>> Hi, I'm Dr. Rob Rozbruch.
And I'm going to discuss joint preservation surgery with osteotomy for realignment
of a bowleg in a patient with medial compartment arthritis.
It's important that we have a goal when we're talking about realignment.
And that is, that a line between the hip and the ankle goes through the center of the knee.
That's what assures normal knee mechanics.
As a person has more bowleg or varus deformity, the force on the medial side of the knee,
the inside of the knee goes up, and the force on the outside part of the knee goes down.
And that creates a situation where the deformity overloads the respective compartment
of the knee.
And that's what we're trying to remedy with this approach.
Here's an example of a woman who has large bowleg, alignment deformities,
and advanced medial compartment arthritis of the knee.
Essentially, you've got bone on bone arthritis, related to long-standing,
overload of the medial joint compartment, knee pain, awkward gait, issues with body image,
and here, arthritis has become the problem.
When we plan these surgeries, we use geometry to figure out the angle of the correction
and the location of the osteotomy.
And the typical osteotomy is in the proximal tibia,
just about 2 inches below the knee to realign the leg.
Let's look at Adam, a 55-year-old male who has bilateral bowleg alignment,
as you can see from the long x-ray.
The medial compartments of the knees have been overloaded for years,
and there is moderate medial joint space narrowing and pain.
Here, you can see on the clinical photograph the bowleg alignment corresponding to the x-rays.
Now, our approach here is going to be an opening-wedge osteotomy at the proximal tibia,
illustrated here in this planning radiograph to achieve a normal mechanical axis.
In surgery, we perform the opening-wedge osteotomy and use intra-operative navigation
to confirm that the alignment between hip and ankle is optimal.
The steps of the osteotomy include kind of placement of a wire to plan the location
and orientation of the osteotomy.
The opening-wedge is then filled with a trial, and then this is measured.
And this is replaced with bone graft and a titanium plate and screws.
The joint space congruity improves quite a bit,
as you can see here from the pre-op to the post-op.
The medial joint space has opened up because it is unloaded and the overall congruity
of the joint has improved quite a bit.
So the right side is done.
And now, we are planning to do the left side.
The same thing has been done on the left side with opening-wedge --
-- in, during surgery.
And this is the final clinical and radiographic appearance with correction of the malalignment.
Before and after clinical photographs show a significantly improved appearance.
Adam is very happy.
He walks better.
He feels better, both in terms of his appearance, and his knee pain, and his mobility.
The pre-operative x-rays are shown here
with the large mechanical axis deviation, and this has been corrected.
The joint spaces have improved.
As you can see here on the bottom, the medial joint spaces are unloaded and they are wider
and more symmetrical to the lateral sides.
Now, what I want to show you next is a different example, different patient example
where some intra-articular work was also done.
At the same time that the bowleg was approached, arthroscopic procedure was done and we were able
to identify full thickness cartilage loss on the medial femoral condyle.
This was treated with joint preservation,
cartilage restoration technique here used, microfracture, and stem cells.
The osteotomy was done for realignment.
These are the outcome pictures of the osteotomy and the realignment.
And when we went back a year later to remove the hardware and to repeat the arthroscopy,
you can see how the cartilage has regrown in the area
where there was full thickness cartilage loss.
So this case is a nice example of joint preservation with osteotomy and realignment
for medial compartment arthritis of the knee.
Thanks for your attention.