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Opening wedge osteotomy offers precise correction but longer time to union
Link
http://www.orthosupersite.com/view.asp?rID=25730
January 16, 2008
LAHAINA, Hawaii - While the use of nonarthroplasty options for knee arthritis
has diminished during the last decade, one orthopedic surgeon presenting here
said that realignment osteotomy remains a good option for a certain patient
population.
Today, patients undergoing realignment osteotomy, which can result in the
transfer of weight-bearing forces from the arthritic portion of the knee to a
healthier location in the joint to increase its lifespan, tend to be younger and
more active than in years past, Robert T. Trousdale, MD, said at the Orthopedics
Today Hawaii 2008 meeting.
"Over the past 5 years in our clinic, the average patient age [for osteotomies]
has been 38 years old, and there has been a trend toward smaller annular
corrections, too," said Trousdale, an orthopedic surgeon at the Mayo Clinic in
Rochester, Minn. Also, orthopedic surgeons today "are tending to perform
osteotomies in combination with other procedures, including ACL or PCL
reconstructions and articular cartilage and medical allograft transplants," he
said.
Two major pitfalls for osteotomies are poor patient selection and technique,
which often results in poor alignment postoperatively, he said.
Trousdale said he prefers to use the opening wedge osteotomy rather than the
closing wedge approach.
"Some of the advantages of the medial opening wedge osteotomy include a more
precise correction, its ease of use, it avoids the proximal tibiofibular joint,
and it does not require a fibular osteotomy. It also restores tension to a lax
medial cruciate ligament," he said.
However, "The cost [of an opening wedge osteotomy] is that it takes a longer
time to [achieve] union. The other downside is that a handful of these patients
can have symptoms along the medial side of the knee. In these patients, we may
have to take these plates off a year or two after surgery," he said.
For more information:
Trousdale RT. Nonarthroplasty options for knee arthritis. Presented at
Orthopedics Today Hawaii 2008. Jan. 13-16, 2008. Lahaina, Maui, Hawaii.
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