OBJECTIVE: To explore the corrective strategies and effectiveness of osteotomy surgery for severe lower limb deformities in hypophosphatemic rickets. METHODS: A retrospective analysis was conducted on 29 patients with severe lower limb deformities of hypophosphatemic rickets who underwent surgical treatment between February 2012 and August 2024. There were 9 males and 20 females. The age ranged from 13 to 53 years, with an average of 24.6 years. All patients were deformities of both lower limbs, presenting as 24 cases of O-shaped legs, 2 cases of wind-blown deformities, and 3 cases of X-shaped legs. Based on the full-length films of both lower limbs in the standing position before operation, the osteotomy planes of the femur, tibia, and fibula were designed. Among them, if both the same-sided thigh and leg were deformed, staged surgeries of both lower limbs were selected. If only the thigh or leg were deformed, simultaneous surgeries of both lower limbs were selected. The femur deformity was corrected immediately after osteotomy at the deformed plane; the osteotomy fragment was temporarily controlled with an external fixator, which was removed after perform internal fixation with a steel plate. After fibular osteotomy, the Ilizarov frame or Taylor frame was installed on the tibia and fibula. The threaded rods were removed and then tibial osteotomy was performed on the deformed plane. Patients using the Taylor frame did not undergo deformity correction during operation. The external fixators were adjusted starting 7 days after operation to correct the varus, valgus, and rotational deformities of the lower limb. Patients using the Ilizarov frame corrected the rotational deformity of the tibia during operation. The external fixator was adjusted starting 7 days after operation to correct the varus and valgus deformities of the lower limb. During the treatment period, the patient could walk with partial weight-bearing on the operated limb with crutches. The external fixator was removed after the bone healed. Before operation and at last follow-up, the medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), anatomic lateral distal femoral angle (aLDFA), posterior distal femoral angle (PDFA), and mechanical axis deviation (MAD), lower limb rotation, limb length discrepancy (LLD) were measured. The self-made scoring criteria were adopted to evaluate the degree of lower limb deformity of the patients. RESULTS: All operations were successfully completed, and no complications such as nerve or vascular injury occurred. The adjustment time of the external fixator of the lower limb after operation was 28-46 days, with an average of 37.4 days. The wearing time of the external fixator ranged from 134 to 398 days, with an average of 181.5 days. Mild pin tract infections occurred in 2 limbs. The osteofascial compartment syndrome occurred in 1 limb after operation. No complications related to orthopedic adjustment of the external fixator occurred in other patients. All patients were followed up 6-56 months, with an average of 28.2 months. At last follow-up, full-length films of both lower limbs in the standing position showed that the coronal mechanical axes of the lower limbs of all patients returned to the normal. At last follow-up, MPTA, LDTA, PPTA, aLDFA, PDFA, MAD, lower limb rotation, LLD, and the score of lower limb deformity significantly improved when compared with those before operation ( P<0.05). There was no significant difference in ADTA between pre- and post-operation ( P>0.05). The degree of lower limb deformity were rated as moderate in 2 cases and poor in 27 cases before operation and as excellent in 7 cases, good in 18 cases, and moderate in 4 cases at last follow-up, with an excellent and good rate of 86.2%. CONCLUSION For severe lower limb deformities in hypophosphatemic rickets, immediate correction of deformities with femoral osteotomy and internal plate fixation, as well as gradually correction of deformities with tibiofibular osteotomy and circular external fixation (Ilizarov frame or Taylor frame), have satisfactory therapeutic effects.
Humans ; Male ; Osteotomy/instrumentation* ; Female ; Adult ; Retrospective Studies ; Tibia/abnormalities* ; Adolescent ; Femur/abnormalities* ; Middle Aged ; Fibula/surgery* ; Rickets, Hypophosphatemic/complications* ; Young Adult ; Treatment Outcome ; External Fixators ; Bone Plates ; Lower Extremity Deformities, Congenital/etiology*

PURPOSE: This study compared the radiological and clinical results of minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) of distal tibial fractures, which were classified as the simple intra-articular group and extra-articular group. MATERIALS AND METHODS: Fifty patients with distal tibial fractures, who could be followed-up more than 12 months, were evaluated. Group A consisted of 19 patients treated with MIPO and group B consisted of 31 patients treated with IMN. The results of each group were analyzed by radiological and clinical assessments. RESULTS: The mean operation times in groups A and B were 72.4 minutes and 65.7 minutes, respectively. The mean bone union times in groups A and B were 16.4 weeks and 15.7 weeks, respectively. The bone union rate in groups A and B were 100% and 93%, respectively. The ranges of ankle motion were similar in the two groups at the last follow-up. The mean American Orthopaedic Foot and Ankle Society score was similar: 90.1 in group A and 90.5 in group B. The radiological and clinical results were similar in the intra and extra-articular groups. In groups A and B, two cases of posterior angulation and five cases of valgus deformity of more than 5° were encountered. CONCLUSION: Both MIPO and IMN achieved satisfactory results in extra-articular AO type A and simple articular extension type C1 and C2 distal tibia fractures.
Ankle ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Fracture Fixation, Intramedullary ; Humans ; Tibia ; Tibial Fractures

