scholarly journals Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Giovanni Romeo ◽  
Alberto Bianchi ◽  
Vincenzo Cerbone ◽  
Matteo Maria Parrini ◽  
Francesco Malerba ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Bone Allograft ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Metallic Implant ◽  
Radiographic Outcomes ◽  
Clinical Scores ◽  
Medial Cuneiform ◽  
Forefoot Varus

Adult flatfoot is a common pathology characterized by multiplanar deformity involving hindfoot, midfoot, and forefoot. Various surgical techniques have been described for the treatment but may not adequately correct the fixed forefoot varus component. Residual forefoot supination can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, also known as a Cotton osteotomy. Thus, the aims of this study were to compare clinical, radiological, and functional outcome after Cotton osteotomy, in patients treated with bone allograft or metallic implant. Consequently, 36 patients treated with opening wedge osteotomy of the medial cuneiform for forefoot varus were studied retrospectively. Patients were divided into two groups: the bone allograft group (HBG) (n=18) and the metallic implant group with BIOFOAM® Cotton Wedges (TTW) (n=18). Radiographic assessment and clinical scores including American Orthopaedic Foot and Ankle Society score, Foot Function Index, and visual analogue scale for pain were collected before operation and the last follow-up. The difference between baseline and follow-up for both groups was statistically significant for all the clinical scores and radiographic angles (p < 0.05). Most participants (92%) were very satisfied after surgery. Our results showed that Cotton osteotomy with a metallic implant provided both good clinical and radiographic outcomes comparable with bone allograft.

scholarly journals Radiographic Outcomes and Complications of Medial Column Correction in Adult Acquired Flatfoot Deformity Using A Titanium Wedge

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0017
Author(s):  
Tyler W. Fraser ◽  
Jesse F. Doty ◽  
Anish R. Kadakia
Keyword(s):  
Weight Bearing ◽  
Wedge Osteotomy ◽  
Osteotomy Site ◽  
Opening Wedge ◽  
Common Component ◽  
Radiographic Outcomes ◽  
Medial Cuneiform ◽  
Significant Correction ◽  
Forefoot Varus

Category: Hindfoot, Midfoot/Forefoot, Flatfoot Introduction/Purpose: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. There are multiple options to plantarflex the medial column of the foot, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform. Methods: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 years (Range: 12-70). The average follow-up time for patients was 8.1 months (6-17 months). All patients underwent a six-month non-operative treatment course prior to operative intervention. The average time from the initial visit with the primary surgeon (JFD, ARK) to the day of surgical intervention was 211 days (29-1296 days). The choice to use a titanium wedge, versus an alternative method of correction of the medial column, was at the discretion of the primary surgeon (JFD, ARK). Results: A dorsal opening wedge medial cuneiform osteotomy was performed in all patients. All radiographic parameters showed statistically significant correction from preoperative to postoperative. All cases had multiple concomitant procedures performed to address the flatfoot deformity, so it is difficult to isolate the effect of the medial cuneiform osteotomy. 30/31 cases went on to successful union of the osteotomy within the study follow-up period. There were no instances of hardware pain requiring implant removal. There was 1 case of plantar gapping at the osteotomy site and implant loosening that required revision to a larger titanium wedge which healed uneventfully. No implants had supplemental fixation or additional bone graft placement at the osteotomy site. Conclusion: To our knowledge, this represents the first reported series on the use of structural titanium wedges with an opening wedge osteotomy of the medial cuneiform. There is limited data regarding the use of metal wedges for flatfoot correction. Nearly every patient in our series underwent concomitant procedures as part of the flatfoot reconstruction. This makes it difficult to isolate the effect of the deformity correction provided solely by the medial column correction. Our study suggests that metal wedges are both safe and effective for use in medial column correction, and future studies comparing titanium wedges to traditional techniques are needed.

