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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2013

01.07.2013 | Knee

Gradual correction of idiopathic genu varum deformity using the Ilizarov technique

verfasst von: Young Eun Park, Sang Heon Song, Hyeok Nam Kwon, Mohamed Ahmed Refai, Kwang Won Park, Hae Ryong Song

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 7/2013

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Abstract

Purpose

Proximal tibial osteotomy is an effective treatment option for genu varum deformity among the many other described techniques. The purpose of this study is to evaluate the clinical and radiological outcomes and the complications in gradual correction of idiopathic genu varum deformity using Ilizarov frame.

Methods

Proximal tibial medial opening wedge osteotomy was performed in 21 lower limbs of 11 patients, with whom the Ilizarov external fixator was used for gradual correction of the varus deformity. The mean age of the patients was 24.8 years (SD, 5.3). Deformity measurements of conventional mechanical axis deviation, mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, posterior proximal tibial angle, joint conversion angle, tibio-femoral angle and tibial slope were compared.

Results

The mean time for removal of the Ilizarov fixator was 24.7 weeks. At the last follow-up, the mean of Hospital for Special Surgery knee score increased, and the mean mechanical medial proximal tibial angle, tibio-femoral angle and conventional mechanical axis deviation improved. The differences between preoperative and postoperative posterior proximal tibial angle, mechanical lateral distal femoral angle, joint conversion angle and tibial slope were not significant. Ten complications were observed, of which 8 were minor complications and 2 were minor complications.

Conclusion

With a few complications, normal alignment and orientation of lower extremity can be established in patients with idiopathic genu varum deformity through gradual correction using a Ilizarov fixator.

