What’s New in Limb Lengthening and Deformity Correction

Hamdy, Reggie C.; Bernstein, Mitchell; Fragomen, Austin T.; Rozbruch, S. Robert

doi:10.2106/jbjs.16.00460

Cited by 9 publications

(4 citation statements)

References 108 publications

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“…Distraction osteogenesis has been used to treat complex long-bone nonunions associated with segmental defects and infection [14], [15]; however, the application of this technology has evolved to the correction of LLD secondary to many congenital, traumatic, and infectious etiologies [14], [16], [17]. IM lengthening nails provide new opportunities for limb equalization and deformity correction from conventional external fixation [18].…”

Section: Discussionmentioning

confidence: 99%

Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

et al. 2018

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The application of distraction osteogenesis through the use of magnet-operated, remote-controlled intramedullary lengthening continues to provide new opportunities for accurate limb equalization. While limb-length discrepancy and deformity can be addressed by total hip arthroplasty alone, the magnitude of correction is limited by the soft-tissue envelope and complications such as sciatic nerve palsy. This 3-patient case series presents the combination of staged ipsilateral total hip arthroplasty and retrograde intramedullary femoral nail lengthening for the correction of both deformity and limb-length discrepancy. Our results report leg-length equalization, independent ambulation without assistive devices, and excellent bone and functional outcomes without complications, demonstrating that this combined technique can be used to achieve targeted lengthening and deformity correction.

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Section: Discussionmentioning

confidence: 99%

Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

et al. 2018

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“…A novel application of the current study was the use of deep learning to automate the lengths of the femur and tibias individually, in addition to the discrepancies between the femurs and tibias, respectively. When considering the etiology of an LLD, knowledge of disparities in the length of the individual long‐bones of the lower extremity is an important consideration as it may provide insight into where a surgical correction (i.e., targeted lengthening) is necessary [1, 6, 19]. Furthermore, incorporation of the measurement of the femurs and tibias individually may allow for the identification of alternate sources of asymmetry other than developmental etiologies [13].…”

Section: Discussionmentioning

confidence: 99%

Radiographic findings involved in knee osteoarthritis progression are associated with pain symptom frequency and baseline disease severity: a population-level analysis using deep learning

Kunze

Jang

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo (1) develop a deep‐learning (DL) algorithm capable of producing limb‐length and knee‐alignment measurements, and (2) determine the association between limb‐length discrepancy (LLD), coronal‐plane alignment, osteoarthritis (OA) severity, and patient‐reported knee pain. MethodsA multicenter, prospective patient cohort from the Osteoarthritis Initiative between 2004 and 2015 with full‐limb standing radiographs at 12 month follow‐up was included. A convolutional neural network was developed to automate measurements of the hip–knee–ankle (HKA) angle, femur, and tibia lengths, and LLD. At 12 month follow‐up, patients reported their frequency of knee pain since enrollment and current level of knee pain. ResultsA total of 1011 patients (2022 knees, 52.3% female) with an average age of 61.2 ± 9.0 years were included. The algorithm performed 12,312 measurements in 5.4 h. ICC values of HKA and LLD ranged between 0.87 and 1.00 when compared against trained radiologist measurements. Knees producing pain most days of the month were significantly more varus (mean HKA:− 3.9° ± 2.8°) or valgus (mean HKA:2.8° ± 2.3°) compared to knees that did not produce any pain (p < 0.05). In varus knees, those producing pain on most days were part of the shorter limb compared to nonpainful knees (p < 0.05). Baseline Kellgren–Lawrence grade was significantly associated with HKA magnitude, LLD, and pain frequency at 12 month follow‐up (p < 0.05 all). ConclusionA higher frequency of knee pain was associated with more severe coronal plane deformity, with valgus deviation being one degree less than varus on average, suggesting that the knee tolerates less valgus deformation before symptoms become more consistent. Knee pain frequency was also associated with greater LLD and baseline KL grade, suggesting an association between radiographically apparent joint degeneration and pain frequency. Level of evidenceIV case series.

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“…Additionally, Mathavan also suggested that this method can separate bone formation from resorption and thus could be of interest across a wide array of orthopedic applications including as a predictive diagnostic tool to identify if fractures will heal successfully or result in delayed healing or nonunion. There is a review article which reviews techniques in limb lengthening and deformity [ 25 ]. As far as we can determine, our group is the only one using PET/CT bone scanning to evaluate patient treatment with a TSF.…”

Section: Discussionmentioning

confidence: 99%

Can Na18F PET/CT bone scans help when deciding if early intervention is needed in patients being treated with a TSF attached to the tibia: insights from 41 patients

Lundblad

Karlsson-Thur

Maguire

et al. 2020

Eur J Orthop Surg Traumatol

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Purpose To demonstrate the usefulness of positron emission tomography (PET)/computed tomography (CT) bone scans for gaining insight into healing bone status earlier than CT or X-ray alone. Methods Forty-one prospective patients being treated with a Taylor Spatial Frame were recruited. We registered data obtained from successive static CT scans for each patient, to align the broken bone. Radionuclide uptake was calculated over a spherical volume of interest (VOI). For all voxels in the VOI, histograms and cumulative distribution functions of the CT and PET data were used to assess the type and progress of new bone growth and radionuclide uptake. The radionuclide uptake difference per day between the PET/CT scans was displayed in a scatter plot. Superimposing CT and PET slice data and observing the spatiotemporal uptake of 18F− in the region of healing bone by a time-sequenced movie allowed qualitative evaluation. Results Numerical evaluation, particularly the shape and distribution of Hounsfield Units and radionuclide uptake in the graphs, combined with visual evaluation and the movies enabled the identification of six patients needing intervention as well as those not requiring intervention. Every revised patient proceeded to a successful treatment conclusion. Conclusion Numerical and visual evaluation based on all the voxels in the VOI may aid the orthopedic surgeon to assess a patient’s progression to recovery. By identifying slow or insufficient progress at an early stage and observing the uptake of 18F− in specific regions of bone, it might be possible to shorten the recovery time and avoid unnecessary late complications.

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What’s New in Limb Lengthening and Deformity Correction

Cited by 9 publications

References 108 publications

Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

Total hip arthroplasty and femoral nail lengthening for hip dysplasia and limb-length discrepancy

Radiographic findings involved in knee osteoarthritis progression are associated with pain symptom frequency and baseline disease severity: a population-level analysis using deep learning

Can Na18F PET/CT bone scans help when deciding if early intervention is needed in patients being treated with a TSF attached to the tibia: insights from 41 patients

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