Combination of external fixation using digital six-axis fixator and internal fixation to treat severe complex knee deformity.
Knee
Osteotomy
Q spatial fixator (QSF)
Valgus
Varus
Journal
Journal of orthopaedic surgery and research
ISSN: 1749-799X
Titre abrégé: J Orthop Surg Res
Pays: England
ID NLM: 101265112
Informations de publication
Date de publication:
27 Jan 2023
27 Jan 2023
Historique:
received:
08
02
2022
accepted:
11
01
2023
entrez:
28
1
2023
pubmed:
29
1
2023
medline:
1
2
2023
Statut:
epublish
Résumé
Severe knee valgus/varus or complex multiplanar deformities are common in clinic. If not corrected in time, cartilage wear will be aggravated and initiate the osteoarthritis due to lower limb malalignment. Internal fixation is unable to correct severe complex deformities, especially when combined with lower limb discrepancy (LLD). Based on the self-designed digital six-axis external fixator Q spatial fixator (QSF), which can correct complex multiplanar deformities without changing structures, accuracy of correction can be improved significantly. This retrospective study included 24 patients who suffered from complex knee deformity with LLD treated by QSF and internal fixation at our institution from January 2018 to February 2021. All patients had a closing wedge distal femoral osteotomy with internal fixation for immediate correction and high tibia osteotomy with QSF fixation for postoperative progressive correction. Data of correction prescriptions were computed by software from postoperative CT scans. Mean discrepancy length of operative side was 2.39 ± 1.04 cm (range 0.9-4.4 cm) preoperatively. The mean difference of lower limb was 0.32 ± 0.13 cm (range 0.11-0.58 cm) postoperatively. The length of limb correction had significant difference (p < 0.05). The mean MAD and HKA decreased significantly (p < 0.05), and the mean MPTA and LDFA increased significantly (p < 0.05). There were significant increase (p < 0.05) in the AKSS-O, AKSS-F and Tegner Activity Score. The lower limb alignment was corrected (p < 0.05). The mean time of removing external fixator was 112.8 ± 17.9 days (range 83-147 days). Complex knee deformity with LLD can be treated by six-axis external fixator with internal fixation without total knee arthroplasty. Lower limb malalignment and discrepancy can be corrected precisely and effectively by this approach.
Sections du résumé
BACKGROUND
BACKGROUND
Severe knee valgus/varus or complex multiplanar deformities are common in clinic. If not corrected in time, cartilage wear will be aggravated and initiate the osteoarthritis due to lower limb malalignment. Internal fixation is unable to correct severe complex deformities, especially when combined with lower limb discrepancy (LLD). Based on the self-designed digital six-axis external fixator Q spatial fixator (QSF), which can correct complex multiplanar deformities without changing structures, accuracy of correction can be improved significantly.
METHODS
METHODS
This retrospective study included 24 patients who suffered from complex knee deformity with LLD treated by QSF and internal fixation at our institution from January 2018 to February 2021. All patients had a closing wedge distal femoral osteotomy with internal fixation for immediate correction and high tibia osteotomy with QSF fixation for postoperative progressive correction. Data of correction prescriptions were computed by software from postoperative CT scans.
RESULTS
RESULTS
Mean discrepancy length of operative side was 2.39 ± 1.04 cm (range 0.9-4.4 cm) preoperatively. The mean difference of lower limb was 0.32 ± 0.13 cm (range 0.11-0.58 cm) postoperatively. The length of limb correction had significant difference (p < 0.05). The mean MAD and HKA decreased significantly (p < 0.05), and the mean MPTA and LDFA increased significantly (p < 0.05). There were significant increase (p < 0.05) in the AKSS-O, AKSS-F and Tegner Activity Score. The lower limb alignment was corrected (p < 0.05). The mean time of removing external fixator was 112.8 ± 17.9 days (range 83-147 days).
CONCLUSIONS
CONCLUSIONS
Complex knee deformity with LLD can be treated by six-axis external fixator with internal fixation without total knee arthroplasty. Lower limb malalignment and discrepancy can be corrected precisely and effectively by this approach.
Identifiants
pubmed: 36707900
doi: 10.1186/s13018-023-03530-0
pii: 10.1186/s13018-023-03530-0
pmc: PMC9881260
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
65Subventions
Organisme : Shaanxi Provincial Science and Technology Department
ID : S2018-YF-YBSF-0265
Informations de copyright
© 2023. The Author(s).
Références
Clin Orthop Relat Res. 2012 Dec;470(12):3630-6
pubmed: 22639329
Acta Orthop Traumatol Turc. 2019 Mar;53(2):100-105
pubmed: 30554836
Chiropr Osteopat. 2005 Jul 20;13:11
pubmed: 16026625
Arch Phys Med Rehabil. 2018 May;99(5):981-993.e2
pubmed: 29229292
Clin Orthop Relat Res. 2011 Jul;469(7):2003-11
pubmed: 21210313
Ann R Coll Surg Engl. 2010 Mar;92(2):101-5
pubmed: 20353638
Gait Posture. 2002 Apr;15(2):195-206
pubmed: 11869914
J Orthop Trauma. 2004 Aug;18(7):403-9
pubmed: 15289684
J Child Orthop. 2021 Apr 19;15(2):130-136
pubmed: 34040659
Clin Orthop Relat Res. 2017 May;475(5):1472-1482
pubmed: 27896679
Knee Surg Sports Traumatol Arthrosc. 2022 Nov 11;:
pubmed: 36367544
J Bone Joint Surg Am. 2005 Sep;87 Suppl 1(Pt 2):271-84
pubmed: 16140800
Zhonghua Wai Ke Za Zhi. 2020 Nov 1;58(11):876-881
pubmed: 33120452
J Orthop Sports Phys Ther. 2003 May;33(5):221-34
pubmed: 12774997
Orthop Traumatol Surg Res. 2020 Nov;106(7):1361-1366
pubmed: 33046433
Gait Posture. 2017 Sep;57:115-123
pubmed: 28600975
Arthritis Rheum. 2013 Feb;65(2):355-62
pubmed: 23203672
Ann Rheum Dis. 2010 Nov;69(11):1940-5
pubmed: 20511608
Cureus. 2022 Jan 7;14(1):e21010
pubmed: 35154982
Int Orthop. 2016 Apr;40(4):835-41
pubmed: 26239534
Chiropr Osteopat. 2005 Jul 20;13:12
pubmed: 16080787
J Pediatr Orthop. 2019 Jul;39(Issue 6, Supplement 1 Suppl 1):S10-S13
pubmed: 31169640
Kans J Med. 2022 Oct 24;15:369-372
pubmed: 36320336
J Am Acad Orthop Surg. 2018 May 1;26(9):313-324
pubmed: 29629916
J Clin Orthop Trauma. 2020 Jul;11(Suppl 4):S621-S625
pubmed: 32774038
J Bone Joint Surg Am. 1987 Jan;69(1):32-8
pubmed: 3805069
J Orthop Trauma. 2016 Jul;30(7):e256-61
pubmed: 27206256
Bone Joint J. 2017 Feb;99-B(2):283-288
pubmed: 28148674
Clin Orthop Relat Res. 1989 Jan;(238):249-81
pubmed: 2910611
J Rheumatol. 2010 Oct;37(10):2133-40
pubmed: 20634243
Clin Sports Med. 2019 Jul;38(3):361-373
pubmed: 31079768