High tibial osteotomy with a dynamic axial fixator

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High tibial osteotomy with a dynamic axial fixator

PRECISION IN ACHIEVING ALIGNMENT

V. Bachhal, MBBS, MSOrtho, DNBOrtho, Registrar in Orthopaedics1; S. S. Sankhala, MBBS, MSOrtho, Professor of Orthopaedics2; N. Jindal, MBBS, Orthopaedic Resident2; and M. S. Dhillon, MBBS, MSOrtho, MNAMS, Professor Head of Orthopaedics1

1 Postgraduate Institute of Medical Education & Research, Sector-12, Chandigarh 160012, India.
2 Sawai Man Singh Medical College & Hospital, Sawai Ramsingh Road, Jaipur 302004, Rajasthan, India.

Journal of Bone and Joint Surgery – British Volume, Vol 93-B, Issue 7, 897-903.  doi: 10.1302/0301-620X.93B7.26124

  • The authors reported outcome on 32 patients(37knees) who underwent hemicallostasis with a dynamic external fixator for osteoarthritis of the medial compartment of the knee.
  • mean age at operationof 54.6 years.
  • The aim was to achieve a valgus overcorrectionof 2° to 8° or mechanical axis at 62.5% (± 12.5%).
  • At a mean follow-up of 62.8 months the authors found that there was no changein the mean range of movement, and no statistically significantdifference in the Insall-Salvati index or tibial slope (p =0.11 and p = 0.15, respectively).
  • The mean hip-knee-ankle angle changed from 190.6 (183° to 197°) to 176.0° (171°to 181°), with a mean final position of the mechanical axisof 58.5% (35.1% to 71.2%).
  • The desired alignment was attained in 31 of 37 (84%) knees.
  • The authors reported excellent results in 21 patients, 13 good results, two fair and one poor result according to the Oxford knee score with no correlation betweenage and final score.
  • This score was at its best at one year with a statistically significant deterioration at two years(p = 0.001) followed by a small but not statistically significant deterioration until the final follow-up (p = 0.17).
  • In Ahlback grade 1 osteoarthritis patients the results were excellent or good
  • Complications included pin tract infections involving16.4% of all pins used, delayed union in two, knee stiffness in four, fracture of the lateral cortex in one and ring sequestrum in one.
  • The authors reported that hemicallostasis provides precision in attaining the desired alignment without interfering with tibial slope or patellar height, and is relatively free of serious complications.

 

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