osteotomy

Aetiology

Trauma

RA

Rickets / osteomalacia

Issues

Horizontal joint line important

- < 10° tilt acceptable

> 10^o joint line tilt / due to femoral valgus

- continues to overload lateral compartment

Management Summary

Stage 0

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

Stage 1 / Normal X-ray, abnormal MRI

Forage: 80% G/E

Bisphosphonates

Stage 2 / Abnormal X-ray with cysts and sclerosis

A:  As for Stage I

Chondrolysis

Definition

- loss of 50% joint space or < 3mm joint space

Epidemiology

- female 2:1

- 10-20% of SUFE 

Causes

1.  Head penetration

- use only 1 screw

2.  Immunologically mediated global loss of articular cartilage

- can occur in no treatment of SUFE

Clinical

Causes of Deformity

Metabolic Bone Disease

Paget's

Fracture Malunion

Previous Osteotomy

Options

1.  Intra-articular correction

2.  Simultaneous osteotomy and TKR

3.  Staged correction and TKR

1.  Intra-articular correction 

Indications

Femur

- draw line of mechanical axis of femur

Pathology

Premature fusion of the volar & ulna aspects of the distal radius

- progressive ulnar & volar tilt of distal radial surface

Ulna becomes prominent through normal growth & subluxes dorsally

Lunate lies deeply between lower end of radius and ulna

Dislocated Hip

Issue

Hip has been out for some time

- degree of acetabular dysplasia evident

- less time for remodelling

- increased instability if not addressed

Management

Open reduction + FDRO / Pelvic Osteotomy 

- usually perform pelvic osteotomy to correct acetabular dysplasia

- reserve FDRO for > 3 years / or if difficult reducing hip