Level of evidence

Retrospective case series, Level IV.
Literatur
1.
Zurück zum Zitat Adili A, Bhandari M, Giffin R, Whately C, Kwok DC (2002) Valgus high tibial osteotomy. Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 10(3):169–176PubMedCrossRef Adili A, Bhandari M, Giffin R, Whately C, Kwok DC (2002) Valgus high tibial osteotomy. Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 10(3):169–176PubMedCrossRef
2.
Zurück zum Zitat Bachhal V, Sankhala SS, Jindal N, Dhillon MS (2011) High tibial osteotomy with a dynamic axial fixator: precision in achieving alignment. J Bone Jt Surg Br 93(7):897–903 Bachhal V, Sankhala SS, Jindal N, Dhillon MS (2011) High tibial osteotomy with a dynamic axial fixator: precision in achieving alignment. J Bone Jt Surg Br 93(7):897–903
3.
Zurück zum Zitat Coogan PG, Fox JA, Fitch RD (1996) Treatment of adolescent Blount disease with the circular external fixation device and distraction osteogenesis. J Pediatr Orthop 16(4):450–454PubMedCrossRef Coogan PG, Fox JA, Fitch RD (1996) Treatment of adolescent Blount disease with the circular external fixation device and distraction osteogenesis. J Pediatr Orthop 16(4):450–454PubMedCrossRef
4.
Zurück zum Zitat Feldman DS, Madan SS, Ruchelsman DE, Sala DA, Lehman WB (2006) Accuracy of correction of tibia vara: acute versus gradual correction. J Pediatr Orthop 26(6):794–798PubMedCrossRef Feldman DS, Madan SS, Ruchelsman DE, Sala DA, Lehman WB (2006) Accuracy of correction of tibia vara: acute versus gradual correction. J Pediatr Orthop 26(6):794–798PubMedCrossRef
5.
Zurück zum Zitat Gilbody J, Thomas G, Ho K (2009) Acute versus gradual correction of idiopathic tibia vara in children: a systematic review. J Pediatr Orthop 29(2):110–114PubMedCrossRef Gilbody J, Thomas G, Ho K (2009) Acute versus gradual correction of idiopathic tibia vara in children: a systematic review. J Pediatr Orthop 29(2):110–114PubMedCrossRef
6.
Zurück zum Zitat Hankemeier S, Gosling T, Richter M, Hufner T, Hochhausen C, Krettek C (2006) Computer-assisted analysis of lower limb geometry: higher intraobserver reliability compared to conventional method. Comput Aided Surg 11(2):81–86PubMed Hankemeier S, Gosling T, Richter M, Hufner T, Hochhausen C, Krettek C (2006) Computer-assisted analysis of lower limb geometry: higher intraobserver reliability compared to conventional method. Comput Aided Surg 11(2):81–86PubMed
7.
Zurück zum Zitat Hayek S, Segev E, Ezra E, Lokiec F, Wientroub S (2000) Serrated W/M osteotomy. Results using a new technique for the correction of infantile tibia vara. J Bone Joint Surg Br 82(7):1026–1029PubMedCrossRef Hayek S, Segev E, Ezra E, Lokiec F, Wientroub S (2000) Serrated W/M osteotomy. Results using a new technique for the correction of infantile tibia vara. J Bone Joint Surg Br 82(7):1026–1029PubMedCrossRef
8.
Zurück zum Zitat Hernigou P, Ma W (2001) Open wedge tibial osteotomy with acrylic bone cement as bone substitute. Knee 8(2):103–110PubMedCrossRef Hernigou P, Ma W (2001) Open wedge tibial osteotomy with acrylic bone cement as bone substitute. Knee 8(2):103–110PubMedCrossRef
9.
Zurück zum Zitat Insall JN, Ranawat CS, Aglietti P, Shine J (1976) A comparison of four models of total knee-replacement prostheses. J Bone Jt Surg Am 58(6):754–765 Insall JN, Ranawat CS, Aglietti P, Shine J (1976) A comparison of four models of total knee-replacement prostheses. J Bone Jt Surg Am 58(6):754–765
10.
Zurück zum Zitat Joo SY, Park HW, Park KB, Kim BS, Park JS, Kim HW (2007) A new classification for idiopathic genu vara. Yonsei Med J 48(5):833–838PubMedCrossRef Joo SY, Park HW, Park KB, Kim BS, Park JS, Kim HW (2007) A new classification for idiopathic genu vara. Yonsei Med J 48(5):833–838PubMedCrossRef
11.
Zurück zum Zitat Kendoff D, Board TN, Citak M, Gardner MJ, Hankemeier S, Ostermeier S, Krettek C, Hufner T (2008) Navigated lower limb axis measurements: influence of mechanical weight-bearing simulation. J Orthop Res 26(4):553–561PubMedCrossRef Kendoff D, Board TN, Citak M, Gardner MJ, Hankemeier S, Ostermeier S, Krettek C, Hufner T (2008) Navigated lower limb axis measurements: influence of mechanical weight-bearing simulation. J Orthop Res 26(4):553–561PubMedCrossRef
12.
Zurück zum Zitat Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Jt Surg Am 85-A(1):78–85 Koshino T, Murase T, Saito T (2003) Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. J Bone Jt Surg Am 85-A(1):78–85
13.
Zurück zum Zitat Laurencin CT, Ferriter PJ, Millis MB (1996) Oblique proximal tibial osteotomy for the correction of tibia vara in the young. Clin Orthop Relat Res 327:218–224PubMedCrossRef Laurencin CT, Ferriter PJ, Millis MB (1996) Oblique proximal tibial osteotomy for the correction of tibia vara in the young. Clin Orthop Relat Res 327:218–224PubMedCrossRef
14.
Zurück zum Zitat Maurer F, Wassmer G (2006) High tibial osteotomy: does navigation improve results? Orthopedics 29(10 Suppl):S130–S132PubMed Maurer F, Wassmer G (2006) High tibial osteotomy: does navigation improve results? Orthopedics 29(10 Suppl):S130–S132PubMed
15.
