J Knee Surg 2012; 25(05): 375-384
DOI: 10.1055/s-0031-1299659
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Correction of Proximal Tibia Varus with External Fixation

Kashif Ashfaq
1   Limb Lengthening and Complex Reconstruction Service (LLCRS), Hospital for Special Surgery, New York, New York
,
Austin T. Fragomen
1   Limb Lengthening and Complex Reconstruction Service (LLCRS), Hospital for Special Surgery, New York, New York
,
Joseph T. Nguyen
2   Department of Biostatistics, Hospital for Special Surgery, New York, New York
,
S. Robert Rozbruch
1   Limb Lengthening and Complex Reconstruction Service (LLCRS), Hospital for Special Surgery, New York, New York
› Author Affiliations
Further Information

Publication History

27 April 2011

05 October 2011

Publication Date:
07 May 2012 (online)

Abstract

Correction of proximal tibia varus deformity has been used with success. Our Protocol is to use monolateral frame to correct varus of less than 10 degrees and to use the Taylor spatial frame for deformities greater than 10 degrees and for multiplanar deformities. Is this protocol successful? Ninety-one limbs in 68 patients with proximal tibia varus were treated with percutaneous proximal tibial osteotomy and external fixation. The monolateral and spatial frames were used for 36 and 55 limbs, respectively. Each group was further subdivided into neutral or intentionally overcorrected subgroups. Monolateral group time of correction and time in frame was 15 days (8 to 20) and 101 days (81 to 133), respectively. The preoperative mechanical axis deviation (MAD) was 22 mm medial (10 to 44). Postoperative MAD in the neutral subgroup was 5 mm lateral (2 to 10) and 3 mm medial (0 to 7). Postoperative MAD in the overcorrected subgroup was 10 mm lateral (4 to 20) and one patient was 5 mm medial. Medial proximal tibial angle (MPTA) improved from 85 degrees (79 to 89) to 90 degrees (85 to 96) in the neutral group and to 92 degrees (85 to 98) in the overcorrected group. Spatial frame group time of correction and time in frame was 34 days (7 to 99) and 130 days (95 to 177), respectively. The preoperative MAD was 40 mm medial (range 5 to 155). This improved to 5 mm medial (0 to 30) and 4 mm lateral (0 to 7) in the neutral group, and 17 mm medial (0 to 35) and 11 mm lateral (4 to 28) in the overcorrection group. MPTA improved from 80 degrees (40 to 87) to 88 degrees (83 to 96) in the neutral group and to 84 degrees (89 to 97) in the overcorrected group. In both groups, there was no significant change in the ankle or knee range of motion. There was one refracture in both groups. Our algorithm for treating proximal tibial varus deformities is safe and effective. For simple varus deformities, we recommend use of the monolateral frame. We reserve the use of the spatial frame for large or complex deformity correction.

