Recent studies on fibular osteotomy for varus gonarthrosis and possible subsequent biomechanical changes have attracted increasing attention to the topic. Existing studies have focused mainly on proximal fibular osteotomy with short follow-up periods. The aim of this study was to investigate changes in the alignment of the coronal plane of the ankle and knee joints in patients who underwent vascularized fibula graft harvest (VFGH). The evaluation was based on functional outcomes and radiological measurements.In the comparison between the VFGH side and the contralateral side, no significant differences in the knee inclination (KI) or talar inclination (TI) angle, knee medial clear space (K-MCS) or ankle medial clear space (A-MCS) distance were noted. However, a significant difference in the hip knee (HKA) angle was observed between the operated and nonoperated sides (0.3° ± 1.8° and 1.5° ± 1.9°, respectively [p = 0.019]). Statistically significant differences in both the knee society score (KSS) and the AOFAS scores were found between the ipsilateral donor limb and the contralateral healthy limb. Although the contralateral healthy side had better clinical scores than the VFGH side, the outcomes of the VFGH side were still satisfactory or excellent.

Introduction: Traditionally, in total knee arthroplasty (TKA), it is aimed to keep the mechanical axis of the lower extremity neutral (mechanical alignment: 3° varus-valgus in the coronal plane) to improve long-term outcomes. This study aimed to assess the mid-term radiological and clinical results of patients with postoperative residual varus (more than 3° of varus) after mechanically-aligned TKA. Methods: A total of 616 individuals who had undergone TKA for primary knee osteoarthritis between 2008 and 2013 in our tertiary care hospital were retrospectively examined. All TKAs were performed with the mechanical alignment strategy. For radiological evaluation, hip-knee-ankle (HKA) angle, knee alignment angle (KAA), mechanical medial proximal tibial angle (mMPTA), knee inclination (KI), joint line orientation angle relative to ground (JLOA-G), posterior tibial slope (PS), joint line convergence angle (JLCA) were measured. Besides, patients’ latest radiographs were screened for any clue of aseptic loosening or mechanical failure. Knee Society Score (KSS) (knee and functional subgroups), and Lysholm, Oxford, and Tegner scores were used for clinical evaluation. In addition, knee flexion and extension limitations were assessed. Results: After applying the exclusion criteria, a minimum of five-year follow-up result of 110 patients was demonstrated. There were 101 females (92%) and nine males (8%). The mean follow-up time was 65.8 ± 6.3 months (range: 60.8-75.8 years). The mean age was 65.9 ± 7.7 years (range: 39 to 89 years). The preoperative mean mechanical axis angle of the lower extremity was 17.3° ± 7.8° (range: 13.4-43.9°), whereas it was 8.3° ± 3.6° (range: 3.2-19.8°) postoperatively. The preoperative mean flexion angle was 90.7° ± 23.8° (range: 40-130°), and the extension limitation was -2.5° ± 7.4° (range: -40-0°), whereas, postoperatively, they were 102.8° ± 15.4° (range from 40° to 150°) and -3.7° ± 7.5° (range from -40° to 0°), respectively. The latest follow-up's mean KSS knee subgroup was 67 ± 18.4 (range: 12-93), the mean KSS functional subgroup was 74 ± 23.6 (range: 20-100), the mean Lysholm score was 81.7 ± 15.7 (range:25-100), the mean Tegner score was 3.65 ± 0.99 (range: 1-5), the mean Oxford score was 37.4 ± 6.5 (range: 9-48). There was no patient with aseptic loosening or mechanical failure. Conclusions: In the mid-term follow-up of patients with residual varus after mechanically-aligned TKA, satisfactory clinical and radiological results were obtained without aseptic loosening or implant failure.

Background: Many successful osteotomies have been reported for the treatment of acetabular dysplasia. However, triple pelvic osteotomy remains a technically challenging procedure with potential for significant complications. This study examined a series of Tönnis periacetabular osteotomy (TPAO) procedures performed using the modified Stoppa approach to treat acetabular dysplasia in adolescents. Objective: To describe the radiographic outcomes, complications, and early functional results of TPAO using the modified Stoppa approach for acetabular dysplasia in adolescents. Methods: This study included 16 patients (20 hips) who underwent TPAO using the modified Stoppa approach for symptomatic acetabular dysplasia. The characteristics of the patients and the surgical procedure were discussed. The radiologic outcome was evaluated using the lateral center-edge (CE) and Tönnis roof angles. Perioperative data including surgery duration, blood loss, and complications were recorded. Complications were also discussed. Results: The mean age of the patients was 11.5±1.1 (10 to 13) years. The mean preoperative anteroposterior CE angle was 14.7±3 degrees (7 to 19 degrees), and the mean postoperative angle was 35.7±3.1 degrees (30 to 42 degrees; P<0.001). The mean preoperative Sharp’s angle was 55.9±5.4 degrees (48 to 65 degrees), and the postoperative mean was 33±5 degrees (24 to 40 degrees; P<0.001). The mean Tönnis angle before and after osteotomy was 23.3±7.1 degrees (17 to 36 degrees) and 7.1±2 degrees (4 to 10 degrees), respectively (P<0.001). The mean operative time was 42.2±10.3 minutes with a mean blood loss of 167.7±50.3 mL. One patient sustained a bladder injury as a major complication. Conclusions: The use of TPAO with the intrapelvic modified Stoppa approach in the treatment of hip dysplasia provides the benefits of a single incision, access to 2 hips in the same session, positional advantage, and abductor function preservation. Early results are satisfactory and safe. Level of Evidence: Level IV.