scholarly journals Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants

2019 ◽  
Vol 4 (3) ◽  
pp. 247301141986897
Author(s):  
Tyler W. Fraser ◽  
Anish R. Kadakia ◽  
Jesse F. Doty
Keyword(s):  
Bone Grafting ◽  
Weight Bearing ◽  
Osteotomy Site ◽  
Opening Wedge ◽  
Common Component ◽  
Future Studies ◽  
Radiographic Outcomes ◽  
Medial Cuneiform ◽  
Forefoot Varus

Background: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. Multiple options exist to plantarflex the medial column, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform. Methods: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 (range: 12-70). The average follow-up time for patients was 12.2 months (8-24). Results: All radiographic parameters were statistically significantly improved from preoperative to postoperative ( P < .05). There were no instances of nonunion of the medial cuneiform osteotomy. There was 1 implant that loosened and was revised to a larger implant that healed uneventfully. No wedges were removed for continued pain at the osteotomy site. Conclusion: This study suggests that metal wedges are both safe and effective for use in medial column correction based on early follow-up data. Future studies comparing titanium wedges versus traditional bone grafting for Cotton osteotomies may provide further analysis of radiographic correction, operative time, procedure cost, and outcomes. There were no instances of pain over the titanium wedge site. Radiographic outcomes are similar to those reported for opening wedge Cotton osteotomies including bone grafting and wedge plates with screws. Future studies will help determine the long-term maintenance of correction and hardware survivorship. Level of Evidence: Level IV, case series.

scholarly journals Effect of the additional first ray osteotomy on hindfoot alignment after calcaneal osteotomy for the correction of mild-to-moderate adult type pes plano-valgus

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668474
Author(s):  
Jun Young Choi ◽  
Seong Mu Cha ◽  
Ji Woong Yeom ◽  
Jin Soo Suh
Keyword(s):  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Adult Type ◽  
Hindfoot Alignment ◽  
Calcaneal Osteotomy ◽  
Medial Cuneiform ◽  
Significant Difference ◽  
First Ray ◽  
Pes Plano Valgus

Purpose: To determine the effect of the additional first ray osteotomy on hindfoot alignment for the correction of pes plano-valgus. Methods: Data obtained from 37 consecutive patients recruited from 2006 to 2014 who underwent medial displacement calcaneal osteotomy (MDCO) alone (group H) or MDCO followed by medial cuneiform opening wedge osteotomy (MCOWO) (group HF) with a minimum 1-year follow-up were reviewed retrospectively. The mean follow-up periods were 34 and 32 months. Results: Degree of decrease of Talonavicular coverage angle (TNCA) via surgery or postoperative TNCA on standing foot AP radiographs were not significantly different between group H and HF ( p = 0.287). The calcaneal pitch angle and medial cuneiform height on the standing foot lateral radiographs was significantly increased after operation in group HF ( p = 0.01), there was a significant difference with group H as well ( p = 0.033). In group HF, the Meary’s angle was significantly decreased after operation, a significant difference compared to group H ( p = 0.009). Hindfoot alignment angle on the hindfoot alignment view was decreased after operation in both groups but was not significantly different between both groups ( p = 0.410). Hindfoot alignment ratio was also increased after the operation in both groups, but was not different between two groups ( p = 0.783). Conclusion: The additional first ray osteotomy using MCOWO had no correctional power for hindfoot correction, although it caused improvement in some radiographic parameters.

scholarly journals Medial Cuneiform Opening-Wedge Osteotomy for the Treatment of Hallux Valgus

2019 ◽  
Vol 4 (1) ◽  
pp. 247301141881331
Author(s):  
Jason S. Ahuero ◽  
John S. Kirchner ◽  
Paul M. Ryan
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Low Profile ◽  
Medial Cuneiform ◽  
The Mean ◽  
Wedge Plate

