Deformities Around The Knee PDF

Deformities Around the Knee Knee deformities are a common orthopedic issue affecting individuals of all ages. These deformities can cause pain, instability, and limitations in daily activities. Dr. Mohamed Nabil  Planes of Motion at the Knee...

Deformities Around the Knee Knee deformities are a common orthopedic issue affecting individuals of all ages. These deformities can cause pain, instability, and limitations in daily activities. Dr. Mohamed Nabil  Planes of Motion at the Knee The knee joint demonstrates complex biomechanics through three primary planes of motion: Sagittal Plane Coronal Plane Transverse Plane Enables flexion and extension movements Facilitates varus and valgus motion Allows rotational movements of the knee of the knee joint  Common Deformities Varus Deformity Valgus Deformity Flexion Deformity Extension Deformity Knee alignment is inward, Knee alignment is outward, Knee is fixed in a bent position. Knee is fixed in a straight causing a "bow-legged" causing a "knock-kneed" Causes include muscle position. Causes include muscle appearance. Causes include appearance. Causes include contractures, nerve damage, or contractures, nerve damage, or osteoarthritis, trauma, and ligament injuries, bone joint stiffness. joint stiffness. growth disorders. deformities, and arthritis.  Coronal Deformities Coronal deformities are deviations from the normal alignment of the knee joint in the frontal plane. These deviations can be varus (bow-legged) or valgus (knock- kneed), affecting the overall knee structure and function.  Sagittal Deformities Sagittal deformities involve deviations in the knee joint's alignment along the sagittal plane Recurvatum \ Procarvatum.  Rotational Deformities Rotational deformities affect the alignment of the leg and foot in relation to the knee joint. These deformities can cause pain, instability, and difficulty walking. OUT-TOEING \ IN-TOEING  STAHELI PROFILE FOR ROTATION DEFORMITIES The Staheli profile is a widely used tool for assessing rotational deformities of the lower extremities. It utilizes standardized measurements to evaluate the alignment of the femur, tibia, and foot. The profile helps identify the degree and type of rotational deformities, facilitating appropriate treatment planning and predicting potential outcomes.  Causes of Knee Deformities Physiological Congenital 0-2 yrs varus These deformities are present at birth and can be caused by genetic factors or problems during 2-3 yrs valgus fetal development. Examples include Blount's 4-5 yrs maximum valgus disease and genu varum. 7 yrs decreased to normal valgus Acquired Traumatic These deformities develop over time due to These deformities are caused by injuries, such as factors like Rickets, osteoarthritis, rheumatoid fractures or ligament tears. These injuries can arthritis, or bone tumors. They may also be lead to instability, malalignment, or malunited. caused by repetitive stress, such as from sports Examples include genu valgum and genu or overuse. recurvatum. Ligamentous hyper-laxity  Clinical Evaluation Process Patient History 1 Gather information about the patient's symptoms, onset, and progression. Physical Examination 2 Assess the patient's gait, range of motion, alignment, and tenderness. Neurovascular Assessment 3 Check for any signs of nerve or blood vessel compression. Functional Assessment 4 Evaluate the patient's ability to perform daily activities. The evaluation is crucial for identifying the underlying cause of the knee deformity and developing a personalized treatment plan.  Radiographic Assessment Techniques Radiographic assessment is a vital component in diagnosing and managing knee deformities. Standard radiographic views, including anteroposterior (AP), lateral, and sunrise views, are crucial for evaluating alignment and assessing the severity of deformities. AP views assess joint space and alignment. Lateral views evaluate joint space, tibial slope, and patellofemoral joint. Sunrise views are useful for assessing the patellofemoral joint and for evaluating potential for patellofemoral instability. CR long film standing with patella facing forward  Classification of Knee Deformities Radiographic Analysis Angle Measurement Medical imaging plays a crucial role in Angles such as the mechanical axis deviation identifying and classifying knee deformities. and the hip-knee-ankle angle are measured to quantify the deformity. Alignment Assessment Deformity Categories The alignment of the femur, tibia, and patella is Knee deformities are categorized into varus assessed to determine the type and severity of (bowleg), valgus (knock-knee), and combined the deformity. deformities.  