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Early clinical results were evaluated for 22 adult patients who had undergone an open wedge tibial osteotomy by hemicallotasis (HCO) due to medial compartment osteoarthritis. The mean age at the time of the index operation was 56 (range 33-66) years. The mean duration of follow up was 16 (range 9-23) months. The median hip-knee-ankle angle (HKA) was 169 (range 162-186) deg preoperatively and 182 (range 175-191) deg at follow up. We did not observe any early collapse of the new bone wedge. The median time to fixation was 79 (range 63-125) days. Complications included two pintract infections, and two hematomas were revised. Two patients felt pain during the phase of distraction, but the procedure could be continued after a short break. We evaluated the clinical results on the HSS, Lysholm, and Tegner activity scores. At the latest follow up examination, all of the scores had improved. Our findings demonstrate that HCO requires an exact correction, is a simple technique, and appears to reduce the chance of nerve and vascular damage.
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PMID:Open wedge tibial osteotomy by hemicallotasis for medial compartment osteoarthritis. 1140 51

High tibial osteotomy is an accepted method for treatment of medial osteoarthritis. An alternative technique is an open-wedge osteotomy and consecutive callotasis (CO) using an external fixator. The purpose of this study was to evaluate the clinical and radiological results and the efficiency of this technique for precise correction. This prospective study included 41 patients (44 knees) evaluated by the HSS score, radiological stage of osteoarthritis, bone healing, and complications after a follow-up period of 49 (36-61) months. The HSS score increased from median 67 preoperatively to 82 points at the time of follow-up (p<0.001). Of 44 knees, excellent/good results were found in 70.5% and fair/poor in 29.5%. The median preoperative femorotibial anatomical angle was 3.6 degrees varus and 9.4 degrees valgus at the latest follow-up examination. The total time in external fixation was median 80 (61-125) days. We observed one early collapse of the new bone wedge, one complete corticotomy, and pin tract infections in ten cases. Furthermore, two hematomas required revision surgery. Hemicallotasis with external fixators allows constant manipulation of alignment during the healing process to optimize alignment. The disadvantage of the external fixation is the risk of pin track infection. Therefore, CO may constitute an important contribution to our algorithm in the treatment of varus gonarthrosis.
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PMID:[An open wedge tibial head osteotomy using continuous callus distraction. An alternative method for the treatment of of varus arthrosis]. 1545 7

Osteonecrosis of the femoral head is a condition that affects upwards of 10,000 individuals in the USA each year. The peak incidence is in the fourth decade of life, and overall, there is a male preponderance. The condition accounts for up to 12% of total hip arthroplasties performed in developed countries. The etiology can be traumatic or non-traumatic, with 90% of atraumatic cases attributed to corticosteroid therapy or excess alcohol consumption. Osteonecrosis of the femoral head reflects the final common pathway of a range of insults to the blood supply and ultimately results in femoral head collapse, acetabular involvement, and secondary osteoarthritis. Currently, conservative treatment options, which aim to correct pathophysiologic features allowing revascularization and new bone formation, appear to be able to delay but not halt the progression of this condition. As a consequence of femoral head osteonecrosis, many individuals undergo surgical treatments including: core decompression, osteotomy, non-vascularized bone matrix grafting, free vascularized fibular grafts, limited femoral resurfacing, total hip resurfacing, and total hip arthroplasty.
HSS J 2009 Sep
PMID:SAS weekly rounds: avascular necrosis. 1929 40