Zurück zum Zitat McCarthy JJ, Mark AK, Davidson RS (2007) Treatment of angular deformities of the tibia in children: acute versus gradual correction. J Surg Orthop Adv 16(3):118–122PubMed McCarthy JJ, Mark AK, Davidson RS (2007) Treatment of angular deformities of the tibia in children: acute versus gradual correction. J Surg Orthop Adv 16(3):118–122PubMed
16.
Zurück zum Zitat Miller BS, Dorsey WO, Bryant CR, Austin JC (2005) The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 33(10):1552–1557PubMedCrossRef Miller BS, Dorsey WO, Bryant CR, Austin JC (2005) The effect of lateral cortex disruption and repair on the stability of the medial opening wedge high tibial osteotomy. Am J Sports Med 33(10):1552–1557PubMedCrossRef
17.
Zurück zum Zitat Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25(6):639–646PubMedCrossRef Miller BS, Downie B, McDonough EB, Wojtys EM (2009) Complications after medial opening wedge high tibial osteotomy. Arthroscopy 25(6):639–646PubMedCrossRef
18.
Zurück zum Zitat Myers TG, Fishman MK, McCarthy JJ, Davidson RS, Gaughan J (2005) Incidence of distal femoral and distal tibial deformities in infantile and adolescent Blount disease. J Pediatr Orthop 25(2):215–218PubMedCrossRef Myers TG, Fishman MK, McCarthy JJ, Davidson RS, Gaughan J (2005) Incidence of distal femoral and distal tibial deformities in infantile and adolescent Blount disease. J Pediatr Orthop 25(2):215–218PubMedCrossRef
19.
Zurück zum Zitat Nagi ON, Kumar S, Aggarwal S (2007) Combined lateral closing and medial opening-wedge high tibial osteotomy. J Bone Jt Surg Am 89(3):542–549CrossRef Nagi ON, Kumar S, Aggarwal S (2007) Combined lateral closing and medial opening-wedge high tibial osteotomy. J Bone Jt Surg Am 89(3):542–549CrossRef
20.
Zurück zum Zitat Paley D (1990) Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 250:81–104PubMed Paley D (1990) Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 250:81–104PubMed
21.
Zurück zum Zitat Paley D, Maar DC, Herzenberg JE (1994) New concepts in high tibial osteotomy for medial compartment osteoarthritis. Orthop Clin North Am 25(3):483–498PubMed Paley D, Maar DC, Herzenberg JE (1994) New concepts in high tibial osteotomy for medial compartment osteoarthritis. Orthop Clin North Am 25(3):483–498PubMed
22.
Zurück zum Zitat Robinson PM, Papanna MC, Somanchi BV, Khan SA (2011) High tibial osteotomy in medial compartment osteoarthritis and varus deformity using the Taylor spatial frame: early results. Strateg Trauma Limb Reconstr 6(3):137–145CrossRef Robinson PM, Papanna MC, Somanchi BV, Khan SA (2011) High tibial osteotomy in medial compartment osteoarthritis and varus deformity using the Taylor spatial frame: early results. Strateg Trauma Limb Reconstr 6(3):137–145CrossRef
23.
Zurück zum Zitat Rozbruch SR, Segal K, Ilizarov S, Fragomen AT, Ilizarov G (2010) Does the Taylor spatial frame accurately correct tibial deformities? Clin Orthop Relat Res 468:1352–1361PubMedCrossRef Rozbruch SR, Segal K, Ilizarov S, Fragomen AT, Ilizarov G (2010) Does the Taylor spatial frame accurately correct tibial deformities? Clin Orthop Relat Res 468:1352–1361PubMedCrossRef
24.
Zurück zum Zitat Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124(10):649–653PubMedCrossRef Spahn G (2004) Complications in high tibial (medial opening wedge) osteotomy. Arch Orthop Trauma Surg 124(10):649–653PubMedCrossRef
25.
Zurück zum Zitat Stanitski DF, Dahl M, Louie K, Grayhack J (1997) Management of late-onset tibia vara in the obese patient by using circular external fixation. J Pediatr Orthop 17(5):691–694PubMed Stanitski DF, Dahl M, Louie K, Grayhack J (1997) Management of late-onset tibia vara in the obese patient by using circular external fixation. J Pediatr Orthop 17(5):691–694PubMed
26.
Zurück zum Zitat Tanaka T, Kumagae Y, Saito M, Chazono M, Komaki H, Kikuchi T, Kitasato S, Marumo K (2008) Bone formation and resorption in patients after implantation of beta-tricalcium phosphate blocks with 60% and 75% porosity in opening-wedge high tibial osteotomy. J Biomed Mater Res B Appl Biomater 86(2):453–459PubMed Tanaka T, Kumagae Y, Saito M, Chazono M, Komaki H, Kikuchi T, Kitasato S, Marumo K (2008) Bone formation and resorption in patients after implantation of beta-tricalcium phosphate blocks with 60% and 75% porosity in opening-wedge high tibial osteotomy. J Biomed Mater Res B Appl Biomater 86(2):453–459PubMed
27.
Zurück zum Zitat van Hemert WL, Willems K, Anderson PG, van Heerwaarden RJ, Wymenga AB (2004) Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiological study with a new evaluation system. Knee 11(6):451–456PubMedCrossRef van Hemert WL, Willems K, Anderson PG, van Heerwaarden RJ, Wymenga AB (2004) Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiological study with a new evaluation system. Knee 11(6):451–456PubMedCrossRef
Metadaten
Titel
Gradual correction of idiopathic genu varum deformity using the Ilizarov technique
verfasst von
Young Eun Park
Sang Heon Song
Hyeok Nam Kwon
Mohamed Ahmed Refai
Kwang Won Park
Hae Ryong Song
Publikationsdatum
01.07.2013
Verlag
Springer-Verlag
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 7/2013
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-2074-7

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