briard jl. how to correct extra articular deformity. slide 27 40
TRANSCRIPT
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lateral release: but bad structures for release which may be weak or loose and lead to lateral instability in flexion
resect more medial plateau DANGER of subsequent medial instability!
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in flexion:• femoral rotation unchanged• patella : OK• but lateral structures are elongated and
weak and there is a danger of overstretching and of rotating the femoral implant to obtain stability.
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So, with such a knee:So, with such a knee: in flexion: use the transepicondylar line as in flexion: use the transepicondylar line as
a guide to be parallel with the AP cutsa guide to be parallel with the AP cuts use a constrained design for small use a constrained design for small
deformitydeformity
Or, you may:Or, you may: Want to keep the lateral structures strongWant to keep the lateral structures strong use lateral condyle osteotomy use lateral condyle osteotomy ????????
(not an excellent indication)(not an excellent indication)
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But, if the deformity is more But, if the deformity is more important > 8-10°important > 8-10°
Concomitant tibial Concomitant tibial metaphysealmetaphyseal osteotomyosteotomy- Medial closing wedgeMedial closing wedge- Lateral opening wedgeLateral opening wedge
Opening wedgeOpening wedge
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192°192°
Tibia valgumTibia valgum
Watch out !
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180°180°
and then …Closing wedgeand then …Closing wedgeIA surgery
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4th MESSAGE4th MESSAGE
Femoral deformitiesFemoral deformities are more are more difficult than tibial deformities difficult than tibial deformities
Because their correction influences both Because their correction influences both extension & flexion gapextension & flexion gap
Femur varum ++++Femur varum ++++
Valgum deformitiesValgum deformities are difficult are difficult due to release technique and risk of due to release technique and risk of instabilityinstability
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60 y old60 y old
Femur varumFemur varum
+ malunion in IR+ malunion in IR
163°163°
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IA surgeryIA surgery
+ femoral + femoral osteotomyosteotomy
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Gosse 162Gosse 162182182
scan: +15 –15°scan: +15 –15°
162°162°
MalunionMalunion
Supracondylar FxSupracondylar Fx
67 Y67 Y
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Retroversion: 14°Retroversion: 14° Anteversion: 15°Anteversion: 15°
29° Internal Rotation
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182°182°
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If you want to achieve correct surgery:If you want to achieve correct surgery: