Detaillierte Beitrags-Information
| Beitragstitel | LOWER LIMB OSTEOTOMIES FOR JOINT REALIGNEMENT IN A PATIENT WITH HEREDITARY MULTIPLE EXOSTOSES AND SYMPTOMATIC BONE DEFORMITY: A CASE REPORT |
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| Beitragscode | P097 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Objective: Hereditary multiple exostoses (HME) is an autosomal dominant condition, characterised by the development of multiple osteochondromas. Patients may develop significant bone deformity in their lower limbs. These abnormalities, inequality of lower limb length and angular deformity (varus or valgus) of the knee and ankle joints may predispose the joints to premature degeneration, eventually requiring joint replacement surgery. We report a case of a 54-years old HME-affected male patient, who initially developed pain of his right ankle joint due to valgus malalignment. Seven years later he developed early medial compartment osteoarthritis of the left knee as a result of pronounced varus malalignment of the joint line. Methods: According to long standing radiographs right tibio-talar angle showed a valgus malalignment of 21° in the frontal plane. Correction was performed with closing varus osteotomy at the supramalleolar level of the distal tibia. Concerning the left knee, a 24° of varus deformity of the distal femur (mLDFA 108°) and a 19° of valgus deformity of the proximal tibia (mMPTA 106°) were measured, resulting in a overall varus orientation of the joint line. Operative realignment of the knee joint required double level correction, with combined medial closing wedge osteotomy of the proximal tibia and medial opening wedge osteotomy of the distal femur, inserting the tibial wedge into the femoral osteotomy gap. Results: After both interventions the patient achieved considerable pain relief. After correction of the valgus malalignment of the right ankle joint a nearly physiologic 4° valgus angle and a recentered mechanical leg axis were obtained. Overall correction of the left knee joint line was achieved as planned, with residual undercorrection of the distal femur (mLDFA 100°) and optimal correction of the proximal tibia (mMPTA 90°). The resulting partially arthritic and deformity dependent varus alignment will be corrected at the time of later knee arthroplasty. Conclusion: Pronounced bone deformities in HME disease may lead to severe joint malalignments increasing the risk for early osteoarthritis in the biomechanically stressed joint compartment. Apart of symptomatic pain relief, operative correction of malalignment with varus and/or valgus realignment osteotomies may reduce the overload of the affected joint and may in turn delay progression of arthritic degeneration and need for early joint replacement. |