Use of Tibial Cortical Autograft for the Osteotomy Site in Medial Opening-Wedge High Tibial Osteotomy.

Background: Medial opening-wedge high tibial osteotomy (OWHTO) is a useful treatment option in patients with medial compartment osteoarthritis. Typically, the osteotomy site is filled with material such as autologous bone graft, allograft, or synthetic bone substitute. However, all these options have disadvantages. Purpose/Hypothesis: The purpose of this study was to describe tibial cortical autograft as an alternative to conventional graft options. It was hypothesized that the tibial rectangular cortical bone that is removed from the proximal medial cortical surface of the distal tibial fragment longitudinally could be a reliable option for recovery of the gap in the osteotomy area. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 520 patients with medial compartment osteoarthritis who underwent OWHTO between June 2009 and March 2019 were retrospectively analyzed. Patients were divided into 3 groups according to the graft material used to fill the osteotomy site: allograft in group A, iliac crest autograft in group B, and tibial autograft in group C. Bone union, evaluated by radiographs performed at 2 weeks, 4 weeks, 2 months, 3 months, 6 months, and 1 year postoperatively, was defined as occurring when at least 50% of the gap site was bridged with callus. Clinical assessment was performed using the International Knee Documentation Committee (IKDC) and Lysholm scores. Results: Included were 122 patients: 40 patients in group A, 42 patients in group B, and 40 patients in group C. The mean correction was 13.87°± 3.58° in group A, 12.33°± 3.92° in group B, and 14.10°± 2.99° in group C. The mean time for radiological bone union was 6.95 ± 1.40 months in group A, 4.48 ± 1.02 months in group B, and 5.07 ± 1.70 months in group C. Patients in all groups had similar IKDC and Lysholm scores at the final follow-up. Conclusion: This is the first report of this specific procedure in the literature. All clinical and radiological findings showed that use of tibial cortical autograft was an efficient method in patients undergoing OWHTO.

Tibial cancellous bone auto-grafting for medial open-wedge high tibial osteotomy: bone void filling with tissue harvested from osteotomized medullary canal.

The aim of the study was to evaluate the clinical and radiological outcomes in a series of patients undergoing open wedge high tibial osteotomy (OWHTO) using tibial cancellous autograft harvested from the osteotomized medullary canal which is not reported in the literature before. Patients with medial compartment osteoarthritis were treated with OWHTO and tibial cancellous auto- grafting performed from the osteotomized medullary canal and used for bone void filling. Seventy patients (seventy-two knees) treated with OWHTO were analyzed. All patients started partial weight-bearing with crutches the day after surgery and full-weight bearing eight weeks after surgery, according to radiological evaluation. Fifty-seven women and 13 men with a mean age of 54.2±8.1 years were evaluated in this study. The mean correction angle was 8.4±2.5° (range: 5.3°-14.3°). The osteotomy sites of all patients were grafted with tibial cancellous autografts. In all patients bony union was detected after surgery. No implant failures or major complications were en- countered. Clinical and radiological findings revealed that bone void filling with the harvested autograft from the osteotomized medullary canal may be a satisfactory and reliable option in OWHTO.

Early and mid-term results of Tönnis lateral acetabuloplasty for the treatment of developmental dysplasia of the hip.

OBJECTIVES: This study aimed to present the clinical and radiological results of a large patient group operated by Tönnis lateral acetabuloplasty (TLA) for developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: The retrospective study was conducted with 66 hips of 41 patients (5 males, 36 females; mean age: 32.3±18 months; range, 11 to 132 months) operated for DDH using the TLA technique in a single center between February 2012 and December 2016. Adductor tenotomy was performed on 52 (79%) hips. There was a need for additional femoral shortening and derotation-varization osteotomy in 14 (21%) hips. Clinical outcomes were evaluated with modified McKay criteria. The acetabular index and lateral migration index for the subluxated hip were calculated, and the femoral head position was evaluated according to Perkin's line and Shenton's line. The Severin classification was used to assess the outcome of the hips. RESULTS: The mean follow-up period was 27±11 months. According to the modified McKay criteria for DDH, 77.3% of hips were classified as excellent, 16.6% as good, and 6.1% as fair. The mean acetabular index decreased from 36.1° preoperatively to 18.6° postoperatively. The mean postoperative improvement for the acetabular index was 17.5±5. The lateral migration index improved from 89.7 to 10.6%. A statistically significant difference was determined between the preoperative and postoperative measurements of the acetabular index and lateral migration index (p<0.001). CONCLUSION: Tönnis lateral acetabuloplasty was found to be safe and effective with a low learning curve, and successful treatment decreases the duration of follow-up required in patients with DDH.

A new modification of the Trapdoor Procedure without surgical hip dislocation in the management of patients with osteonecrosis of the femoral head: A retrospective case series.