Background: While proximal first metatarsal osteotomy combined with distal soft tissue realignment is accepted as standard treatment of moderate to severe hallux valgus with metatarsus primus varus, none of the described proximal metatarsal osteotomies address the hyper-obliquity of the first metatarsocuneiform joint. An opening-wedge osteotomy of the medial cuneiform can potentially correct the 1-2 intermetatarsal angle (IMA) in addition to normalizing the hyper-obliquity of the first tarsometatarsal (TMT) joint. The purpose of this study was to retrospectively review the early radiographic and clinical results of the use of a medial cuneiform opening-wedge osteotomy fixed with a low-profile wedge plate combined with distal soft tissue realignment for the treatment of hallux valgus. Methods: Fourteen feet (13 patients; 2 male and 11 female, average age 56 years, range 22-75) with hallux valgus underwent an opening-wedge osteotomy of the medial cuneiform fixed with a low-profile nonlocking wedge plate combined with distal soft tissue realignment. The mean preoperative hallux valgus angle (HVA) was 32 degrees and the IMA was 16 degrees. HVA, 1-2 IMA, proximal first metatarsal inclination (PFMI), and presence of osteoarthritis of the first TMT joint were assessed on preoperative and final postoperative radiographs. Final postoperative radiographs were also evaluated for radiographic union and hardware failure at an average of 7 months (range, 3-19 months) postoperatively. Results: A mean intraoperative correction of 19 degrees and 7 degrees was achieved for the HVA and IMA, respectively. The mean HVA was 22 degrees and the mean IMA was 11 degrees at the time of final follow-up. At final follow-up, a recurrence of the deformity was observed in 12/14 feet. There were 2 nonunions—one plate failure and one screw failure. No first TMT joint instability or arthritis was observed. All patients were ambulatory without assistive device in either fashionable or comfortable shoe wear. Conclusion: Medial cuneiform opening-wedge osteotomy resulted in unreliable correction of HVA and IMA at short-term follow-up with a high rate of early recurrence of hallux valgus deformity and a complication rate similar to that of the Lapidus procedure. This procedure cannot be recommended for addressing hallux valgus in the setting of increased obliquity of the first TMT joint. Level of Evidence: Level IV, case series.

scholarly journals Opening-wedge high tibial osteotomy: a seven - to twelve-year study

Joints ◽  
2016 ◽  
Vol 04 (01) ◽  
pp. 006-011 ◽  
Author(s):  
Gennaro Pipino ◽  
Pier Indelli ◽  
Domenico Tigani ◽  
Giuseppe Maffei ◽  
Davide Vaccarisi
Keyword(s):  
High Tibial Osteotomy ◽  
Healing Process ◽  
Surgical Techniques ◽  
Long Term Results ◽  
Wedge Osteotomy ◽  
Consecutive Series ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy

Purpose: medial opening-wedge osteotomy is a widely performed procedure used to treat moderate isolated medial knee osteoarthritis. Historically, the literature has contained reports showing satisfactory midterm results when accurate patient selection and precise surgical techniques were applied. This study was conducted to investigate the clinical and radiographic seven- to twelve-year results of opening-wedge high tibial osteotomy in a consecutive series of patients affected by varus knee malalignment with isolated medial compartment degenerative joint disease. Methods: we reviewed a case series of 147 medial opening-wedge high tibial osteotomies at an average follow-up of 9.5 years. Endpoints for evaluation included the reporting of adverse effects, radiographic evidence of bone union, radiographic changes in the correction angle during union, and clinical and functional final outcomes. Results: good or excellent results were obtained in 94% of the cases: the patients reported no major complications related to the opening-wedge high tibial osteotomy surgical technique, bone graft resorption, implant choice or postoperative rehabilitation protocol. At final follow-up, the average hip-knee angle was 4° of valgus without major loss of correction during the healing process. A statistically significant change in the patellar height was detected postoperatively, with a trend towards patella infera. Conclusions: medial opening-wedge high tibial osteotomy is still a reliable method for correcting varus deformity while producing stable fixation, thus allowing satisfactory stability, adequate bone healing and satisfactory mid- to long-term results. Level of evidence: Level IV, therapeutic cases series.

