SYMPOSIUM: 2013 LIMB LENGTHENING AND RECONSTRUCTION SOCIETY What Risk Factors Predict Usage of Gastrocsoleus Recession During Tibial Lengthening?

Abstract Background Tibial lengthening is frequently associated with gastrocsoleus contracture and some patients are treated surgically. However, the risk factors associated with gastrocsoleus contracture severe enough to warrant surgery during tibial lengthening and the consistency with which gastrocsoleus recession (GSR) results in a plantigrade foot in this setting have not been well defined. Questions/purposes We compared patients treated with or without GSR during tibial lengthening with respect to (1) clinical risk factors triggering GSR use, (2) ROM gains and patient-reported outcomes, and (3) complications after GSR. Methods Between 2002 and 2011, 95 patients underwent tibial lengthenings excluding those associated with bone loss; 82 (83%) were available for a minimum followup of 1 year. According to our clinical algorithm, we performed GSR when patients had equinus contractures of greater than 10°while lengthening or greater than 0°before or after lengthening. Forty-one patients underwent GSR and 41 did not. Univariate analysis was performed to assess independent associations between surgical characteristics and likelihood of undergoing GSR. A multivariate regression model and receiver operating characteristic curves were generated to adjust for confounders and to establish risk factors and any threshold for undergoing GSR. Chart review determined ROM, patient-reported outcomes, and complications. Results Amount and percentage of lengthening, age, and etiology were risk factors for GSR. Patients with lengthening of greater than 42 mm (odds ratio [OR]: 4.13; 95% CI: 1.82, 9.40; p = 0.001), lengthening of greater than 13% of lengthening (OR: 3.88; 95% CI: 1.66, 9.11; p = 0.001), and congenital etiology (OR: 1.90; 95% CI: 0.86, 4.15; p = 0.109) were more likely to undergo GSR. Adjusting for all other variables, increased amount lengthened (adjusted OR: 1.05; 95% CI: 1.02, 1.07; p \ 0.001) and age (adjusted OR: 1.02; 95% CI: 0.99, 1.05; p = 0.131) were associated with undergoing GSR. Patients gained 24°of ankle dorsiflexion after GSR. Selfreported functional outcomes were similar between patients with or without GSR. Complications included stretch injury to the posterior tibial nerve leading to temporary and partial loss of plantar sensation in two patients

Staged Extra-Articular Deformity Correction in the Setting of Total Knee Arthroplasty

Background: Extra-articular lower-leg deformities mandate unique considerations when planning total knee arthroplasty (TKA). Poor limb alignment may increase perioperative complications and cause early implant failure. This study reports on the safety and efficacy of staged, extra-articular deformity correction about the knee in the setting of osteoarthritis and TKA. Methods: A retrospective review was conducted from December 2007 to December 2019 identifying 30 deformities in 27 patients (average age: 52.7 years; range 31-74) who underwent staged surgical correction of extra-articular deformity in preparation for TKA. Patient demographics, surgical details, clinical and radiographic measurements, severity of knee arthritis, and complications were collected. Results: There were 17 femur and 12 tibia deformities. There was an average improvement of 14.7° of deformity measured in the coronal plane and 12.7° of deformity in the sagittal plane in the femur and 13.5° in the coronal plane and 10.3° in the sagittal plane in the tibia. Leg length discrepancies improved by 26 mm on average (1-100 mm). After an average 3.1-year follow-up, 12 out of 27 patients proceeded with primary or revision TKA. There were no cases of blood transfusion, nerve palsy, or compartment syndrome, and all patients achieved bony union. Conclusions: Staged, extra-articular deformity correction is a safe and effective approach to improve limb alignment in the setting of knee osteoarthritis and TKA