Ankle arthrodesis is a common and standard treatment for patients with end-stage ankle arthritis. The surgical goals of ankle arthrodesis are to obtain bony union between the tibia and talus with adequate alignment, and provide a pain-free plantigrade foot for weightbearing activities. To achieve successful fusion, the surgeon should closely examine the patient's factors before surgery, particularly the following: adjacent arthritis and deformity, infection, avascular necrosis of talus, Charcot arthropathy, and rheumatoid arthritis. Recently, ankle arthroplasty has been reported to provide satisfactory clinical results. On the other hand, long-term follow-up results are still lacking, and considering the various complications of arthroplasty, ankle arthrodesis is still the primary surgical treatment for advanced arthritis of the ankle joint.
Ankle Joint ; Ankle* ; Arthritis ; Arthritis, Rheumatoid ; Arthrodesis* ; Arthroplasty ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Hand ; Humans ; Necrosis ; Talus ; Tibia ; Weight-Bearing

Proximal tibial osteotomy is the preferred method for treating medial compartment knee arthritis with varus deformity. The purpose of this treatment is to reduce the weight burden of the lesion by correcting the mechanical axis of the patient with degenerative arthritis of medial tibiofemoral joint and abnormal alignment. In general, the proximal tibial osteotomy provides satisfactory clinical results when suitable patient are selected by considering the extent of cartilaginous injury and the age of the patient and the correct technique is performed. In tibial osteotomy, medial open wedge osteotomy is used widely because of its short operation time and relatively simple technique. This review describes the current knowledge of patient selection, preoperative evaluation and planning, treatment principles, surgical techniques, rehabilitation procedures and complications in open wedge high tibial osteotomy.
Arthritis ; Congenital Abnormalities ; Humans ; Joints ; Knee ; Knee Joint ; Methods ; Osteoarthritis ; Osteotomy* ; Patient Selection ; Rehabilitation ; Tibia*

PURPOSE: The purpose of this study was to evaluate changes in the coronal alignment of the knee and ankle joints after open wedge high tibial osteotomy (OWHTO) to determine factors related to the recurrence (R) of the varus deformity by serial analysis. MATERIALS AND METHODS: Sixty-four OWHTOs were enrolled in this study. The weight bearing line (WBL) ratio, joint line convergence angle (JLCA), knee joint inclination, mechanical axis-tibial plateau angle, talar inclination (TI), and distal tibia articular angle (DTAA) were serially assessed. Serial correlation analysis between all parameters was performed. Patients were divided into R group and no recurrence (NR) group according to the WBL ratio (55%) at postoperative one year. RESULTS: The preoperative WBL ratio showed significantly negative correlation with serial changes of JLCA, TI, and DTAA (p < 0.05). The JLCA, TI, and DTAA as well as WBL ratio showed a significantly larger degree of varus alignment in the R group than in NR group at postoperative 6 weeks and 1 year after OWHTO (p < 0.05). CONCLUSIONS: Sufficient correction of the WBL and restoration of the JLCA during OWHTO are essential to prevention of the R of varus deformity after the surgery because they are the only modifiable factors during surgery. LEVEL OF EVIDENCE: IV, Case series
Ankle Joint ; Ankle ; Congenital Abnormalities ; Humans ; Joints ; Knee Joint ; Knee ; Osteoarthritis ; Osteotomy ; Recurrence ; Tibia ; Weight-Bearing

The alignment of lower extremities is an important consideration in many clinical situations, including fracture reduction, high tibia osteotomy, total knee arthroplasty, and deformity correction. Mal-alignment of lower extremities is not only a simple cosmetic problem, but it can also produce pain, limp, and early degenerative arthritis. An assessment of lower extremity alignment, including its location and magnitude of deformity, can be achieved via mal-alignment test and mal-orientation test, using a lower extremity standing full-length radiography. Proper evaluation allows the surgeon to determine an effective treatment plan for deformity correction.
Arthroplasty, Replacement, Knee ; Congenital Abnormalities* ; Lower Extremity* ; Osteoarthritis ; Osteotomy ; Radiography ; Tibia

Melorheostosis is a very rare sclerosing bone disease with pain, joint stiffness, and limitation of motion. Its characteristic on radiography is a dense bone formation along the side of the bone, resembling the flow of candle grease. Various conservative or surgical methods have been practiced in treating pain and deformities. This is a report on the successful treatment result of six cases of melotheostosis, involving the metatarsal, metacarpal, clavicle, and tibia, which weretreated by conservative and operative treatment methods.
Arthralgia ; Bone Diseases ; Clavicle ; Congenital Abnormalities ; Melorheostosis* ; Metatarsal Bones ; Osteogenesis ; Radiography ; Tibia

OBJECTIVETo investigate results of total knee arthroplasty using the long-stem tibial component combined with metallic wedge of knee prosthesis for the treatment of proximal defects.

