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Hungarian Radiology

MAY 15, 2010

[Radiological assessment of the combined high tibial osteotomy in the frontal plane]

PAPP Miklós, KÁROLYI Zoltán, FAZEKAS Péter, SZABÓ László, PAPP Levente, RÓDE László

[INTRODUCTION - High tibial osteotomy (HTO) is a generally accepted treatment for medial unicompartmental osteoarthritis of the knee with varus alignment. The main principle of HTO is to achieve a transfer of loading from diseased, arthritic areas of the joint to areas with relatively intact, healthly cartilage. This stress reduction can be achieved with correction of the loading axis. A stress reduction occurs in the medial compartment of the knee when the loading axis is transferred from the medial compartment to just lateral to the center of the joint. PATIENTS AND METHODS - We performed radiological assessment of 52 knees preoperatively and after combined high tibial osteotomy (CO) in the 10th postoperative week, in the 12th postoperative month and in the 5th postoperative year on a standing weight-bearing anteroposterior radiograph. CO involved performing a proximal osteotomy parallel to the tibial plateau, followed by a distal osteotomy extending from the lateral part of the tibia to the line of the proximal osteotomy at the center of the tibial condyle. After closure of the lateral part of the osteotomy and consequent opening of the medial part, the removed lateral bone wedge was transferred to the gap on the medial side. Pre- and postoperatively we measured the lateral angle between the anatomic axis of the femur and the distal articular surface of the femur (FCFS), the lateral angle between the anatomic axis of the tibia and the proximal articular surface of the tibia (TP-TS) and the lateral angle between the distal articular surface of the femur and the proximal articular surface of the tibia (the articular component of the varus deformity FC-TP). We determined the FTA as a sum of FC-FS, TP-TS and FC-TP. RESULTS - The FC-TP, the TP-TS and the FTA decreased significantly after CO according to data measured in the 10th postoperative week. We achieved the planned correction (FTA 171-169°) in 77% of cases. Undercorrection (FTA ≥172°) was detected in 7, overcorrection (FTA ≤168°) was noted in 5 cases. We detected significant loss of correction between the 10th postoperative week and the 12th postoperative month (the FTA increased significantly, the loss of correction was 1° in 26 cases, 2° in 7 cases). The valgus alignment did not increase in any case. The articular component did not change in 36 cases. We did not note significant loss of correction and the valus alignment did not increase in any case between the 12th postoperative month and 5th postoperative year. We noted the recurrence of varus deformity in 1 case. We detected loss of correction due to increasing articular component in further 4 cases. The FC-FS did not change during the first 5 postoperative years. CONCLUSION - If we achieved the planned correction (FTA 171-169°) according to data measured in the 10th postoperative week on a standing weight-bearing anterposterior radiographs, we did not detect recurrence of varus deformity in any case during the first 5 postoperative years. If the articular component (FC-TP) did not change between the 12th postoperativ month and the 5th postoperative year (in 61.5% of cases), in our opinion we achieved the optimal correction.]

Hungarian Radiology

DECEMBER 27, 2010

[The effect of the orientation of the distal femur on the correction of axis after closing-wedge high tibial osteotomy - Short-medium term radiological assessment]

PAPP Miklós, KÁROLYI Zoltán, FAZEKAS Péter, SZABÓ László, PAPP Levente, RÓDE László

[Introduction - High tibial osteotomy (HTO) is a generally accepted treatment for medial unicompartmental osteoarthritis of the knee with varus alignment. The clinical result is affected by the correction of the varus malalignment. The degree of correction appears to be dependent not only on correction performed on tibia but also on the orientation of the distal femur. The valgus orientation of the distal femur can be associated with postoperative over-correction and varus orientation of the distal femur with postoperative under-correction. Patients and methods - We performed radiological assessment of 82 knees preoperatively and after closing wedge high tibial osteotomy (CWO) in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (23-54 months) on a standing weight-bearing anteroposterior radiograph. Pre- and postoperatively we measured the orientation of the distal femur, described as the lateral angle between the anatomic axis of the femur and the distal articular surface of the femur (FC-FS). We subdivided the knees into 3 groups based on the orientation of the distal femur. In group A the FC-FS was 83-85° (normal orientation of the distal femur), in group B the FC-FS was £82° (valgus orientation of the distal femur) in group C the FC-FS was ³86° (varus orientation of the distal femur). Pre- and postoperatively we measured the lateral angle between the anatomic axis of the tibia and the proximal articular surface of the tibia (TP-TS) and the lateral angle between the distal articular surface of the femur and the proximal articular surface of the tibia (the articular component of the varus deformity FC-TP) in all groups. We determined the anatomical femorotibial angle (FTA) as a sum of FC-FS, TP-TS and FC-TP. Results - In the first ten postoperative weeks - with significant osseous correction happened in the three groups - the articular component also decreased significantly in groups A and B, but did not change in group C. Between the postoperative 10th and the final follow-up examinations we did not notice significant osseous correction loss in any groups. In groups A and B the articular correction loss was not significant, at the same time in group C we noted significant articular correction loss. Conclusion - At valgus orientation of the distal femur the CWO results in greater correction of the limb’s anatomical axis than the osseal correction performed on the tibia. This additional correction equals the (preoperatively unpredictable) amount of the articular correction. At varus orientation of the distal femur the CWO results in less correction of the limb’s anatomical axis than the osseal correction performed on the tibia. This difference equals the (preoperatively unpredictable) loss of articular correc- tion.]

Hypertension and nephrology

APRIL 20, 2011

[Water intoxication caused by diuretics]

RADÓ János, KOVÁCS Andrea

[Water metabolism in the organism is regulated very exactly under normal circumstances. Sometimes, however, when the level of the antidiuretic hormone is inappropriately high and fluid consuming is not limited, water intoxication can develop. This is especially paradoxical during treatment with diuretics. Authors observed in a cachectic, potassium wasting, 87-year-old female patient, hyponatremia associated with clinical water intoxication developing in a hot period of summer, during long-term thiazide diuretic (chlorthalidone) treatment administered because of high blood pressure. Diagnosis was based besides the clinical picture on the severe hyponatremia and was supported by the relatively high urine osmolality in the presence of a very low plasma osmolality. Despite treatment of hyponatremia in accordance to the recommandations “overcorrection” occurred and turned into fatal hypernatremia. In the period of low plasma osmolality the patient was treated with intravenous infusions containing isotonic saline supplemented with potassium. When hypertonicity developed hypotonic intravenous infusions were given. Authors discuss the literature of hyponatremia with special reference to the dilemmas of therapy such as “slow” versus “rapid” correction as well as procedures to be done in case of “overcorrection”.]