Paley Principles Of Deformity Correction Pdf - Download Free Apps
Bone factors consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodeling. The pathologic structures which cause the valgus deformity are mainly bony and soft tissue related. But in those patients who undergo total knee replacement, osteoarthrosis remains the most common cause. Persistence of genu valgum from childhood may exist secondary to metabolic disorders, such as rickets and renal osteodystrophy.
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Valgus deformity in adults is most commonly seen in patients with inflammatory arthritis, tibial malunion, physeal arrest or tibial plateau fracture. It can be congenital or secondary to osteoarthrosis, rheumatic diseases and post-traumatic arthritis and due to an over-correction consequent to a valgus osteotomy. The causative factors for valgus deformity of the knee are described as many. This malalignment results in an increased rate of progression of osteoarthrosis in the knee is proven in animal models. Varus or valgus malalignment has a tremendous influence on the loading of the articular surfaces of the knee. According to Paley and Tetsworth, the knee joint is not perpendicular to the mechanical axis of the lower limb but internally rotated at 3°. Since the weight-bearing axis of the lower limb follows the mechanical axis, a valgus alignment will increase the load in the lateral compartment of the knee. Valgus deformity is usually defined when the anatomical tibiofemoral angle is equal to or greater than 10°.
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Varus alignment is more common in males than in females. A line that falls towards the lateral side of the knee indicates that the lower extremity is in valgus. Normal alignment is defined when this line passes through the centre of the knee. Normal mechanical axis of the knee is defined as a line that passes from the centre of the hip to the centre of the ankle. Mechanical tibiofemoral angle (1.3 ± 2° varus) or anatomical tibiofemoral angle (6 ± 2° valgus) can be used to denote normal knee joint alignment. The former is at 5–7° valgus to the anatomical axis ( Figure 1 ). Mechanical axis of the femur is different from that of anatomical axis. In the case of straight bone like the tibia, both mechanical and anatomical axes are the same. Mechanical axis is the axis or the line of weight bearing through the bone.
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Mechanical axis and anatomical axis are the two alignment parameters in the lower extremity. This chapter structure wise describes the pathology, classification of valgus deformity, radiographic planning, surgical approaches, method of valgus deformity correction, implant selection, associated deformities, precautions and intraoperative complications. The long-term results in valgus knees are relatively inferior to those with varus deformity. Obtaining an accurate axis restoration, component orientation and joint stability in a valgus knee with combined bony and ligamentous pathology may be a difficult task. Proper preoperative planning, clinical examination, necessary implant backup and good operative skill are mandatory to manage bone deformities or soft tissue pathology or both in valgus deformity. Various sequences have been described to achieve balancing while doing a total knee replacement. Bone defects like lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodeling along with soft tissue pathologies like tight lateral collateral ligament (LCL), posterolateral capsule (PLC), popliteus tendon (POP), hamstring tendons, the lateral head of the gastrocnemius (LHG) and iliotibial band (ITB) can add to the magnitude of valgus deformity. The deformity can be caused by either bony or ligamentous pathology or both. Valgus deformity in total knee replacement is a much lesser encountered problem than varus deformity.