OBJECTIVE: The aim of this paper was to investigate the mid-term results of a modified Trapdoor procedure that can allow grafting of the femoral head without surgical hip dislocation in the management of patients with osteonecrosis of the femoral head. METHODS: 16 hips of 12 patients (7 female, 5 male; mean age = 38.5 ± 10.7) surgically treated by the new modification of Trapdoor procedure were retrospectively reviewed and included in the study. Based on the Association Research Circulation Osseous (ARCO) classification system, seven hips (43.7%) were stage 2, and nine hips (56.3%) were stage 3. The mean follow-up was 48.4 ± 25.7 months (range = 12-107). All the patients were evaluated postoperatively at the 6th week, 3rd month, 6th month, 1st year, and annually thereafter until their final follow-up. Clinical assessment was performed using the Harris Hip scoring (HHS) system, Non-Arthritic Hip score (NAHS) and Visual analogue pain scale (VAS). At the final follow-up, degenerative changes were examined according to the Kellgren-Lawrence scale. RESULTS: ThemeanHHS increased from53.43 ± 9.0 (range = 36-67) preoperatively to 83.81 ± 6.1 (range = 72-95) at the final follow-up (P < 0,001). Themean NAHS increased from 51.5 ± 8.2 (range = 36.25-61.25) preoperatively to 86 ± 3.2 (range = 81.5-90) (P < 0,001) at the final follow-up. The mean preoperative VAS decreased from 7.85 ± 0.9 (range = 6.45-9.5) to 3.05 ± 0.9 (range = 1.6-5.2) (P < 0,001) at the final follow-up. 13 hips demonstrated 80 and higher scores according toHHS. In the remaining three hips (ARCOstage 3), the mean postoperative HHS, NAHS, and VAS scores were 76, 82, and 3,2 respectively. According to Kellgren-Lawrence scale, three hips (18,75%) were determined as grade 0, 10 hips (62.5%) as grade 1, and 3 hips (18.75%) as grade 2. CONCLUSION: The Modified Trapdoor procedure without surgical hip dislocation seems to be a suitable technique with favorable clinical outcomes for the treatment of ARCO stage 2 and stage 3 osteonecrosis of the femoral head. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Surgical treatment of thoracolumbar tuberculosis: a retrospective analysis of autogenous grafting versus expandable cages.

PURPOSE: There has been no uniform and extensive description of the use of expandable cages in the setting of thoracolumbar tuberculosis. The purpose of the study was to evaluate the results of the expandable cages and compare with autogenous strut grafting in thoracolumbar tuberculosis. METHODS: From January 2003 to January 2014, a total of 28 patients with thoracolumbar tuberculosis were treated surgically in our medical center. Patients were divided into three groups. 17 patients received anterior-only surgery; consisting of autogenous iliac bone grafting only in 9 (Group 1), grafting with anterior screw-rod system instrumentation after debridement in 8 patients (Group 2). 11 patients underwent anterior surgery including debridement and distraction of the kyphosis by cages after corpectomy following posterior instrumentation (Group 3).The changes in degree of kyphotic deformity, loss of correction, intervertebral height and loss of intervertebral height were evaluated preoperatively, postoperatively and at the final follow-up. RESULTS: Patients were followed 52 ± 10.7 months (range, 18-120 months). Mean age in the Group 1 was 42 (18-69) years, 62 (19-86) years in the Group 2 and 51 (19-71) years in the Group 3. There was no statistically significant difference (P > 0.05) in the focal kyphosis preoperatively, postoperatively and at the last follow-up between three groups. There were statistically significant differences (P < 0.05) in loss of correction, intervertebral height (preoperative, postoperative and final follow-up) and loss of intervertebral height between three groups. There was a greater loss of correction in Group 1 when compared with Group 2 and Group 3. The difference was statistically significant (p < 0.001). There was no statistically significant difference in the intervertebral height postoperatively and follow-up between Group 1 and Group 2. There was a significant increase in the intervertebral height in Group 3 when compared with Group 1 and Group 2. There was also a significant increase in the intervertebral height in Group 2 when compared with Group 1. There was a greater loss of intervertebral height in Group 1 than in Group 2 and Group 3. The difference was statistically significant (p < 0.001). CONCLUSIONS: Expandable cages are an acceptable surgical option for the treatment of thoracolumbar tuberculosis. Sagittal alignment is better prevented with the expandable cages than anterior grafting with or without anterior instrumentation. Subsidence of the expandable cages is not uncommon and results in the loss of Cobb angle correction and intervertebral height. However, anterior vertebral column reconstruction by expandable cages provides a very high and effective rate of deformity correction and maintenance.

External rotator sparing with posterior acetabular fracture surgery: does it change outcome?

This study analyses the results of the treatment with external rotator sparing approach in acetabular fractures to determine whether muscle sparing has a positive impact on functional outcome. 20 patients with a mean age of 45.9 years (range: 26-64) that had been treated for displaced acetabular fractures were included in this series. Short Musculoskeletal Function Assessment (SMFA) questionnaire and hip muscle strength measurement were done at the 24-month of follow-up period. The radiographic results at the final followup were excellent in 9 hips (45%), good in 6 hips (30%), fair in 4 hips (20%), and poor in one hip (5%) according to the criteria developed by Matta. The average SMFA score for all of the patients was 18.3 (range: 0-55.4). The mean dysfunctional and bother indexes were 17.2 and 20.6, respectively. The overall muscle strength deficit was 11.8%. The greatest loss of strength was in internal rotation. In patients with better postoperative reduction quality of acetabular fracture, peak torque, and maximum work of hip flexion, extension and also internal rotation maximum work deficit were significantly lower (P < 0.05). Accurate initial reduction and longer postoperative muscle strengthening exercise programs seem critical to decrease postoperative hip muscle weakness after acetabular fractures.