METHODSFrom January 2011 to May 2013, 10 patients (11 knees) were treated with total knee arthroplasties using the long-stem tibial component with metallic tibial wedge of knee prosthesis. All the patients were female and the average age was 67 years old (ranged, 60 to 77 years old). All the patients were osteoarthritis. All the patients were classified as T2A style. The patients were evaluated according to knee score system (KSS).

RESULTSAll the patients were followed up for 12 months on average (ranged 3 to 29 months). The clinical outcome was assessed using KSS score, including knee pain score, knee stability score, knee range of motion score and knee walking score, knee stairs score. There were significantly differences at 6 weeks, 3 months, 6 months and 12 months between pre-and postoperative KSS score.

CONCLUSIONThe mechanical stability of tibial fixation in primary TKA is significantly increased by using the long-stem tibial component with metallic wedge of knee prosthesis, even in the presence of poor proximal bone.

Aged ; Arthroplasty, Replacement, Knee ; Female ; Humans ; Knee Joint ; physiopathology ; surgery ; Knee Prosthesis ; Male ; Osteoarthritis, Knee ; physiopathology ; surgery ; Range of Motion, Articular ; Tibia ; abnormalities ; physiopathology ; surgery

Stress fractures of the tibia are relatively common in military and young people. However, stress fracture of the proximal tibia is rare in elderly patients, but has been reported in association with osteoporosis, Paget disease, rheumatoid arthritis, pyrophosphate arthropathy, and knee deformities. We experienced a 65-year-old patient who did not have a chronic disease, with a stress fracture with primary degenerative knee osteoarthritis with varus deformity, which occurred at the proximal tibia, and we report on this unusual case with a literature review.
Aged ; Arthritis, Rheumatoid ; Chronic Disease ; Congenital Abnormalities* ; Fractures, Stress* ; Humans ; Knee* ; Military Personnel ; Osteoarthritis ; Osteoarthritis, Knee* ; Osteoporosis ; Tibia*

OBJECTIVE: To investigate the clinical effect of total knee arthroplasty on patients with knee osteoarthritis combined with mild to moderate valgus knee deformity.
 METHODS: A total of 15 patients received total knee arthroplasty for correcting mild (10°-15°) to moderate (15°-30°) valgus knee between January 2011 and February 2014 in Xiangya Hospital of Central South University. We adopted a stable prosthesis surgery through patellar medial approach, osteophytes cleaning, conventional osteotomy, a selective soft tissue release and balance technical correcting of knee valgus deformity. Then conventional anticoagulation and symptomatic rehabilitation was utilized. Preoperative and postoperative X-ray was conducted in patients with measuring femor-tibial angle (FTA) and inspecting the prosthesis position. FTA, visual analog scale (VAS) standard, and parallel knee scoring system (KSS) were used to evaluate the clinical effect.
 RESULTS: Fifteen patients were followed up for 14 to 36 (22.40±11.88) months. The hospitalization time was 7-13 (7.73±1.58) d; operative time was 58-110 (81.8±16.85) min, the dominant blood loss was 140-600 (337.30±143.65) mL. Two cases had knee extension hysteresis, and the knee activity recovered after exercise. Leg power lines were normal. Three postoperative cases suffered anterior knee pain. They were subjected to celecoxib analgesic treatment and the pain gradually eased after 3 months. One postoperative case showed incision discharge and swelling, which was healed after change of dressing. During follow-up, review of X-ray film does not show prosthesis loose, subsidence and other complications. The knee valgus angle (8.1±1.8)°, knee motion range (107.33±9.61)°, KSS knee score (74.7±14.5, 75.3±2.7) and pain score (2.5±0.9) were significantly better than the preoperative (P<0.05). The clinical and function KSS scores showed that the improvement rate was 80%. 
 CONCLUSION Total knee arthroplasty is an effective way to treat patients with knee osteoarthritis combined with mild to moderate valgus knee deformity. The correction of deformity and improvement of joint function can be achieved significantly. The clinical result is satisfactory and patients' quality of life is improved.
Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Blood Loss, Surgical ; Humans ; Knee Joint ; abnormalities ; Knee Prosthesis ; Operative Time ; Osteoarthritis, Knee ; surgery ; Osteophyte ; surgery ; Osteotomy ; Pain, Postoperative ; therapy ; Patella ; surgery ; Quality of Life ; Tibia ; Treatment Outcome