Mild Deformities: Conservative Management Physical Therapy Bracing Weight Management Lifestyle Modifications Strengthening exercises target Custom-fitted braces support Excess weight puts stress on quadriceps and hamstrings. the knee and reduce stress. It the knee joint. Losing weight Avoid high-impact activities Stretching improves flexibility can help maintain alignment can reduce pain and improve like running or jumping. Use and range of motion. and reduce pain. function. assistive devices such as canes or walkers.  Moderate Deformities: Surgical Intervention 1 Osteotomy 2 High Tibial Osteotomy Osteotomies are bone-cutting This procedure involves cutting the procedures, used to realign the knee tibia just below the knee to realign joint. They involve precisely cutting the knee joint. The bone is then fixed the bone and repositioning it to in its new position using screws or improve the alignment of the leg. plates. 3 Distal Femoral Osteotomy 4 Joint Replacement This procedure involves cutting the For severe cases with arthritis , a total femur just above the knee joint. The knee replacement might be needed. bone is then fixed in its new position This procedure involves removing to correct the alignment. damaged cartilage and bone and replacing it with an artificial joint. Corrective Osteotomies: Principles and Techniques Osteotomy is a surgical procedure involving cutting a bone to correct deformities, improve alignment, and reduce pain. Osteotomies are a common treatment option for knee deformities, particularly those that are not severe. Planning 1 Precise planning and detailed pre-operative assessment Osteotomy 2 Open wedge\ closing \dome Fixation 3 Stable fixation with plates, screws, or external fixators Rehabilitation 4 Progressive rehabilitation program to restore function  Osteotomy Types Open Wedge Osteotomy Closing Wedge Osteotomy Dome Osteotomy A bone cut is created, then the bone is A wedge of bone is removed and the A curved cut is made, typically used for opened, creating space for correction. remaining bone is closed, bringing the bone correcting deformities in the femur. ends closer.  High Tibial Osteotomy (HTO): Indications and Outcomes High tibial osteotomy (HTO) is a surgical procedure that involves cutting and realigning the tibia, the larger bone in the lower leg. This procedure is typically performed to correct varus deformities (bowleggedness) of the knee, often due to osteoarthritis. 80% Success Rate HTO has a high success rate in relieving pain and improving knee function. 70% Pain Reduction Many patients experience significant pain reduction following HTO. 2-5 Years Outcomes Positive outcomes are typically observed within 2-5 years post-surgery.  Distal Femoral Osteotomy (DFO) Outcomes DFO Procedure Indications Outcomes Distal femoral osteotomy (DFO) is a DFO is indicated for knee deformities DFO can effectively improve knee surgical procedure that involves cutting where the knee joint alignment is altered, alignment, reduce pain, and enhance the distal femur to correct deformities like leading to pain, instability, and functional functional mobility in patients with knee varus or valgus deformities. limitations. deformities. The procedure involves making a precise It is typically performed on patients with a Studies have shown that DFO is an cut in the femur, followed by well-defined and correctable knee effective treatment option for knee repositioning the bone fragments and deformity. The procedure is often deformities, leading to improved knee fixing them with plates or screws. combined with other corrective function, reduced pain, and increased procedures, such as tibial osteotomy. mobility. However, the success rate can vary depending on the severity of the deformity, patient factors, and surgical technique.  Multi-level Deformity Correction 1 Planning and Assessment Careful pre-operative planning is critical for achieving optimal results. It involves detailed physical examination, radiographic evaluation, and 3D modeling. 2 Surgical Correction This involves addressing deformities at multiple levels of the leg, including the femur, tibia, and ankle. Different surgical techniques may be employed based on the specific deformity. 3 Post-operative Management After surgery, patients undergo a structured rehabilitation program involving physical therapy, bracing, and weight-bearing restrictions to optimize healing and function.  Limb Lengthening Techniques External Fixation Ilizarov Technique Intramedullary Nail External fixators stabilize and lengthen A common external fixation method, it uses An internal method where a nail is inserted bones. They provide a controlled, gradual circular frames and wires to stabilize the within the bone, allowing for lengthening by lengthening process. bone. distraction.  Management of Complex Deformities 1 Multidisciplinary Approach 2 Advanced Imaging Techniques Complex knee deformities often Detailed imaging studies like CT require a team of specialists scans and 3D reconstructions are including orthopedic surgeons, essential for planning complex physiatrists, and physical therapists. procedures. 