scholarly journals Double column osteotomy for correction of residual adduction deformity in idiopathic clubfoot

2010 ◽  
Vol 92 (8) ◽  
pp. 673-679 ◽  
Author(s):  
Michel Eshak Loza ◽  
Sherif NG Bishay ◽  
Hassan Magdy El-Barbary ◽  
Atef Abdel-Aziz Zaki Hanna ◽  
Yehia Nour El-Din Tarraf ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Major Complication ◽  
Idiopathic Clubfoot ◽  
Grading System ◽  
Residual Deformity ◽  
Abductor Hallucis ◽  
Opening Wedge ◽  
Medial Cuneiform ◽  
Plantar Fasciotomy

INTRODUCTION Adduction of the forefoot is the most common residual deformity in idiopathic clubfoot. The ‘bean-shaped foot’, which is a term used to describe a clinical deformity of forefoot adduction and midfoot supination, is not uncommonly seen in resistant clubfoot. SUBJECTS AND METHODS Fifteen children (20 feet) with residual forefoot adduction in idiopathic clubfeet aged 3–7 years were analyzed clinically and radiographically. All of the cases were treated by double column osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) with soft tissue releases (plantar fasciotomy and abductor hallucis release), to correct adduction, supination and cavus deformities. Pre-operative measurements of certain foot angles were compared with their corresponding postoperative values. RESULTS A grading system for evaluation of the results using a point scoring system was suggested to evaluate accurately both clinical and radiographic results after a follow-up period of an average of 2.3 years. Eight feet (40%) had excellent, eight (40%) good, three (15%) fair, and one (5%) poor outcome. There was no major complication. There was significant improvement in the result (P > 0.04). CONCLUSIONS Double column osteotomy can be considered superior to other types of bone surgeries in correction of residual adduction, cavus and rotational deformities in idiopathic clubfoot.

scholarly journals Double-high insert presents with worse mid-term outcomes in cruciate-retaining medial-pivotal total knee arthroplasty – a propensity score matched analysis with averaged 8-year follow-up

2021 ◽  
Author(s):  
Shuai Xiang ◽  
Yingzhen Wang ◽  
Chengyu Lv ◽  
Changyao Wang ◽  
Haining Zhang
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Womac Score ◽  
Cruciate Retaining ◽  
Radiographic Outcomes ◽  
Clinical Scores ◽  
Total Knee ◽  
Knee Society Function Score

Abstract Background The aim of this study was to compare the mid-term clinical and radiographic outcomes between medial-pivotal (MP) insert and double-high (DH) insert used under cruciate-retaining condition in ADVANCE® total knee arthroplasty (TKA). Methods The follow-up was conducted for 158 consecutive patients underwent unilateral ADVANCE® TKA from January 2011 to April 2014. 84 MP inserts and 74 DH inserts were used under cruciate-retaining condition. A 1:1 propensity score matching (PSM) analysis was performed between MP insert and DH insert to compare the clinical and radiographic outcomes. Results After a 1:1 PSM, 120 patients (60 pairs) were matched between MP insert and DH insert. The baseline demographic parameters and clinical scores were comparable between the two groups. The postoperative clinical outcomes at an averaged 8-year follow-up of both groups were significantly improved. The range of motion (ROM) of DH group was better than that of MP group and equivalent Knee Society Function Score (KSFS) between the two groups was found. However, the Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and Forgotten Joint Score (FJS) of MP group were found to be significantly superior than those of DH group. Comparable complication rate and revision rate were observed between the two groups. The radiographic results were also equally good between MP and DH group. Conclusions Although the mid-term clinical and radiographic outcomes of DH insert are fairly good, the clinical scores of DH group were worse than those of MP group.

scholarly journals Preliminary Experience Using Bioactive Glass Wedges for Cotton Osteotomy

