Limb Reconstruction Case Study – Specialist Knee Surgeons in Worcester, Droitwich, Birmingham and Bromsgrove

Limb Reconstruction Case Study

Case Presentation

Can a severe external rotational deformity of the tibia be safely and effectively corrected using the new Orthofix rotation translation hinges?

by Mohi El-Shazly

A 36 year old patient presented with bilateral anterior knee pain. He had had multiple operations to improve patellar tracking on the right side with no success and ended up with a patellectomy and a custom-made trochlear resurfacing prosthesis. He now wanted the left knee dealt with.

On examination he was found to have severely squinting patellae.

Examination of his left hip for range of motion showed 55 degrees of internal rotation and 5 degrees of external rotation indicating severe anteversion of the femoral neck. A Sheffield Ring Fixator was applied, a fibular and percutaneous low energy tibial osteotomy were performed and gradual correction of the external tibial torsion was performed using the new rotation translation hinges.

Results/Outcome

Fifteen degrees of rotational correction was performed acutely.

A further 10 degrees were then corrected gradually, using the new rotation translation hinges, leaving him with just under 20 degrees of external rotation, as per his pre-operative plan. The position of the hinges was then altered to act as angulation hinges to correct 4 degrees of varus as identified by his follow-up scanogram.

Paralysis of extensor hallucis longus was noted in the immediate postoperative period, probably due to neuropraxia at the site of fibular osteotomy at the junction of the upper and middle thirds of the leg. This is now recovering.

The frame was removed at 10 weeks postoperatively. He had full correction of the deformity as planned. When last seen at 15 weeks postoperatively, he was very pleased with the alignment of the leg and could feel improvement in patellar tracking. He is not back to full activity to be able to assess his anterior knee pain yet.

Conclusions

The new rotation translation hinges allow easy progressive correction of rotational deformity of the tibia. They are easily adjustable to correct angular deformity without any major frame alteration. Anterior knee pain caused by significant rotational malalignment should be addressed by correcting the rotational deformity, before attempting any patellar re-alignment procedures