Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007 Oct;21(10):1062-6.
[Article in Chinese]
Yu C, Wang Z, Shang Y.
Department of Knee Joint, Luoyang Hospital of Orthopedics and Traumatics, Luoyang Henan 471002, PR China. ycc44568@sohu.com
OBJECTIVE: To explore the technique of the soft tissue balancing in the total knee arthroplasty (TKA) for the patients with the knees of varus deformity and flexion contracture. METHODS: From January 2001 to December 2005, 86 patients (19 males, 67 females; age, 57-78 years; average, 66 years) with the knees of varus deformity and flexion contracture underwent primary TKA and the balancing of the soft tissues. All the patients had suffered from osteoarthritis. The unibilateral affection was found in 68 patients and the bilateral affection in 18. The varus deformity angle was averaged 12.3 degrees (range, 6-34 degrees). The soft tissue varus accounted for 56.7% and the bony varus accounted for 43.3%. The flexion contracture < 10 degrees was found in 21 knees, 10-19 degrees in 45 knees, 20-29 degrees in 22 knees, and > 30 degrees in 16 knees, with an average angle of 18.9 degrees. RESULTS: The flexion contractures were improved. Before operation the average angle of the flexion contracture was 18.9 degrees but after operation only 4 patients had a residual flexion contracture of 5 degrees and the remaining patients had a complete correction. The follow-up for 37 months (range, 6-72 months) in all the patients revealed that only 6 patients had a residual flexion contracture of 5-10 degrees and the others had a full extension. Before operation the average varus angle was 12.3 degrees (range, 6-34 degrees) and the average tibiofemoral angle was 174.7 degrees (range, 170.3-175.6 degrees), but after operation the residual varus angle > 3 degrees was only found in 2 patients. The complications occurring during operation and after operation were found in 6 patients, injuries to the attachment of the medial collateral ligaments in 2, patellar clunk syndromes in 2, cerebral embolism in 1, and lacunar infarction in 1, with no nerve disorders left after the medical treatment. No skin necrosis, the cut edge infection or deep infection occurred. CONCLUSION: The balancing of the soft tissues is a major management for correction of the varus deformity and the flexion contracture. The proper balancing of the soft tissues can achieve an obvious recovery of the function and correction of the varus deformity after TKA.
PMID: 17990770 [PubMed - indexed for MEDLINE]
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Mostrando entradas con la etiqueta rodilla en flexión. Mostrar todas las entradas
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RODILLA EN FLEXION
1: J Pediatr Orthop. 2008 Sep;28(6):626-31. Links
Guided growth for fixed knee flexion deformity.
Klatt J, Stevens PM.Department of Orthopaedics, University of Utah, Salt Lake City, UT 84158, USA.
BACKGROUND: Fixed knee flexion deformity (FKFD) is an insidious problem that may complicate the management of patients with neuromuscular compromise due to cerebral palsy, spina bifida, arthrogryposis, and other conditions. The energy costs associated with crouch gait may become prohibitive and, with the inexorable progression of fixed knee flexion, secondary pain may ensue as a result of fragmentation of the patella and/or tibial tubercle. Concomitant or compensatory flexion deformity of the hips and lumbar lordosis may develop, along with "pseudo equinus" of the ankles. Recommended treatments for FKFD have included bracing; physical therapy; and, in recalcitrant cases, distal femoral osteotomy, posterior release, or frame distraction. However, these latter modalities are fraught with potential complications including neurovascular damage, loss of fixation, undercorrection malunion, fracture, and recurrent deformity. Considering that FKFD is often bilateral, the complication risks for a given patient are doubled. In a previous study, the senior author reported successful hemiepiphysiodesis of the distal anterior femur using staples. However, further experience has demonstrated some of the limitations of stapling including relatively slow correction and occasional hardware migration. This led to the development of a more versatile and reliable solution using a pair of anterior tension band plates. METHODS: In this retrospective clinical study, we are reporting this new technique of promoting gradual correction through guided growth of the distal femur, using a pair of anterior 8-plates. The correction is accomplished simultaneously and bilaterally, without immobilization, and may be combined with other operative procedures as indicated. We reviewed the charts, radiographs in a group of patients treated accordingly. RESULTS: In this group of 18 patients with 29 deformities, we noted correction averaging 1.3 degrees (range, 0.0 [1 patient]-4.8 degrees), with minimal complications. No inadvertent coronal plane deformities were created. Upon full correction, the plates were removed so as to avoid recurvatum.
