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Tibial Condylar Valgus Osteotomy (TCVO): an intra-articular osteotomy for severe varus deformities: rationale and short term results
ESSKA Academy. Chaudhary M. Nov 8, 2019; 286385
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Tibial Condylar Valgus Osteotomy (TCVO): an intra-articular osteotomy for severe varus deformities: rationale and short term results

EKA Free Papers

Topic: HTO

Chaudhary M.1, Lakhani P.1, Chaudhary J.2, Chaudhary S.3
1International Deformity & Lengthening Institute, Chaudhary Hospital . Dept of Orthopaedic Surgery, AKOLA, India, 2Lokmanya Tilak Memorial Medical College, Undergraduate Studies, Mumbai, India, 3D.Y. Patil Medical College, Undergraduate Studies, Navi Mumbai, India

Introduction: . Full Length x-rays help determine origin of varus deformity which accompanies Medial Compartment Osteoarthritis (MCOA). It may arise from the tibia, femur or the knee joint. Most High Tibial Osteotomies (HTO) aim to correct varus deformity in the upper tibial metaphysis. Attention has recently focused on femoral contribution to the varus, obliquity of Joint line & need for double osteotomies. There is insufficient attention to deformities arising from within the joint in MCOA. Increased Joint Line Convergence Angle (JLCA) & Condylar Plateau Angle (CPA) denotes that the varus is arising from the knee joint.
Objectives: To measure and analyse varus deformities that arise from within the knee joint in MCOA and study results of an intra-articular HTO called Tibial Condylar Valgus osteotomy (TCVO)surgery to correct intra-articular (IA) varus
Aims: We aimed to find the source of severe varus deformities in MCOA & study the role of intraarticular (IA) Tibial Condylar Valgus Osteotomy (TCVO) to accurately and safely correct varus & mechanical axis deviation (MAD).
Methods Long x-rays of 118 limbs with severe MCOA revealed two groups with large varus (MAD >10%) and severe varus (MAD < 10%). We measured MPTA, mLDFA, NSA, JLCA & CPA in all. 23 segments in 19 patients had TCVO. 12 underwent only TCVO, fixed with a locking plate (Group A). 11 segments (seven patients) had TCVO & added Focal Dome Osteotomy (FDO) with an Ilizarov fixator (Group B). Mean preoperative %MAD = -19.4%, JLCA = 8.1° and CPA = 11.2°. Mean preop HSS score was 35.7 and WOMAC was 68.9%. Statistical analysis was done using Pearson's correlation coefficient r, t test, Mann Whitney U test & Wilcoxon signed rank test.
Results JLCA (r=-0.576) and MPTA (r=0.362) correlated well with %MAD in severe varus deformities. Postoperative %MAD was 49.3% (group A = 38%, group B = 61.7%). JLCA reduced to 3.4° in both groups and CPA to 2.2° (group A = 3.9°, group B = 0.3°, p=0.65). HSS score improved to 70.3.
Conclusion An a-la-carte approach is needed to address varus deformities by HTO in MCOA. An increased JLCA or CPA may be seen in full-length x-rays of severe varus deformities where the Mechanical axis passes at < 10% of the joint width. Tibial Condylar Valgus osteotomy(TCVO) corrects the intra-articular deformity. Added extraarticular Focal Dome osteotomy(FDO) using an Ilizarov fixator accurately corrects the mechanical axis which may ensure long term pain relief.
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