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VOLUME 7 , ISSUE 2 ( August, 2012 ) > List of Articles

Original Article

The treatment of high tibial osteotomy non-union with the Ilizarov external fixator

John J. Gillooly, Konstantinos Tilkeridis, Robert B. Simonis, Fergal Monsell

Keywords : Non-union, High tibial osteotomy, Ilizarov, External fixator, Circular frame

Citation Information : Gillooly JJ, Tilkeridis K, Simonis RB, Monsell F. The treatment of high tibial osteotomy non-union with the Ilizarov external fixator. 2012; 7 (2):93-97.

DOI: 10.1007/s11751-012-0138-3

License: CC BY-NC-SA 4.0

Published Online: 01-12-2012

Copyright Statement:  Copyright © 2012; The Author(s).


Abstract

To evaluate the results of the Ilizarov external fixator in the treatment of non-union post–high tibial osteotomy (HTO). Five non-unions, in four patients, following HTO were treated by Ilizarov fixation. Clinical outcome was assessed pre- and post-operatively by the Knee Society Clinical Rating System (KSCRS). Radiological analysis assessed bone healing pre- and post-operatively and measured proximal tibial alignment. All cases healed with a mean time of 25 ± 3 weeks (Mean ± SD) (range, 24–30 weeks) in the fixator. The clinical and radiological outcome improved in all cases. Four knees were initially in excessive varus and underwent correction of alignment, as measured by medial proximal tibial angle (MPTA), from 75.5° ± 8.4° (mean ± SD) to 90.2° ± 2.7° (normal range, 85°–90°). One patient was in excessive valgus and had a correction of MPTA from 100° to 87°. The KSCRS knee score improved from 35.6 ± 10.8 to 86.6 ± 13.9 (mean ± SD) (normal score = 100) and the functional score from 37.8 ± 11.8 to 85.4 ± 10.5 (mean ± SD) (normal score = 100). The Ilizarov technique is a minimally invasive method that produces excellent clinical, radiological and functional outcomes.


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  1. Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67(7):1136-1140
  2. Dowd GS, Somayaji HS, Uthukuri M (2006) High tibial osteotomy for medial compartment osteoarthritis. Knee 13(2):87-92
  3. Vainionpaa S, Laike E, Kirves P, Tiusanen P (1981) Tibial osteotomy for osteoarthritis of the knee. A five to ten-year followup study. J Bone Joint Surg Am 63(6):938-946
  4. Devgan A, Marya KM, Kundu ZS, Sangwan SS, Siwach RC (2003) Medial opening wedge high tibial osteotomy for osteoarthritis of knee: long-term results in 50 knees. Med J Malaysia 58(1):62-68
  5. Sen C, Kocaoglu M, Eralp L (2003) The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow-up). Knee Surg Sports Traumatol Arthrosc 11(3):139-144
  6. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13-14
  7. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25(3):425-465
  8. Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101-104
  9. Paley D, Chaudray M, Pirone AM, Lentz P, Kautz D (1990) Treatment of malunions and mal-nonunions of the femur and tibia by detailed preoperative planning and the Ilizarov techniques. Orthop Clin North Am 21(4):667-691
  10. Bauer GC, Insall J, Koshino T (1969) Tibial osteotomy in gonarthrosis (osteo-arthritis of the knee). J Bone Joint Surg Am 51(8):1545-1563
  11. Coventry MB (1979) Upper tibial osteotomy for gonarthrosis. The evolution of the operation in the last 18 years and long term results. Orthop Clin North Am 10(1):191-210
  12. Hsu RW (1989) The study of Maquet dome high tibial osteotomy. Arthroscopic-assisted analysis. Clin Orthop Relat Res 243:280- 285
  13. Tjornstrand B, Hagstedt B, Persson BM (1978) Results of surgical treatment for non-union after high tibial osteotomy in osteoarthritis of the knee. J Bone Joint Surg Am 60(7):973-977
  14. Cameron HU, Welsh RP, Jung YB, Noftall F (1993) Repair of nonunion of tibial osteotomy. Clin Orthop Relat Res 287:167-169
  15. Wolff AM, Krackow KA (1990) The treatment of nonunion of proximal tibial osteotomy with internal fixation. Clin Orthop Relat Res 250:207-215
  16. Schatzker J, Burgess RC, Glynn MK (1985) The management of nonunions following high tibial osteotomies. Clin Orthop Relat Res 193:230-233
  17. Rozbruch SR, Herzenberg JE, Tetsworth K, Tuten HR, Paley D (2002) Distraction osteogenesis for nonunion after high tibial osteotomy. Clin Orthop Relat Res 394:227-235
  18. Parvizi J, Hanssen AD, Spangehl MJ (2004) Total knee arthroplasty following proximal tibial osteotomy: risk factors for failure. J Bone Joint Surg Am 86-A(3):474-479
  19. Stevens MA, DeCoster TA, Garcia F, Sell JJ (1995) Septic knee from Ilizarov transfixation tibial pin. Iowa Orthop J 15:217-220
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