3 Custom-Made Implants 4 Minimally Invasive Techniques These implants can be tailored to the patient's unique anatomy, When possible, minimally invasive improving the accuracy and success techniques are preferred to reduce of surgery. post-operative pain and recovery time.  Pediatric Knee Deformities: Considerations and Treatments Developmental Considerations Treatment Strategies Children's bones and growth plates are still developing, affecting Non-operative methods like bracing or physical therapy are often treatment approaches. The growth plates influence the response to the first line of treatment. Surgery is considered when deformities surgical interventions. are severe or fail to respond to conservative management. Growth plates are areas of rapidly growing cartilage near the ends of long bones. These plates can be damaged during surgery, which The choice of surgical technique depends on the child's age, the can impact bone growth. type and severity of the deformity, and the growth potential of the child's bones.  Guided Growth Technique for Knee Deformities in Pediatrics Guided growth techniques offer a minimally invasive approach for treating knee deformities in growing children. These techniques use 8-plates or screw to influence bone growth, correcting deformities gradually over time. Rehabilitation and Post-operative Care Initial Stage Focuses on reducing pain, swelling, and inflammation. Rest and ice application Compression and elevation Pain management medications Intermediate Stage Emphasizes regaining range of motion, strength, and flexibility. Gentle exercises and physical therapy Gradual weight-bearing progression Improving functional activities Advanced Stage Focuses on restoring full functional capacity and returning to activities. Strengthening and endurance exercises Proprioceptive training for balance and coordination Progressive return to sports and activities  Complications and Preventive Strategies Infection Malunion Neurovascular Injury Rehabilitation Aseptic loosening, deep vein Osteotomy can lead to delayed Careful pre-operative planning Adherence to a post-operative thrombosis, and wound healing union or nonunion, requiring and surgical technique are rehabilitation program is issues can occur. revision surgery. crucial to minimize risks. essential for optimal outcomes.  Key Takeaways and Conclusion Understanding Knee Deformities Multifaceted Approach Knowledge of knee deformities is essential for orthopedic surgeons, Management of knee deformities involves a comprehensive approach, ensuring correct diagnosis and treatment. encompassing evaluation, classification, and treatment. Tailored Treatment Plans Focus on Rehabilitation Treatment options vary based on the severity and nature of the deformity, Rehabilitation plays a crucial role in restoring function, improving mobility, ranging from conservative measures to corrective surgeries. and achieving optimal outcomes.  Knee Replacement Surgeries Knee replacement surgery is a common procedure that can restore mobility and improve quality of life for individuals suffering from severe knee pain and dysfunction. Dr. Mohamed Nabil  Overview of the Knee Joint Complex Joint Ligaments and Tendons Cartilage and Meniscus The knee joint is a complex hinge joint Strong ligaments provide stability, while Cartilage cushions the bones, and the meniscus connecting the thighbone (femur) to the tendons connect muscles for movement. acts as a shock absorber. shinbone (tibia).  Common Knee Conditions Requiring Replacement Knee Injuries Osteoarthritis Rheumatoid Arthritis Severe injuries, such as a torn ACL or A chronic autoimmune disorder in which the The most common type of arthritis. It occurs meniscus, can lead to chronic pain and which the body's immune system attacks the occurs when the cartilage that cushions the instability.. arthritis. attacks the joints. the ends of bones wears down over time. time.  Causes and Symptoms of Osteoarthritis Wear and Tear Genetics Over time, the cartilage that Some people are genetically cushions the knee joint can wear predisposed to developing wear down, leading to bone-on- osteoarthritis, making them more on-bone friction. more susceptible. Injury Obesity Previous knee injuries, such as Excess weight puts extra stress on ligament tears or fractures, can on the knee joint, accelerating increase the risk of osteoarthritis. cartilage deterioration. osteoarthritis.  Determining Candidacy for Knee Replacement Pain and Stiffness Persistent pain and stiffness despite conservative treatments. Functional Limitations Difficulty with daily activities, such as walking, climbing stairs, and getting in and out of chairs. Osteoarthritis Severe osteoarthritis, where joint damage is advanced. Medical History Review of medical history, including previous surgeries and conditions. Physical Examination Physical assessment of knee joint, including range of motion and stability. Imaging Tests X-rays, MRI scans, and other imaging tests to assess the severity of knee joint damage.  