Dr. Neville Strick
Dr. Neville Strick completed his undergraduate and junior doctor training in South Africa in 1993, and his orthopaedic training in New Zealand, specializing in knee and hip surgery. His public hospital practice includes lower limb trauma and complex primary and revision arthroplasty, which he combines with teaching registrars and medical students. Dr. Strick has been using OrthoView to plan his procedures since 2009.
The patient (male, age 53) has a history of hypophosphatemic rickets. The associated bone abnormalities and leg mal-alignment had been addressed by bilateral closing wedge tibial osteotomies when the patient was approximately 40 years of age. The patient was now experiencing pain in both knees and was having difficulty walking.
Considering the right leg first, examination of the long leg weight bearing AP x-ray shows good mechanical axis alignment but a significantly oblique knee joint line. It was apparent that mild osteoarthritis had become worse over time, presumably as a result of the joint obliquity.
Surgical strategies were now considered.
Whilst combined femoral and tibial osteotomies could have corrected the joint obliquity, it was judged that the joint surfaces were too badly damaged. A total knee replacement (TKR) would replace the worn joint surfaces; however, it would not be possible to achieve correct alignment with a TKR alone since this would involve cutting ligaments. A combined proximal tibial osteotomy and TKR were therefore proposed and the subject of a detailed pre-operative plan.
Post-op Films & Discussion
The trials for the knee replacement were fitted first, and the knee joint determined to be a good functional fit - ligament balance with the cuts required being a major consideration. The osteotomy followed with disruption of the fibula to perform the inverted dome osteotomy and the use of the revision stem to anchor the bone, along with a small plate for added support. Bony union was anticipated to be adequate due to the nature of the dome osteotomy
At his 6-week return assessment, the patient was pleased with the progress and results and is now preparing for the left lower limb to also be repaired to improve function via a similar method. The union is progressing well with subsequent follow up, and the patient remains very happy with the outcome.
Clearly pre-operative planning is essential with a case like this. In times gone by, planning this surgery would have required the surgeon to trace the x-ray images and apply multiple bits of paper to go through the above steps. This study describes a “final draft” of the plan but the software allows many ‘what if’ scenarios, with the ability to very easily return to the beginning of a step. In a case like this, it is gratifying when the templating steps match the intra-operative steps very closely, and having used OrthoView software for multiple complex cases, I can safely say this is a consistent outcome. I would also say that the more complex the case, the more useful the planning software is.
Materialise OrthoView is a digital templating solution used by orthopaedic surgeons to create detailed pre-operative plans quickly and easily from digital x-ray images. Materialise OrthoView facilitates digital planning and templating for joint arthroplasty and revisions, trauma, limb deformity correction, osteotomy and spinal assessment and is chosen by hospitals worldwide to complete their target of film-free radiology.