Surgical problems relative to specific disorders – previous HTO

Surgical problems
Surgical problems

 


Surgical problems relative to specific disorders – previous HTO

Time buying procedure for unicompartmental OA


Valgus closing wedge osteotomy

Bone defect in lateral side of tibia

Rotational deformity

Lateral compartment scarring



Multiple studies have shown less successful outcomes after HTO in TKA

Patella infera, difficulties in exposure, poor lateral skin flap vascularity

Risk factors for failure : male gender, obesity, young age, varus-valgus laxity, pre-existing limb malalignment



Surgical problems relative to specific disorders – previous HTO

Opening-wedge proximal tibial osteotomy

More popular over the past decade

Less anatomic change than closing wedge technique


36 patients(HTO to TKR) vs 1300 primary TKR

Technically straightforward in most cases

Clinical results were inferior, lower knee scores and more pain

Erak S, Naudie D, MacDonald SJ, et al: Total knee arthroplasty following medial opening wedge tibial osteotomy: technical issues early clinical results, Knee 18:499, 2011.


49 UKA to TKA / 43 HTO to TKA / 43 rev TKA / 97 primary TKA

Total op time : significantly higher in HTO to TKA & rev TKA

Length of stay : shorter in primary TKA

Functional outcomes : HTO = UKA = Primary TKA

Complication rate : HTO = rev TKA > UKA = Primary TKA

Michael B. Cross, MD et al: Revising an HTO or UKA to TKA: Is it More Like a Primary TKA or a Revision TKA?, 

The Journal of Arthroplasty 29:229-231, 2014


Popular posts from this blog

Mirels’ Classification for pathologic fractures

Image
 Mirels’Classification Mirels H: Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 249:256–264, 1989. Mirels’Classification : Nature of lesion Mirels’Classification : Nature of lesion Orthopedic Radiology: A Practical Approach, Greenspan, Adam; Lippincott, 2000 Diagnosis of Bone and Joint Disorders, Resnick, Donald, W. B. Saunders Mirels’Classification : Nature of lesion Score of 8 or higher  consider prophylactic internal fixation Guideline aids in decision making, but does not serve as an absolute criterion Each patient should be evaluated individually, keeping two generally accepted principles in mind.  First, prophylactic internal fixation of an impending fracture is technically easier than fixation of an actual pathologic fracture. Second, patient morbidity is decreased with prophylactic fixation compared with fixation after the fracture. Prophylactic intramedullary fixation (↓pain and prevent subsequen...
Read more

Tibial spine fracture

Image
  Tibial spine fracture HyperExtension and femur external rotation during a fall Intercondyle eminence : Medial spine (ACL attachment) + Lateral spine ACL fiber -> tibial spine, inter-meniscal lig, MM attachment Classification Modified Meyers and McKeever classification Non-Operative management Type I, II (after C/R) Long leg cast, Slightly flexion (avoid ACL positional tension) Hemarthrosis evacuation Closed reduction (Physician’s preference for Type II) Surgical treatment Type II & III & IV Reduction method : Arthroscopic vs Open Fixation method : Suture vs Screw
Read more

Adrena incidentaloma: Diagnosis & Treatments

Epidemiology Adrenal incidentaloma is an adrenal mass lesion with a diameter of more than 1 cm incidentally detected by imaging. Adrenal incidentaloma is found in at least 2% of the population, and the prevalence increases with age. Adrenal incidentaolma is found in 1% of 40s and 7% of 70s. Most adrenal incidentalomas are endocrine-inactive adrenocortical adenomas that do not release hormones. The prevalence of endocrine-inactive adrenocortical adenoma is 60 to 85% of endocrine-active adrenocortical adenoma, endocrine-active adrenocortical adenoma is 5 to 10% of cortisol producing adenoma, aldosterone-producing adenoma is 2 to 5%, and pheochromocytoma is 5 to 10 %. 2 to 5% of the unilateral adrenal mass is a malignant adrenocortical carcinoma and 15% is metastatic cancer at other sites. Diagnosis Diagnostic evaluation should be performed in patients with adrenal masses greater than 1 cm. Two important factors must be considered. First, does the tumor secrete hormones that can harm...
Read more