A.Sh.Ariamanesh Jan.2016 Esfahan-IRAN Osteotomies around the knee; The effect of simultaneous hip and ankle disorders on results A.Sh.Ariamanesh Jan.2016 Esfahan-IRAN

&A) Coxa vara valga

Genu Valgum in Children with Coxa Vara Resulting from Hip Disease Journal of Pediatric Orthopaedics: March/April 1997 - Volume 17 - Issue 2 - pp 225-229 Coxa Vara : March/April 1997 - Volume 17 - Issue 2 - pp 225-229 Genu Valgum in Children with Coxa Vara Resulting from Hip Disease Shim, Jong Sup M.D.*; Kim, Hui Taek M.D.†; Mubarak, Scott J. M.D.‡; Wenger, Dennis R. M.D.‡ Abstract Summary: Three patients with chronic hip disease and progressive coxa vara deformity also had an unrecognized compensatory ipsilateral genu valgum until the primary hip deformity had been corrected operatively. This unrecognized genu valgum may become subtly worse in a growing child because of lateralization of the mechanical axis of the lower extremity with respect to the knee joint. Operative correction of coxa vara acutely moves the mechanical axis farther laterally, causing the occult genu valgum to become clinically apparent. The genu valgum may subtly worsen over time in a growing child because of lateralization of the lower extremity mechanical axis with respect to the knee joint, with the resulting abnormal Hueter-Volkmann forces across the physis causing progressive genu valgum. Recognition of occult genu valgum before correcting coxa vara in children allows the surgeon the better to advise the family about the need for possible subsequent operations on the knee.

B) Excess Antiversion

D) Ankle pain

Paper conclusions; Patients with preoperative varus malalignment frequently had an abnormal Ankle joint orientation (excessive lateral tilt) relative to the ground in the coronal plane. ankle joint line

The proximal tibial osteotomy would change the relative ankle joint line orientation more than the knee joint line orientation due to longer lever arm.

After HTO the relative ankle joint orientation became more parallel to the ground even though the ankle joint orientation after HTO was slightly overcorrected compared to the normal controls probably due to intentional overcorrection strategy in HTO.

Foot Ankle Int. 2014 Jul;35(7):725-9. doi: 10. 1177/1071100714531230 Foot Ankle Int. 2014 Jul;35(7):725-9. doi: 10.1177/1071100714531230. Epub 2014 Apr 9. Ankle Deformity After High Tibial Osteotomy for Correction of Varus Knee: A Case Report. Jeong BO1, SooHoo NF2. Author information KEYWORDS: ankle; high tibial osteotomy; knee; supramalleolar osteotomy PMID: 24719400 [PubMed - in process] Share on Facebook Share on Twitter Share on Google+

E) Distal tibial torsions

A few researches has shown that tibial malrotation affects the distribution of loads whithin the knee.( Yazdi ,et al ESSKA 2014)

Malrotation of the distal tibial fragmnet negates the intended effect of offloading the diseased compartment .

Furthermore leads to abnormal ankle contact pressures.

No study in the literature. Does constitusional tibial torsion compromise the offloading effect of HTO? May be No study in the literature.

Thanks for your attention Every day of life can be a challenge; Prepare for it Refuel for it Train for it Reset for it Thanks for your attention