To what extent can success be attributed to planning? As with most things in life it undoubtedly helps, and in orthopaedic surgery there are many good reasons to use digital planning tools for both complex and simple procedures, given that digital images and picture archiving and communication systems (PACS) are now the norm in most hospitals.
SOFCOT, or the Congress of the French Society of Orthopaedic Surgery and Traumatology, is the biggest congress of its kind for the French-speaking world. Annually held in Paris, the trade show is the place to be for orthopaedic surgeons, giving them an opportunity to get up to date with the latest techniques, publications and technology.
When Dr. Noble, an orthopaedic surgeon specializing in total joint replacement at Palm Beach Orthopaedic Institute, FL, found himself without hard copy X-rays to plan his hip and knee arthroplasty procedures, he took a leap towards digital pre-operative planning.
30-year-old Partiban from Malaysia was an avid futsal player until he started noticing pain in his left knee throughout one year. The pain worsened until he had difficulties squatting and running; it eventually caused him to stop playing futsal. The patient was referred to Prof. Dr. Azhar M. Merican, who deduced that the underlying cause for the pain was a deformity of the patient’s left upper tibia. The deformity was due to the malunion of a fracture sustained in a motor vehicle accident when the patient was 14 years old. At the time, the fracture had been treated with a plaster cast.
Dr. Matthew Allen, Professor of Small Animal Surgery at the University of Cambridge, was faced with a challenging case when he encountered Bella, a Romanian Bucovina shepherd dog. Bella was plagued by severe mobility problems, and her owner was initially referred to Dr. Allen to assess the feasibility of a knee replacement. However, due to the aggressive nature of a total knee replacement and the fact that the bone of Bella’s knee joint was only partly damaged, Dr. Allen tried to come up with a different approach.
For patients with early stages of osteoarthritis, high tibial osteotomy (HTO) can be a useful treatment option. In the closing-wedge version of this operation, a wedge of bone is cut out of the lateral side of the tibia, whereas with the opening-wedge osteotomy, a bone graft is inserted in a cut made on the medial side. Both realign the knee and relieve pressure from the joint. The closing-wedge technique is more common, but recently, the opening-wedge osteotomy has become more popular since it is less invasive and possibly results in less deformity of the proximal tibia.