2018 ◽  
Vol 3 (4) ◽  
pp. 247301141879686
Author(s):  
Tood Borenstein ◽  
Tyler Gonzalez ◽  
Janet Krevolin ◽  
Bryan Den Hartog ◽  
David Thordarson
Keyword(s):  
Bioactive Glass ◽  
Case Series ◽  
Clinical Results ◽  
Delayed Union ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Opening Wedge ◽  
Radiographic Outcomes ◽  
Initial Correction

Background: Medial cuneiform dorsal opening wedge (Cotton) osteotomy is often used for treating forefoot varus in patients undergoing surgery for stage II posterior tibialis tendon dysfunction. The goal of this study was to examine the radiographic outcomes of Cotton osteotomy with bioactive glass wedge to assess for both maintenance of correction and clinical results and complications. We hypothesized that bioactive glass wedges would maintain correction of the osteotomy with low complication rates. Methods: Between December 2015 and June 2016, the charts of 17 patients (10 female and 7 male) who underwent Cotton osteotomy using bioactive glass wedges were retrospectively reviewed. Patient age averaged 56.8 years (range, 16-84). The average follow-up was 6.5 months. Radiographs were reviewed to assess for initial correction and maintenance of correction of medial column sag as well as for union. Charts were reviewed for complications. Results: The medial column sag correction averaged 15.6% on the final postoperative lateral radiograph. Meary angle averaged 19 degrees (3.14-42.8 degrees) preoperatively and 5.5 degrees (0.4-20.7 degrees) at final follow-up. All patients achieved clinical and radiographic union. One patient developed neuropathic midfoot pain and was managed with sympathetic blocks. One patient had a delayed union that healed at 6 months without surgical intervention. No patients required the use of custom orthotics or subsequent surgical procedures. Conclusion: Cotton osteotomy with bioactive glass wedges produced consistent correction of the medial column with low risk. Level of Evidence: Level IV, case series.

scholarly journals Surgical Anatomy of the Medial Cuneiform (Cotton) Osteotomy

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988534
Author(s):  
Baofu Wei ◽  
Brian C. Lau ◽  
Annunziato Amendola
Keyword(s):  
Tilt Angle ◽  
Tibialis Anterior ◽  
Articular Surface ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Small Branch ◽  
Medial Cuneiform ◽  
Significant Difference ◽  
Oblique Incision ◽  
Distal Articular Surface

Background: The Cotton osteotomy, or dorsal-opening wedge osteotomy of the medial cuneiform (MC), is used to address medial column alignment to restore the static-triangle of support. There are many described techniques regarding the incision and osteotomy. Successful completion of the osteotomy requires knowledge of the anatomy, particularly the location of the medial dorsal cutaneous nerve (MDCN). This study describes the relationship between MDCN, tibialis anterior, extensor-hallucis-longus tendon, and ligamentous attachments to the MC. A technique to determine a safe location for the osteotomy is also described. Methods: Twelve fresh-frozen adult foot specimens were used for this study (7 male and 5 female). The MDCN and its branches were dissected and its relationship with the MC was documented. Osteotomy tilt angle and relationship to structures around the MC were measured. Results: MDCN traveled medially and distally over the dorsum of the MC, and a small branch to the MC was observed. The tilt angle was 80.1 ±1.4 degrees. There was no significant difference between the distance from the distal-articular surface to the midline of the cuneiform and to the interosseous ligament ( P = .69), or between the distance from the distal-articular surface to the second tarsometatarsal joint and to the origin of the Lisfranc ligament ( P = .12). Conclusions: The dorsal-medial-oblique incision effectively protected MDCN and the MC. We believe the osteotomy should be performed in the safe zone to maintain the stability of the opening wedge. Clinical relevance: The dorsal-medial-oblique incision could reduce the risk of injury to the MDCN and the tibialis-anterior tendon.

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