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Xi-Qing Pan, Jin-Hui Liu, Jiang-Li Zhang, An Chai, Feng Li, Lei Shu, Wei Zhao Department of Joint Surgery, Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, People’s Republic of ChinaCorrespondence: Jin-Hui Liu, Department of Joint Surgery, Third Hospital of Shijiazhuang, No. 15 Tiyu South Street, Shijiazhuang, Hebei, 050011, People’s Republic of China, Tel +86 13191872146, Fax +86 31185990628, Email jinhuiauliu6@126.comObjective: In this study, we aim to examine the effects of osteotomy under varying posterior slope angles on knee joint function recovery following knee arthroplasty.Methods: We conducted a retrospective analysis from September 2015 to September 2018 on 240 patients who underwent knee arthroplasty three years previously. The study participants were categorized based on changes in the angle of the posterior slope before and after surgery: Group 1, > 5°; Group 2, 3°– 5°; Group 3, 0°– 3°; Group 4, − 3°– 0°; Group 5, < − 3°. All participants were affected with knee osteoarthritis. The Knee Society Clinical Rating System (KSS) knee function score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) knee function score, Visual Analogue Scale (VAS) pain score, and postoperative complications were measured 3 years after surgery.Results: The level of pain experienced by the patients decreased significantly than before, with pain scores ranging from 1.0– 3.0, and there was a statistical difference between groups (H = 93.400, P

Purpose To evaluate the risk factors for developmental coxa vara (DCV) recurrence following valgus osteotomy of the proximal femur. Methods We retrospectively reviewed records of 32 DCV patients (46 hips) treated surgically (2005 to 2012). Recurrencerelated factors, including age at initial surgery, side, sex, fixation methods, diagnosis of coxa vara, premature capital femoral physeal closure and postoperative Hilgenreiner epiphyseal (HE) angle, head-shaft (HS) angle, medial femoral offset and posterior slope angle (PSA) were analyzed. Results At 4.7-year mean follow-up, 12 hip deformities recurred (26%). Postoperative HE angle > 41° and negative offset were statistically significant univariate and multivariate risk factors for the deformity recurrence. Increased PSA was common preoperatively, which accounted for 59% of hips. Postoperative PSA > 20° was associated with a high recurrence rate in the univariate analysis. Age was another univariate risk factor for the recurrence. Recurrence rate was 52% in the < 6.5-year age group versus 4% in the > 6.5-year age group. Other factors were not statistically significantly related to recurrence. Conclusion DCV is a 3D deformity. To prevent recurrence, HE angle should be restored to < 41° in the coronal plane. Sagittal malalignment (abnormal PSA) should be corrected concurrently, so that, the direction of surgical correction is along the true deformity plane. During valgus osteotomy, the distal fragment should be lateralized to maintain a normal mechanical axis. [ABSTRACT FROM AUTHOR]

Purpose Early diagnosis and treatment of slipped capital femoral epiphysis (SCFE) is important to prevent slip progression and avoid complications. We sought to determine if MRI findings in patients with unilateral SCFE could indicate 'pre-slip' or predict future SCFE in the contralateral hip. Methods A prospective study evaluated patients with unilateral SCFE over a two-year period. MRI of the asymptomatic hip was performed within the perioperative period. Patients were followed with radiographs until a contralateral slip occurred or until physeal closure. Demographics, clinical stability, severity, posterior slope angle (PSA), modified Oxford Bone Score (mOBS) and patency of the triradiate cartilage were recorded and statistical analysis performed. Results In all, 33 of 54 patients with unilateral SCFE were enrolled into the study. In all, 29 (87.8%) had complete follow- up. Five of the enrolled patients (15.2%) developed a sequential slip requiring in situ pinning. Six of 33 (18.2%) patients had positive MRI findings: four of which proceeded to sequential SCFE and two which did not. One sequential slip had a negative MRI. PSA predicted 1/11 sequential slips (sensitivity 9.09%, specificity 81.4%, positive predictive value (PPV) 11.1%, negative predictive value (NPV) 77.8%) and mOBS predicted 5/11 sequential slips (sensitivity 45.5%, specificity 93%, PPV 62.5%, NPV 87%). An open triradiate cartilage was present in 8/11 patients with sequential slips (sensitivity 72.7%, specificity 81.4%, PPV 50%, NPV 92.1%). Conclusion MRI findings consistent with 'pre-slip' were present in 66.7% of patients who developed a sequential SCFE. Further study on the utility/sensitivity of MRI in predicting sequential SCFE is warranted. [ABSTRACT FROM AUTHOR]

Opening wedge high tibial osteotomy (OWHTO) is widely used to treat unicompartmental osteoarthritis of the knee caused by degenerative deformations of the anatomical axes of the leg. However, since it is difficult to accurately plan the surgical adjustment degrees such as coronal correction angle and tibial posterior slope angle in order to align the axes before the actual procedure, a number of studies have proposed analytical models to solve this problem. While previous analytical models for OWHTO were limited to specific tibial configurations, this study proposes a Generic analytical osteotomy model (GAOM) and a surgical planning system that are applicable for general tibial morphologies and tibia conditions. The validity and generality of the model were verified in a total of 60 OWHTO cases. Results showed that the tibial shape and the slope of the cut plane significantly affect the adjustment degrees. Comparison between the required degrees and the ones estimated from GAOM resulted in the mean error of 0.12°. The surgical planning system, based on GAOM, allows the operating surgeon to easily calculate surgical parameters needed to treat a patient. [ABSTRACT FROM AUTHOR]

High tibial osteotomy (HTO) has been used to successfully treat patients with genu varus deformities that can improve mechanical function and condition in the knee joint. Clinical studies have reported that bow legs often occur with a concentrated load on the varus of the tibia. This study aimed to analyze and verify the clinical test data result by utilizing the three-dimensional (3D) static finite element method (FEM). The 3D model of lower extremities, which include the femur, tibia, meniscus, and knee articular cartilage, was created using the images from a computer tomography scan and magnetic resonance imaging. In this report, we compared changes in stress distribution and force reaction on the tibial plateau because of critical problems caused by unexpected changes in the tibial posterior-slope angle because of HTO. The results showed that the 5° wedge-angle virtual opening wedge HTO without and with the posterior-slope angle shows has a load concentration of approximately 60% and 45% in the medial region, respectively. [ABSTRACT FROM AUTHOR]