Primary Knee Symposium: Biomechanical Considerations in the Knee
Non-Arthroplasty Solutions for Knee OA - Arthur Malkani, MD
Dr. Malkani's presentation focused on osteotomies—the indications, pre-operative planning, surgical technique, results, and complications. His indications for an osteotomy include: pain, younger age group, isolated medial compartment OA, adequate ROM, lack of contracture, stable knee, no thrust / subluxation. He discussed his patient selection PSlide A for which he performs a series of x-rays, a bone scan, and an MRI (when indicated).
He discussed the goals for an osteotomy in a varus knee PSlide B and valgus knee. PSlide C Dr. Malkani's observations on a lateral closing wedge include: disrupts tibia – fibula joint, residual deformity, patella tendon shortening, peroneal injury, union likely. Opening wedge observations include: less deformity, patella tendon less involved, medial soft tissue concerns, and union concerns.
Tips for performing an osteotomy include: once decided on angle of correction, make the osteotomy on trasparent paper as low as possible on the tibial tubercle and exiting 1cm below the lateral edge at the tip of the fibula. Once you have made the osteotomy on trasparent paper, measure the angle and height of the plate tooth then measure the osteotomy line during surgery and evaluate the type of plate (maintaining the same angle) and choose the right tooth.
He reviewed the potential pitfalls in proximal tibial osteotomies. PSlide D Potential complications include: undercorrection, delayed/non-union, infection, vascular injury, peroneal palsy, DVT, and intraoperative fracture.
He concluded with a review of clinical results PSlide E and his summary points:
- Osteotomy about the knee has a role
- Results deteriorate over time
- Patient selection is critical
- Pre-operative planning essential
