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High tibial osteotomy with a dynamic axial fixator: precision in achieving alignment
V Bachhal1, S S Sankhala, N Jindal
1Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh 160012, India. vikasbachhal@gmail.com
The Journal of Bone and Joint Surgery. British Volume
|June 28, 2011
Summary
Hemicallostasis with a dynamic external fixator precisely realigns the knee for osteoarthritis, achieving desired valgus alignment in 84% of patients. While Oxford knee scores initially improved, they later declined, with some complications noted.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Osteoarthritis Research
Background:
- Osteoarthritis of the knee, particularly the medial compartment, significantly impacts patient mobility and quality of life.
- Accurate limb alignment is crucial for managing knee osteoarthritis and improving surgical outcomes.
- Hemicallostasis offers a method for precise bone alignment during corrective procedures.
Purpose of the Study:
- To evaluate the effectiveness of hemicallostasis using a dynamic external fixator for medial compartment knee osteoarthritis.
- To assess the precision of achieving a target valgus overcorrection or specific mechanical axis.
- To analyze patient outcomes, range of motion, and complication rates following the procedure.
Main Methods:
- Retrospective analysis of 32 patients (37 knees) undergoing hemicallostasis for medial knee osteoarthritis.
- Dynamic external fixator utilized to achieve a target valgus overcorrection (2°-8°) or mechanical axis at 62.5%.
- Follow-up included assessment of range of motion, Insall-Salvati index, tibial slope, hip-knee-ankle angle, and Oxford knee score.
Main Results:
- The desired alignment was achieved in 84% (31/37) of knees, with a mean final mechanical axis at 58.5%.
- No significant changes in mean range of motion, Insall-Salvati index, or tibial slope were observed.
- Oxford knee scores showed initial improvement by one year, followed by a statistically significant deterioration at two years.
Conclusions:
- Hemicallostasis with a dynamic external fixator enables precise attainment of desired knee alignment in medial compartment osteoarthritis.
- The technique does not adversely affect tibial slope or patellar height.
- While generally safe, potential complications include pin tract infections and joint stiffness; outcomes may deteriorate after the first year.