 
  • References

  • 1 Coventry MB. Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 1985; 67 (7) 1136-1140
  • 2 Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001; 286 (2) 188-195
  • 3 Paley D. Principles of Deformity Correction. 1st ed. Berlin, Germany: Springer-Verlag; 2005
  • 4 Catagni MA, Guerreschi F, Ahmad TS, Cattaneo R. Treatment of genu varum in medial compartment osteoarthritis of the knee using the Ilizarov method. Orthop Clin North Am 1994; 25 (3) 509-514
  • 5 Grelsamer RP. Unicompartmental osteoarthrosis of the knee. J Bone Joint Surg Am 1995; 77 (2) 278-292
  • 6 Iorio R, Healy WL. Unicompartmental arthritis of the knee. J Bone Joint Surg Am 2003; 85-A (7) 1351-1364
  • 7 Cole BJ, Harner CD. Degenerative arthritis of the knee in active patients: evaluation and management. J Am Acad Orthop Surg 1999; 7 (6) 389-402
  • 8 Hochberg MC, Altman RD, Brandt KD , et al, American College of Rheumatology. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. Arthritis Rheum 1995; 38 (11) 1541-1546
  • 9 Jackson JP, Waugh W, Green JP. High tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 1969; 51 (1) 88-94
  • 10 Coventry MB. Upper tibial osteotomy. Clin Orthop Relat Res 1984; (182) 46-52
  • 11 Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 1993; 75 (2) 196-201
  • 12 Adili A, Bhandari M, Giffin R, Whately C, Kwok DC. Valgus high tibial osteotomy. Comparison between an Ilizarov and a Coventry wedge technique for the treatment of medial compartment osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2002; 10 (3) 169-176
  • 13 Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 1987; 69 (3) 332-354
  • 14 Koshino T, Tsuchiya K. The effect of high tibial osteotomy on osteoarthritis of the knee. Clinical and histological observations. Int Orthop 1979; 3 (1) 37-45
  • 15 Nagel A, Insall JN, Scuderi GR. Proximal tibial osteotomy. A subjective outcome study. J Bone Joint Surg Am 1996; 78 (9) 1353-1358
  • 16 Koshino T, Wada S, Ara Y, Saito T. Regeneration of degenerated articular cartilage after high tibial valgus osteotomy for medial compartmental osteoarthritis of the knee. Knee 2003; 10 (3) 229-236
  • 17 Al-Sayyad MJ. Taylor spatial frame in the treatment of pediatric and adolescent tibial shaft fractures. J Pediatr Orthop 2006; 26 (2) 164-170
  • 18 Rozbruch SR, Kleinman D, Fragomen AT, Ilizarov S. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res 2008; 466 (12) 2923-2932
  • 19 Rozbruch SR, Pugsley JS, Fragomen AT, Ilizarov S. Repair of tibial nonunions and bone defects with the Taylor Spatial Frame. J Orthop Trauma 2008; 22 (2) 88-95
  • 20 Tellisi N, Fragomen AT, Ilizarov S, Rozbruch SR. Lengthening and reconstruction of congenital leg deficiencies for enhanced prosthetic wear. Clin Orthop Relat Res 2008; 466 (2) 495-499
  • 21 Fragomen A, Ilizarov S, Blyakher A, Rozbruch SR. Proximal tibial osteotomy for medial compartment osteoarthritis of the knee using the Taylor spatial frame. Techn Knee Surg 2005; 4: 175-183
  • 22 Sen C, Kocaoglu M, Eralp L. The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow-up). Knee Surg Sports Traumatol Arthrosc 2003; 11 (3) 139-144
  • 23 Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 1979; 10 (3) 585-608
  • 24 Magyar G, Ahl TL, Vibe P, Toksvig-Larsen S, Lindstrand A. Open-wedge osteotomy by hemicallotasis or the closed-wedge technique for osteoarthritis of the knee. A randomised study of 50 operations. J Bone Joint Surg Br 1999; 81 (3) 444-448
  • 25 Geiger F, Schneider U, Lukoschek M, Ewerbeck V. External fixation in proximal tibial osteotomy: a comparison of three methods. Int Orthop 1999; 23 (3) 160-163
  • 26 Klinger HM, Lorenz F, Härer T. Open wedge tibial osteotomy by hemicallotasis for medial compartment osteoarthritis. Arch Orthop Trauma Surg 2001; 121 (5) 245-247
  • 27 Weale AE, Lee AS, MacEachern AG. High tibial osteotomy using a dynamic axial external fixator. Clin Orthop Relat Res 2001; (382) 154-167
  • 28 Agneskirchner JD, Hurschler C, Wrann CD, Lobenhoffer P. The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 2007; 23 (8) 852-861
  • 29 Niemeyer P, Koestler W, Kaehny C , et al. Two-year results of open-wedge high tibial osteotomy with fixation by medial plate fixator for medial compartment arthritis with varus malalignment of the knee. Arthroscopy 2008; 24 (7) 796-804
  • 30 Feldman DS, Madan SS, Ruchelsman DE, Sala DA, Lehman WB. Accuracy of correction of tibia vara: acute versus gradual correction. J Pediatr Orthop 2006; 26 (6) 794-798
  • 31 Madan S, Ranjith RK, Fiddian NJ. Intermediate follow-up of high tibial osteotomy: a comparison of two techniques. Bull Hosp Jt Dis 2002– 2003; 61 (1–2) 11-16
  • 32 Eidelman M, Bialik V, Katzman A. Correction of deformities in children using the Taylor spatial frame. J Pediatr Orthop B 2006; 15 (6) 387-395
  • 33 Feldman DS, Madan SS, Koval KJ, van Bosse HJ, Bazzi J, Lehman WB. Correction of tibia vara with six-axis deformity analysis and the Taylor spatial frame. J Pediatr Orthop 2003; 23 (3) 387-391
  • 34 Siapkara A, Nordin L, Hill RA. Spatial frame correction of anterior growth arrest of the proximal tibia: report of three cases. J Pediatr Orthop B 2008; 17 (2) 61-64
  • 35 Berman AT, Bosacco SJ, Kirshner S, Avolio Jr A. Factors influencing long-term results in high tibial osteotomy. Clin Orthop Relat Res 1991; (272) 192-198
  • 36 Insall JN, Joseph DM, Msika C. High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am 1984; 66 (7) 1040-1048
  • 37 Rudan JF, Simurda MA. High tibial osteotomy. A prospective clinical and roentgenographic review. Clin Orthop Relat Res 1990; (255) 251-256
  • 38 Ivarsson I, Myrnerts R, Gillquist J. High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br 1990; 72 (2) 238-244
  • 39 Yasuda K, Majima T, Tsuchida T, Kaneda K. A ten- to 15-year follow-up observation of high tibial osteotomy in medial compartment osteoarthrosis. Clin Orthop Relat Res 1992; (282) 186-195
  • 40 Dejour H, Neyret P, Boileau P, Donell ST. Anterior cruciate reconstruction combined with valgus tibial osteotomy. Clin Orthop Relat Res 1994; (299) 220-228