CONCLUSION: As an alternative to posterior capsulotomy or supracondylar extension osteotomy, we have found that guided growth is an effective and safe method of gradually correcting FKFD in growing children and adolescents. LEVEL OF EVIDENCE: 4 (retrospective clinical series).
Related articles
-Guided growth for pathological physes: radiographic improvement during realignment. J Pediatr Orthop. 2008 Sep; 28(6):632-9.
-Anterior femoral stapling. J Pediatr Orthop. 2001 Nov-Dec; 21(6):804-7.[J Pediatr Orthop. 2001]
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-ReviewOsteotomies: the surgical treatment of the valgus knee. Sports Med Arthrosc. 2007 Mar; 15(1):15-22.
-ReviewAssessment and management of the lower extremity in myelodysplasia. Orthop Clin North Am. 1987 Oct; 18(4):709-24.
Guided growth for fixed knee flexion deformity.
Klatt J, Stevens PM.Department of Orthopaedics, University of Utah, Salt Lake City, UT 84158, USA.
BACKGROUND: Fixed knee flexion deformity (FKFD) is an insidious problem that may complicate the management of patients with neuromuscular compromise due to cerebral palsy, spina bifida, arthrogryposis, and other conditions. The energy costs associated with crouch gait may become prohibitive and, with the inexorable progression of fixed knee flexion, secondary pain may ensue as a result of fragmentation of the patella and/or tibial tubercle. Concomitant or compensatory flexion deformity of the hips and lumbar lordosis may develop, along with "pseudo equinus" of the ankles. Recommended treatments for FKFD have included bracing; physical therapy; and, in recalcitrant cases, distal femoral osteotomy, posterior release, or frame distraction. However, these latter modalities are fraught with potential complications including neurovascular damage, loss of fixation, undercorrection malunion, fracture, and recurrent deformity. Considering that FKFD is often bilateral, the complication risks for a given patient are doubled. In a previous study, the senior author reported successful hemiepiphysiodesis of the distal anterior femur using staples. However, further experience has demonstrated some of the limitations of stapling including relatively slow correction and occasional hardware migration. This led to the development of a more versatile and reliable solution using a pair of anterior tension band plates. METHODS: In this retrospective clinical study, we are reporting this new technique of promoting gradual correction through guided growth of the distal femur, using a pair of anterior 8-plates. The correction is accomplished simultaneously and bilaterally, without immobilization, and may be combined with other operative procedures as indicated. We reviewed the charts, radiographs in a group of patients treated accordingly. RESULTS: In this group of 18 patients with 29 deformities, we noted correction averaging 1.3 degrees (range, 0.0 [1 patient]-4.8 degrees), with minimal complications. No inadvertent coronal plane deformities were created. Upon full correction, the plates were removed so as to avoid recurvatum.
CONCLUSION: As an alternative to posterior capsulotomy or supracondylar extension osteotomy, we have found that guided growth is an effective and safe method of gradually correcting FKFD in growing children and adolescents. LEVEL OF EVIDENCE: 4 (retrospective clinical series).
Related articles
-Guided growth for pathological physes: radiographic improvement during realignment. J Pediatr Orthop. 2008 Sep; 28(6):632-9.
-Anterior femoral stapling. J Pediatr Orthop. 2001 Nov-Dec; 21(6):804-7.[J Pediatr Orthop. 2001]
-Supracondylar femoral extension osteotomy for knee flexion contracture correction in poliomyelitic conditions Rev Chir Orthop Reparatrice Appar Mot. 2001 Jun; 87(4):361-6.
-ReviewOsteotomies: the surgical treatment of the valgus knee. Sports Med Arthrosc. 2007 Mar; 15(1):15-22.
-ReviewAssessment and management of the lower extremity in myelodysplasia. Orthop Clin North Am. 1987 Oct; 18(4):709-24.
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