Single Stage Tibial Osteotomy and Long Stem Total Knee Arthroplasty to Correct Adverse Consequences of Unequal Tibial Lengthening with an Ilizarov Circular Fixator

Abstract

Introduction: Correction of limb alignment or length discrepancy by circular external fixation is an accepted technique which relies on the correct biomechanical application of the frame and precise corrections which are frequently delegated to the patient to perform. Errors can occur in the execution of the correction by the patient and may result in significant deformity that requires remedial intervention.

Case report: A 67 Caucasian female underwent multifocal limb reconstruction of the lower limb utilising a complex Ilizarov frame. Attendance at follow-up visits did not occur and the patient presented at 6 months with severe deformity due to incorrect execution of the correction protocol which resulted in a 45 degree varus deformity of the tibia. Subsequent correction via acute tibial osteotomy and stabilisation with a stemmed total knee replacement resulted in a good outcome.

Conclusion: Patient compliance with post-operative management is paramount with distraction osteogenesis and should be ensured prior to embarking on lengthening or deformity correction.

Keywords: Adverse event; Complex primary knee arthroplasty; Ilizarov; Patient Compliance.

Figure 1

Initial radiograph showing severe tibiotalar osteoarthritis.

Figure 2

Initial radiograph showing severe tibiotalar osteoarthritis.

Figure 3

Initial frame.

Figure 4

Initial frame.

Figure 5

Fully united ankle fusion.

Figure 6

Consolidated regenerate with severe deformity.

Figure 7

Consolidated regenerate with severe deformity.

Figure 8

Appearance post osteotomy and total knee arthroplasty

Figure 9

Appearance post osteotomy and total knee arthroplasty

Figure 10

Fully united and consolidated osteotomy.