In hip arthroplasties performed on patients with Crowe type 4 dysplasia, femoral shortening is often required to position the hip into the true acetabulum. Nonunion at the osteotomy site is one of the significant comorbidities in osteotomies that lower the hip into the true acetabulum. This study aimed to evaluate the clinical and radiological outcomes of hip arthroplasty with femoral shortening in patients with Crowe type 4 dysplasia using the technique we developed. This study retrospectively evaluated the outcomes of 96 (117 hips) patients who underwent subtrochanteric transverse shortening osteotomy due to Crowe type 4 dysplasia between January 2016 and December 2020, with a minimum follow-up period of 24 months. Harris Hip Score (HHS) was used for clinical evaluation of the patients, followed by comparison of preoperative and postoperative values. Radiological evaluation included assessments of union time, leg length discrepancy, and union rates. Intraoperative and postoperative complications were noted. The HHS had a mean preoperative value of 54.66 ± 7.47 and increased significantly postoperatively to a mean value of 93.82 ± 7.00 (P < .05). Changes in HHS (~39.2) surpass the minimal clinically important difference threshold. At the final follow-up, the union was observed in 115 (98.3%) hips. Despite a follow-up period exceeding 24 months, nonunion was radiologically observed in 2 (1.7%) hips. Our observations had relatively lower rates than those reported in literature. The preoperative and postoperative leg length discrepancies were measured as 5.03 ± 1.09 cm and 0.64 ± 0.74 cm, respectively (P < .05). Intraoperatively, femoral fractures were observed in 12 (10.3%) hips, dislocations in 5 (4.3%) hips, and sciatic nerve injury in 4 (3.4%) hips. In hip arthroplasties performed on patients with Crowe type 4 dysplasia, supporting the strut graft around the subtrochanteric transverse osteotomy site with cancellous bone taken from the trochanter major and femoral head reduces the risk of nonunion, and satisfactory clinical outcomes can be achieved with this method.

Background: To evaluate D-dimer levels in patients with slipped capital femoral epiphysis (SCFE), to investigate their association with disease severity and the development of contralateral slip, and to assess their contribution to existing predictive models. Methods: In this single-center retrospective cohort study, 25 patients with unilateral SCFE diagnosed between January 2020 and April 2024 were included. The control group consisted of age- and sex-matched obese individuals and healthy subjects with normal body mass index (BMI). Clinical variables (age, sex, BMI, stability according to the Loder classification, and chronicity); laboratory parameters [complete blood count, neutrophil-to-lymphocyte ratio (NLR), inflammatory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and coagulation parameters including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer]; and radiographic measurements [Southwick angle, interhip angle difference, posterior sloping angle (PSA), and modified Oxford bone score (MOBS)] were analyzed. Subgroup analyses based on stability and chronicity were performed, and correlations between D-dimer levels and clinical, laboratory, and radiographic parameters were assessed. Multivariable logistic regression models were constructed to predict contralateral slip, and model performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: D-dimer levels were significantly higher in the SCFE group compared with both obese and healthy control groups ( P <0.001). D-dimer showed positive correlations with CRP and NLR and negative correlations with the MOBS and the interhip Southwick angle difference. Higher D-dimer levels were observed in unstable and acute-on-chronic cases ( P <0.001). During a mean follow-up of 24 months, patients who developed contralateral slip had significantly higher D-dimer levels ( P =0.002). The addition of Southwick angle difference to a baseline model including age and MOBS increased the AUC from 0.73 to 0.80, while further inclusion of D-dimer improved the AUC to 0.87. However, the increase in AUC after addition of D-dimer was not statistically significant according to the paired DeLong test ( P =0.18). Conclusion: D-dimer levels are associated with disease severity and the risk of contralateral slip in SCFE. Incorporation of D-dimer into established clinical and radiographic parameters improved predictive model performance. These findings support the role of inflammatory and microvascular processes in the pathogenesis of SCFE and suggest that D-dimer may serve as a useful adjunct biomarker for risk stratification. Levels of Evidence: Level III—retrospective cohort study.