Osteotomy to correct post-traumatic deformity

falling down stairs

This very interesting patient - aged 27 - who recently had an osteotomy for post traumatic pain and deformity. The case was complex and there were a number of issues to resolve in this knee.

Muriel's story

Muriel came to see me with a complex problem relating to her left knee. Sadly she fell down the stairs in Romania approximately 6 months before seeing me, and sustained an intra-articular proximal tibial fracture - in other words a break in the bone that went into the joint itself. The was treated in Romania with open reduction and internal fixation (ORIF) and she had a ligament reconstruction to reconstruct one of the ligaments on the outside of her knee.

Since the time of the surgery, she had always noticed that the knee was a little knock-knee'd (or valgus), and this was getting progressively worse, which was alarming to her. She also felt unstable, and the instability was also getting progressively worse. She also had severe pain on the inner side of her knee and, coupled with the instability and progressive deformity of her knee, wanted a solution. Because of my interest in complex post traumatic knee reconstruction she came to see me in the UK.

On examination

On examination she had really quite significant valgus or bow-legged deformity on the left side but was fairly straight on the right. She had a good range of motion and some minor patellofemoral issues, but I felt these were a 'red herring'.

Imaging

pre-op long leg x-ray
previous tpf

The patient's left knee is in valgus alignment (knock-kneed)

Her X-rays show a significant valgus deformity on the left on the long-leg view. We did digital planning with our planning software and worked out a solution in the form of a medial closing wedge high tibial osteotomy.

Surgery

Post op tibial osteotomy
post op high tibial osteotomy

The patient's left knee after high tibial osteotomy

I used my minimally-invasive technique and made a small incision on the inner aspect of the knee, and then made two cuts from the inner side over towards the lateral side and removed a small wedge of bone - in other words did a 'closing wedge' osteotomy and fixed it with this plate which I helped to design.

adrian wilson

Adrian Wilson


POST-OP RESULTS:

June 2017
I am delighted to say eight months down the line Muriel is completely asymptomatic in terms of instability, no longer has the significant medial aching (pain on the inside of the knee) and now has a straight leg. She is absolutely delighted with the outcome, as am I, and given that she is united the plan is to remove this plate at some point in September. 

Revision osteotomy follow-up
Revision osteotomy

I do like to remove the plates as even in people who feel they are doing extremely well often will say afterwards that their symptoms have significantly improved because the plates do cause some local irritation. In fact the plan is to remove the plates in September 2017, and Muriel is going to fly back to the UK to have this procedure done.


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