus avoided. This description meets with the current operating techniques of the 4-fold semitendinosus technique, and of extra-cortical anchoring with the endobutton/suture disc technique.

TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia--early results in 92 cases.

High Tibial Osteotomy (HTO) is an established treatment for unicompartmental osteoarthritis of the knee with malalignment. The classic procedure for correcting varus deformity is the lateral closed wedge osteotomy of the tibia with osteotomy of the fibula. The disadvantages of this technique are well known. Open wedge osteotomy from the medial side eliminates the risk of compartment syndrome and peroneal nerve injuries. A new fixation device (TomoFix) with an adapted surgical technique allows stable fixation of the osteotomy without the need to fill the osteotomy gap with bone grafts. In a prospective study, 92 consecutive cases were treated with this procedure. Bony healing with remodelling of the medial and posterior cortical bone was observed. Full weight-bearing was possible ten weeks after surgery. There were no implant failures. Complications included one delayed union, two revarisations and one deep infection.