Does the Taylor Spatial Frame accurately correct tibial deformities?

Abstract

Background: Optimal leg alignment is the goal of tibial osteotomy. The Taylor Spatial Frame (TSF) and the Ilizarov method enable gradual realignment of angulation and translation in the coronal, sagittal, and axial planes, therefore, the term six-axis correction.

Questions/purposes: We asked whether this approach would allow precise correction of tibial deformities.

Methods: We retrospectively reviewed 102 patients (122 tibiae) with tibial deformities treated with percutaneous osteotomy and gradual correction with the TSF. The proximal osteotomy group was subdivided into two subgroups to distinguish those with an intentional overcorrection of the mechanical axis deviation (MAD). The minimum followup after frame removal was 10 months (average, 48 months; range, 10-98 months).

Results: In the proximal osteotomy group, patients with varus and valgus deformities for whom the goal of alignment was neutral or overcorrection experienced accurate correction of MAD. In the proximal tibia, the medial proximal tibial angle improved from 80 degrees to 89 degrees in patients with a varus deformity and from 96 degrees to 85 degrees in patients with a valgus deformity. In the middle osteotomy group, all patients had less than 5 degrees coronal plane deformity and 15 of 17 patients had less that 5 degrees sagittal plane deformity. In the distal osteotomy group, the lateral distal tibial angle improved from 77 degrees to 86 degrees in patients with a valgus deformity and from 101 degrees to 90 degrees for patients with a varus deformity.

Conclusions: Gradual correction of all tibial deformities with the TSF was accurate and with few complications.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–I

(A) The preoperative front view of a 49-year-old woman with a varus deformity of the tibia is shown. (B) The preoperative AP radiograph shows 46° varus. (C) The preoperative bipedal 51-inch radiograph shows a MAD of 127 mm medial to midline, MPTA of 40°, and 6.5 cm LLD. (D) A front view of the leg after surgery shows the TSF applied to match the deformity. (E) A front view obtained 5 months after surgery shows correction of the deformity and LLD. The time of deformity correction was 86 days. (F) An AP radiograph obtained 5 months after surgery shows correction of the deformity. There is intentional lateral translation of the diaphysis through the regenerate bone. (G) A front view was obtained 3 months after frame removal. The total time wearing the frame was 193 days. (H) A bipedal 51-inch radiograph was obtained 3 months after frame removal, the LLD was 1 cm and the MAD was 12 mm lateral to the midline. (I) An AP radiograph of the knee 12 months after frame removal shows bony remodeling. MAD = mechanical axis deviation; MPTA = medial proximal tibial angle; LLD = leg-length discrepancy.