• Journal of Veterinary Clinics
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• v.37 no.3
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• pp.135-140
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• 2020

The purpose of this study was to determine the outcome of distal femoral osteotomy for distal femoral varus and medial patellar luxation (MPL) grade 4 in small-breed dogs. Radiographs and medical records were reviewed to collect data and plan the surgery in small-breed dogs with MPL grade 4. Computed tomography (CT) imaging was also performed in cases of severe bone deformities. Signalment, weight, medial patellar luxation and lameness grade, radiographic bone union, complications, pre- and postoperative femoral varus angle, passive range of motion, static weight bearing distribution and visual analogue scale scores were recorded. Thirteen corrective distal femoral osteotomies were performed with ancillary and additional procedures in 9 dogs; 4 dogs had staged bilateral procedures; and four stifles were suspected to have partial or complete rupture of the cranial cruciate ligament. One stifle underwent patellar groove replacement. The mean ± SD pre- and postoperative femoral varus angles were 109.15°± 3.71° and 96.30°± 2.97°, respectively. Significant improvements in passive range of motion, thigh circumference and visual analogue scale (VAS) scores were observed. There was no reluxation of the patella. This study suggests that distal femoral osteotomy with traditional and additional procedures provided satisfactory outcomes in patient healing and functional recovery in small-breed dogs with excessive femoral varus angles.

• Journal of Veterinary Clinics
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• v.37 no.4
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• pp.180-184
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• 2020

The purpose of this study was to report the reliability and validity of oblique single-cut rotation osteotomy (OSCRO) in 3D-reconstructed canine bone models with femoral varus and torsional deformities. A healthy adult male beagle was recruited to create a 3D bone model, and this bone model was modified by using a 3D program. Fifteen bone models were constructed for this study. OSCRO simulation was performed in accordance with the plan after printing using a 3D printing machine. The anatomical lateral distal femoral angle (aLDFA), anteversion angle (AA), anatomical caudo-distal femoral angle (aCdDFA), mechanical caudo-distal femoral angle (mCdDFA) and pre- and postoperative bone length were calculated. There were no significant differences between the target values and postoperative values. In addition, the difference between pre- and postoperative bone length was small (p = 0.001). Our findings suggest that OSCRO could be an effective surgical option for MPL with bone deformities in small-breed dogs that often undergo conventional distal femoral osteotomy.

• Journal of Veterinary Clinics
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• v.30 no.4
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• pp.278-282
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• 2013

This study was performed in 41 dogs with unilateral or bilateral medial patella luxation (MPL) and/or cranial cruciate ligament rupture (CCLR). These dogs were classified into 4 groups according to MPL grading system. Radiographic evaluation was performed for pelvis and stifle joint in the dogs. Norberg, inclination, quadriceps and femoral varus angle were measured and analyzed with MPL grading and the existence of cranial cruciate ligament rupture. The Norberg and inclination angle showed no differences between 4 grading groups and between CCLR and no CCLR groups. However, quadriceps and femoral varus angle were statistically different between grade 1, 2 and grade 3, 4 groups. They also have shown the statistical difference between CCLR and no CCLR group. Further studies for how these parameters affect the prognosis and the results of surgical treatment of MPL should be needed.

• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.62-70
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• 2020

Purpose: External tibia torsion and proximal tibial vara have been reported in severe varus deformed osteoarthritis, which is a tibio-femoral angle of more than 20°. The radiology measurements were compared with those of control group and the preoperative and follow-up radiology and clinical results were examined. Materials and Methods: From January 2007 to March 2016, 43 knees from 37 persons, who underwent total knee arthroplasty for a severe varus deformity of more than 20° on the tibio-femoral angle on the standing radiographs and had a follow-up period more than two years, were examined. The mean follow-up period was 45.7 months. The control group, who underwent conservative treatments, had Kellgren-Lawrence grade three osteoarthritis and a tibio-femoral angle of less than 3° varus. The external tibial torsion of enrolled patients and control group were estimated using the proximal tibio-fibular overlap length and the tibial torsion values on computed tomography. The proximal tibia vara was measured using the proximal tibial tilt angle. The preoperative and postoperative proximal tibio-fibular overlap length, tibial torsion value, proximal tibial tilt angle, and hospital for special surgery (HSS) score were evaluated. Results: The mean proximal tibio-fibular overlap length was 18.6 mm preoperatively and 11.2 mm (p=0.031) at the follow-up. The control group had a mean proximal tibio-fibular overlap length of 8.7 mm (p=0.024). The mean tibial torsion value was 13.8° preoperatively and 14.0° (p=0.489) at the follow-up. The control group had a mean tibial torsion value of 21.9° (p=0.012). The mean proximal tibial tilt angle was 12.2° preoperatively and 0° (p<0.01) at the follow-up. The control group had a mean proximal tilt angle of 1.2° (p<0.01). The preoperative tibiofemoral angle and mechanical axis deviation were corrected from preoperative 28.3° and medial 68.4 mm to postoperative 0.7° and medial 3.5 mm (p<0.01, p<0.01), respectively. The HSS scores increased from 34 points of preoperatively to 87 points at the last follow-up (p=0.028). Conclusion: Patients with advanced osteoarthritis with a severe varus deformity of more than 20° had significant increases in the external tibial torsion and varus of the proximal tibia. The tibial torsion value before and after surgery in the enrolled patients was not changed statistically, but good clinical results without complications were obtained.

