Outcomes of Ankle Arthroplasty with Preoperative Varus Deformity of More Than 20 Degrees: Comparison with the Group of Varus Deformity of Less Than 20 Degrees / 대한족부족관절학회지

PURPOSE: We compared the results of total ankle arthroplasty in patients with preoperative varus deformity of more than 20degrees with those of patients with varus deformity less than 20degrees. MATERIALS AND METHODS: From January 2005 to January 2013, 9 ankles with preoperative varus deformity of more than 20degrees (varus group) and 31 ankles with varus deformity less than 20degrees (control group) underwent total ankle arthroplasty. Clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score, and radiographic results were assessed using tibiotalar varus angle in standing anteroposterior radiographs taken preoperatively and at the last follow-up. RESULTS: The mean duration of clinical follow-up was 42.8 months (14~60 months). The AOFAS score was improved by a mean 47.0 points in the varus group and 37.6 points in the control group. Statistically significant difference was observed between the two groups (p=0.041). Tibiotalar varus angle measured at the last follow-up radiograph was 2.5degrees in the varus group and 1.0degrees in the control group and the difference was not statistically significant (p=0.820). CONCLUSION: Satisfactory clinical and radiographic results can be achieved in patients with varus deformity more than 20degrees by precise bone resection and soft tissue release.

What to Predict Favorable Long-Term Sensory Outcome after Surgery for Infantile Esotropia?

PURPOSE: To analyze pre- and post-operative factors associated with favorable long-term sensory outcome after surgical correction for infantile esotropia. METHODS: This study retrospectively examined 40 patients with infantile esotropia who underwent surgery from January 2000 to December 2010. Clinical characteristics analyzed included age at onset, age at surgery, mean preoperative deviation, amblyopia on initial visit, other associated strabismus (Inferior oblique overaction (IOOA), dissociated vertical deviation (DVD), latent nystagmus), initial and subsequent postoperative motor alignment at 1-week and 2-year follow-up, recurrence rate, and stereopsis. Long-term sensory outcome was categorized as favorable (400 arcsec). RESULTS: The mean follow-up period was 92.53 +/- 46.46 months. There were 19 patients (47.5%) in the favorable group and 21 (52.5%) in the unfavorable group. There were no statistically significant differences between the groups with respect to age at onset or surgery, presence of amblyopia, and prevalence of IOOA and DVD, latent nystagmus, or initial postoperative alignment at 1-week. There was a tendency towards worse binocularity with larger preoperative angles of esodeviation, but it was not significant. Binocularity was significantly higher among those who had surgery at age 24 months. Orthotropic alignment within +/-10 PD at 2-year follow-up was 68.4% in the favorable group and 38.1% in the unfavorable group. Reoperation was performed on 8 patients (38.1%) in the unfavorable group and no patients (0.0%) in the favorable group. CONCLUSIONS: Surgical correction of infantile esotropia within the first 2 years of life and maintenance of orthotropic alignment within +/-10 PD without additional surgery with a minimum follow-up of 2 years may be associated with favorable long-term sensory outcome in infantile esotropia.

Postoperative Limb Alignment after Total Knee Arthroplasty Depending on the Severity of the Varus Knee

PURPOSE: We wanted to evaluate the clinical and radiographic results of total knee arthroplasty according to the preoperative varus deformity. MATERIALS AND METHODS: From September 2003 to October 2005, we performed 53 total knee arthroplasties in 38 patients who had varus deformity of more than 10 degrees of the femorotibial angle. The minimum follow-up period was 2 years. According to the severity of the varus deformity, the patients were classified to three groups: patients with a varus deformity 10 to 15degrees (group I, 38 cases), patients with a varus deformity 15 to 20degrees (group II, 7 cases) and patients with a varus deformity more than 20degrees (group III, 8 cases). RESULTS: The mean preoperative HSS scores were 61.0, 57.6 and 55.6 in groups I, II and III, respectively. The mean HSS scores of the each group were 97.5, 96.1 and 96.8, respectively, at the last follow-up (p=0.728). The mean preoperative range of motion of the each group was 118.7degrees, 121.3degrees and 102.5degrees, respectively, and the ROM was 131.8degrees, 130.0degrees and 128. 3degrees, respectively, at the last follow-up (p=0.932). The mean preoperative femorotibial angle of the each group was -12.1degrees, -16.6degrees and -23.8degrees, respectively, and 4.8degrees, 3.0degrees and 2.1degrees, respectively, at the last follow-up (p=0.021). CONCLUSION: Correction of deformity and restoration of the limb alignment provides satisfactory clinical and radiographic results for patient with varus deformity. The postoperative alignment of the residual varus deformity tended to be within the permissible range.