Correction of Varus and Valgus Knee Misalignments via Tibial Osteotomies

Victoria
1, Baker

Winston

1, Reece

Juan J.

2, Rodrigo

John D.

1 DesJardins

1Department

of Bioengineering, Clemson University, Clemson, SC 2Steadman Hawkins Clinic of the Carolinas, Greenville, SC

Abstract
Tibial osteotomies are procedures used mainly to correct misalignments of the knee in the varus (bowlegged) or valgus (knock-kneed) directions. Surgeons insert a wedge of varying size on the medial side of the knee in varying angles in order to raise one side of the knee and, therefore, correct the joints alignment. Classically, surgeons chose wedge angle based rough X-ray calculations and size based on available bone donor stock. This project seeks to develop a comprehensive rubric for osteotomy size and angle selection based on experimental measurement.

Methods
Valgus Correction (Degrees)

Results:
Effect of Wedge Rotation and Height on Valgus Correction SMALL
30 25 20

Small 10 mm
15

Small 12.5 mm Small 15 mm Small 17.5 mm

10

0 -100 -80 -60 -40 -20 0 20 40 60 80 100

-Anterior/+Posterior Wedge Rotation (Degrees)

Posterior Tilt (Degrees)

Introduction
Upon arrival at EUREKA!, our project had already been begun by a former graduate student of Clemson University. Each bone model had been created, cut, and potted, and the surgical wedges had been cut to the specified sizes of 10, 12.5, 15, and 17.5 mm for each of the three bone sizes. We were challenged to complete the dataset and analyze the results.

Pictures were taken in order to measure the angles formed by the insertion of each wedge.

Effect of Wedge Rotation and Height on Posterior Correction SMALL

30 25 20 15 10 5 0 -100 -80 -60 -40 -20 -5 -10 -15 -20 -25 -30 0 20 40 60 80 100

Small 10 mm Small 12.5 mm Small 15 mm Small 17.5 mm

-Anterior/+Posterior Wedge Rotation (Degrees)

Methods
1. Construct a metal stand for stabilization of the bone models and camera. 2. Gather small, medium, and large size bones along with corresponding wedges in sizes 10mm, 12.5mm, 15mm, and 17.5mm as specified by surgical guidelines. 3. Place the small bone in the stabilizing stand and begin with the 10mm wedge fitting in normal anatomical position. 4. Using a digital camera, snap a photograph from the superior, anterior, and lateral views of the bone. 5. Continue by rotating the wedge 8 times in the medial and lateral directions taking the three photographs at each rotation. 6. Repeat Steps 3-5 for medium and large bone models. 7. Conduct image analysis to determine the angle made by the wedge at each rotation. 8. Create graphs for the data.

The following are the various wedges used for each bone. For each the small, medium and large bones, there are four wedges in sizes 10mm, 12.5mm, 15mm, and 17.5mm

As a result of our project, several charts and graphs were created as a reference point for surgeons to choose the most beneficial wedge size and angle for each patient. With these results, surgeries can be much more precise than previous procedures and hopefully, results will be much more satisfactory and longer lasting.

Discussion:
The project was originally begun after a surgeon requested research in order to create a rubric for more exact measurements of wedge size and angle for use in patients of various sizes. Prior to this project, the surgeon used only approximations and guesses as to what size and angle would be most beneficial to aiding the patients misalignment. After completion of this project, surgeons will have access to a more exact rubric for selection of surgical wedges which will provide a more accurate surgical procedure and longer lasting results.

Conclusion:
During EUREKA!, our project has continued to progress towards its goal. Over the past five weeks, we have collected an entirely new data set in order to try to create more exact results for the surgical wedge rubric. With the new data, the rubric will be more precise for future surgical procedures and therefore, create better results for the patients.

Acknowledgement: Clemson University and the Calhoun Honors College are gratefully acknowledged for support of the EUREKA! Program. Presented at 2011 EUREKA! Poster Forum, Clemson, SC. August 26, 2011.