Opening wedge proximal tibial osteotomy using the plate with wedge
Küçük Resim Yok
Tarih
2006
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Because of the increased life expectancy and the higher activity levels, corrective osteotomies have become more popular in the elderly population to avoid the total knee arthroplasty or to delay its application age. Proximal tibial osteotomy (PTO) is a widely accepted and an extensively used surgical procedure for the treatment in medial compartment osteoarthritis of the knee with malalignment, particularly in young and active patients.In the past, many PTO applications were performed just by radiological evaluations of the patients, even of the patients with severe osteoarthritis and deformity. In these patients, internal fixation was not usually performed. However, even if it was performed, not enough stabilization was provided, and the plaster cast immobilizaton was being applied for a long time postoperatively. It is usual to have poor results in some of these patients that should be normally kept out of indication. In the contemporary PTO techniques, the lateral compartment is preoperatively evaluated with arthroscopy. But for patients who do not for osteotomy, the procedure cannot be applied to them. For the patients who fit for osteotomy, if necessary, the treatment can be initially performed for the intraarticular knee pathologies. Internal or external fixation systems make the cast application unnecessary and let the rehabilitation facilities begin in the early period because of their sufficient stabilization. These results remind us of the applicability of alternatives other than prosthesis, which enables activity without forming artificial joint in patient groups with unicompartmental involvement whose profession requires high activity or who are willing to take sport actively. Recall that in the past, patients with severe osteoarthritis who previously had had osteotomy should be initially kept out of the indication. We think that patients with PTO indication should be separated from the patients of tricompartmental osteoarthritis who will have total knee prosthesis. Moreover, the unicompartmental knee arthroplasty can be an alternative for osteotomy, and the total knee arthroplasty applications should not be chosen as an alternative to PTO but as an advanced treatment step (stage). We also think that arthroplasty applications are not innocent at all because of the possible complications and consequences. Performing the osteotomy carefully by using fixation systems with sufficient stabilization in suitably selected patients, we can obtain satisfactory, intermediate, and long-term results of postoperative fast rehabilitation program.Medial opening wedge osteotomy, as one of the PTO techniques, can be applied as (a) an acute fixation with a plate in which the distraction is acutely applied to treat the present deformity or (b) as a distraction osteogenesis (callus distraction or hemicallotasis) in which the distraction is gradually applied, and the fixation is done by an external fixator. Osteotomy can be performed monoplanar, obliquely or transversely, on mediolateral plane on a flat line or biplanar and by leaving the tibial tubercle in the distal (V-shaped biplanar osteotomy) or proximal (retrotubercular osteotomy) fragment. Plates with various designs are used for the fixation, whereas in the distraction osteogenesis, various types of external fixators are used.A wedge plate designed by the author in proximal tibia medial opening wedge osteotomy, fixating the osteotomy surfaces by supporting them with wedge-shaped protuberances on the plate, is a fixation system that has a sufficient stabilization and enables early rehabilitation in the postoperative period. © 2006 Lippincott Williams & Wilkins, Inc.
Açıklama
Anahtar Kelimeler
High tibial osteotomy, Knee joint/surgery, Knee osteoarthritis/surgery, Medial compartment osteoarthritis/surgery, Open wedge osteotomy, Osteotomy/methods/instrumentation, Proximal tibial osteotomy
Kaynak
Techniques in Knee Surgery
WoS Q Değeri
Scopus Q Değeri
N/A
Cilt
5
Sayı
4