• Journal of Veterinary Clinics
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• v.33 no.6
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• pp.340-345
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• 2016

The present study determined the normal reference ranges for the femoral and tibial joint orientation angles of small-breed dogs. For this purpose, 60 each of cadaveric canine femurs and tibias from normal small-breed dogs (Maltese, Poodle, Shih Tzu, Yorkshire Terrier) were examined with radiographs and photographs. Axial and frontal radiographs and photographs of each bone were obtained, from which anteversion and inclination angles, anatomic lateral proximal and distal femoral angles (aLPFA and aLDFA), mechanical lateral proximal and distal femoral angles (mLPFA and mLDFA), and mechanical medial proximal and distal tibial angles (mMPTA and mMDTA) were measured. The 95% CI for radiographic values of all femurs and tibiae were anteversion angle, $23.4-27.4^{\circ}$; inclination angle, $128.4-130.4^{\circ}$; aLPFA, $117.8-122.1^{\circ}$; aLDFA, $93.7-95.2^{\circ}$; mLPFA $113.8-117.3^{\circ}$; mLDFA $99.2-100.5^{\circ}$; mMPTA $96.8-98.5^{\circ}$; mMDTA $89.4-90.7^{\circ}$. The Maltese had a larger anteversion angle than the Poodle and the Yorkshire Terrier and a larger mLPFA than the Poodle. In the comparison between the radiographs and the photographs, significant differences were found in the anteversion angle, mLPFA, mMPTA, and mMDTA. The established normal reference values might be useful for determining whether a valgus or varus deformity of the femur or the tibia is present and if so, the degree of angular correction needed.

• Journal of the Korean Orthopaedic Association
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• v.53 no.6
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• pp.490-497
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• 2018

Purpose: To evaluate the utility of ceramic-on-polyethylene articular bearing surface when cementless total hip arthroplasty is performed in patients older than 65 years through an analysis of the minimum five-year follow-up results using the ceramic femoral head and cross-linked polyethylene liner. Materials and Methods: From March 2010 to September 2012, 51 patients (56 hips) who were older than 65 years were enrolled in this retrospective study. The mean age at surgery was $70.9{\pm}5.1years$ old. A clinical assessment was analyzed using the Harris hip score. For the radiographic assessment, the cup inclination and anteversion, stem alignment, and wear amount were measured. The postoperative complications were also determined. Results: The mean Harris hip score was improved from preoperative 48 points to postoperative 87 points (p<0.05). The mean cup inclination was $40.9^{\circ}{\pm}6.4^{\circ}$ and the mean cup anteversion was $20.3^{\circ}{\pm}8.1^{\circ}$. The mean cup anteversion of the elevated liner-used group (16 cases) was $14.3^{\circ}{\pm}7.9^{\circ}$ and the mean cup anteversion of the neutral liner used group (40 cases) was $22.4^{\circ}{\pm}9.1^{\circ}$ (p<0.05). The mean stem alignment angle was $0^{\circ}$ (range, varus $4^{\circ}$-valgus $4^{\circ}$). The mean linear wear amount was $0.458{\pm}0.041mm$ and the average annual linear wear rate was $0.079{\pm}0.032mm/yr$. Six cases (10.7%) of intraoperative periprosthetic femoral fractures were encountered. Conclusion: Based on these results, the use of a ceramic-on-polyethylene articular bearing surface in elderly patients with cementless total hip arthroplasty is beneficial. On the other hand, careful effort is needed to prevent intraoperative periprosthetic femoral fractures.

• Journal of the Korean Orthopaedic Association
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• v.56 no.3
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• pp.253-260
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• 2021

Purpose: The least constrained prosthesis is generally recommended in primary total knee arthroplasty (TKA). Nevertheless, a varus/valgus constrained (VVC) prosthesis should be implanted when a semi-constrained prosthesis is not good for adequate stability, especially in the coronal plane. In domestic situations, however, the VVC prosthesis could not always be prepared for every primary TKA case. Therefore, it is sometimes impractical to use a VVC prosthesis for unsual unstable situations. This study provides information for preparing VVC prostheses in the preoperative planning of primary TKA through an analysis of primary VVC TKA cases. Materials and Methods: This study reviewed 1,797 primary TKAs, performed between May 2003 and February 2016. The reasons for requiring VVC prosthesis and the preoperative conditions in 29 TKAs that underwent primary TKA with a VVC prosthesis were analyzed retrospectively. Results: In primary TKA, 29 cases (1.6%) in 27 patients (6 male and 21 female) used VVC prosthesis. Two patients underwent a VVC prosthesis on both knees. The mean age of the patients was 63.4 years old (34-79 years). The mean flexion contracture was 16.2° (-20°-90°), and the mean angle of great flexion was 111.7° (35°-145°). The situations requiring a VVC prosthesis were severe valgus deformity in 10 knees, knee stiffness requiring extensive soft tissue release in 10 knees, previously injured collateral ligaments in five knees, and distal femoral bone defect due to avascular necrosis in four knees. The mean tibiofemoral angle was 25.7° (21°-43°) in 10 cases with a valgus deformity. The mean flexion contracture was 37.5° (20°-90°), and the mean range of motion was 48.5° (10°-70°) in 10 cases with knee stiffness. Conclusion: The preparation of VVC prosthesis is recommended, even for primary TKA in cases of severe valgus deformity (tibiofemoral angle>20°), stiff knee (the range of motion: less than 70° with more than 20° flexion contracture), and the cases with a previous collateral ligament injury. This information will help in the preparation of adequate TKA prostheses for unusual unstable situations.