Types of Knee Replacement Procedures Total Knee Replacement This involves replacing all three joint surfaces of the knee with artificial components. Total knee replacement is the most common type of knee replacement. Partial Knee Replacement  Types of Total Knee Replacements (TKR) Cruciate-Retaining (CR) Posterior-Stabilized (PS) Constrained Design Rotating Platform (RP) (PS) Specifically designed for cases with Incorporates a mobile bearing Preserves the ACL and PCL Features specialized metal posts at severe ligament instability, bearing design that enables ligaments to maintain natural the back of the implant to provide providing controlled knee motion smoother and more natural knee knee stability during movement enhanced stability knee movement movement  Preoperative Evaluation and Preparation A comprehensive evaluation is crucial to determine candidacy for knee replacement surgery. This evaluation helps assess the severity of your knee condition and identify any potential risks. Medical History 1 Detailed review of past illnesses, medications, and surgeries Physical Exam 2 Evaluation of your knee joint, range of motion, and overall health Imaging Studies 3 X-rays, MRI, and other imaging tests to assess the condition of your knee Blood Tests 4 Evaluation of your overall health and identify potential risks Once your evaluation is complete, your surgeon will discuss the details of your knee replacement procedure, including the risks and benefits. Surgical Technique & Approach Approach Knee replacement surgery typically involves an incision on the front of the knee knee {anterior midline incision - medial parapatellar - femoral & tibial cut then then prosthesis component}.  Surgical Risks and Complications 1 Infection 2 DVT 3 Dislocation While rare, infection can occur after any Blood clots can form in the legs, The knee joint may dislocate, requiring after any surgery. It is vital to maintain potentially traveling to the lungs. requiring realignment and surgery. This maintain excellent hygiene both during Patients should be aware of this risk surgery. This complication is less during and after the procedure. risk and take appropriate precautions. common with modern techniques. precautions. 4 Loose Components Components of the artificial knee joint may loosen, requiring revision surgery. Good implant design minimizes this risk.  Recovery and Rehabilitation Process 1 Post-Operative Care The initial recovery phase involves managing pain and swelling, while promoting wound healing. Regular pain medication Ice packs and elevation Compression bandages 2 Physical Therapy Physical therapy plays a crucial role in regaining strength, flexibility, and mobility. Range of motion exercises Strengthening exercises Balance and gait training 3 Gradual Return to Activity Patients gradually increase activity levels, with a focus on proper form and technique. Walking Stair climbing Light weightlifting  Returning to Daily Activities and Sports Returning to Activities Sports and Exercise Personalized Exercise Plan Patients gradually return to activities like Sports participation depends on the individual's Physical therapy helps strengthen muscles, walking, gardening, and light housework. activity level, the type of knee replacement, improve range of motion, and increase and the surgeon's guidance. endurance.  Long-Term Outcomes of Knee Replacement Pain Relief Improved Function Knee replacement surgery aims to Patients can often return to many of significantly reduce pain and improve of their daily activities and enjoy a improve mobility. higher quality of life. Increased Mobility Improved Quality of Life Knee replacement can help individuals The positive impact of knee individuals regain a good range of replacement on pain, function, and motion, making it easier to walk, climb mobility can lead to a more fulfilling and climb stairs, and participate in physical fulfilling and active lifestyle. physical activities.  Revisions and Revision Surgery Wear and Tear Infection Over time, the implant components Infection after the initial surgery can components can wear down or can lead to implant failure. loosen. Bone Loss Misalignment Bone loss around the implant can Improper implant placement or can compromise its stability. alignment can cause pain or instability.  Patient Selection and Shared Decision-Making Comprehensive Assessment Shared Decision-Making Multidisciplinary Approach A thorough evaluation includes medical history, Patients are actively involved in the decision- A team of specialists, including orthopedic history, physical examination, and imaging decision-making process, discussing risks, orthopedic surgeons, physical therapists, and imaging studies to determine candidacy for risks, benefits, and alternatives to knee and pain management experts, collaborate to for knee replacement surgery. replacement surgery. collaborate to tailor treatment plans.