Dr Vincent Villa is specialized in lower limb surgery.
He performs minimally invasive prosthetic hip and knee surgery and athlete knee surgery. He also performs foot and ankle surgeries.
Dr Vincent Villa has contributed to the development of new, now widely spread surgical techniques and to numerous foreign surgeons’ training. In Switzerland he holds a post-grade title for specialist practitioners and he is a member of the FMH.
Purpose Varisation distal femoral osteotomy is a welldescribed treatment for lateral compartment arthrosis in the young, active patient. This treatment may potentially alter the length of the lower limb. The objective of this study was to quantify the change in leg length following lateral opening wedge distal femoral osteotomy using a blade plate.
Methods Between 1998 and 2011, 29 lateral opening wedge distal femoral osteotomies were performed for symptomatic genu valgum with signs of lateral compartment arthrosis or patello-femoral symptoms. The mean age was 44.4 years (±11.3). Average follow-up was 80.2 months (±50.6).
Results The mean osteotomy opening was 8.3° (±2.3). The femoro-tibial mechanical axis (mFTA) was improved significantly, from 187.8° (±3.5) to 180.4° (±2.6) postoperatively ( p < 0.001). The pre-operative leg length discrepancy was −0.7 cm, compared to −0.6 cm postoperatively, which was not significant (n.s.). There were five revisions to arthroplasty for disease progression at meantime of 166.6 months post-operatively. The probability of survival at 60 months was 91.4 % (95 % CI 74.9– 100 %) with end-point of revision to total knee arthroplasty and 87.6 % (95 % CI 74.1–100 %) of revision for complications.
Purpose Opening wedge high tibial osteotomy (HTO) is an accepted treatment option for medial compartment knee osteoarthritis with associated varus lower limb axis in younger, more active patients. A concern with the use of this technique is that posterior tibial slope (PTS) and tibial rotation can be altered. We hypothesized that there is a tendency to increase the PTS and internal rotation of the distal tibia during the procedure and that certain intraoperative parameters may influence the amount of change that can be expected.
Methods A cadaveric model and surgical navigation system were used to evaluate the influence of certain intraoperative factors of the degree of PTS and tibial rotation change observed during medial opening HTO. Parameters evaluated included: degree of osteotomy opening, knee flexion angle, location of limb support (thigh versus foot), performance of a posteromedial release, the status of the lateral cortical hinge, and the degree of osteoarthritis present in the knee.
Results Combining measurements of all specimens and parameters, a mean PTS increase of 2.7 ± 3.9 and a mean tibial internal rotation of 1.5 ± 2.9 were observed. Clinically, significant changes in tibial slope ([2) occurred in 50.4 % of corrections, while significant changes in tibial rotation ([5) occurred in only 11.9 % of corrections. Patients with significant osteoarthritis and concomitant flexion contracture, cases where large corrections were required, and procedures in which the lateral cortical hinge was disrupted were associated with increased PTS change. The other factors evaluated did not exert a significant influence of the degree of PTS change observed.
Conclusions Surgeons should be vigilant for possible PTS change, particularly in high-risk situations as outlined above. Routine use of an intra-operative measure of PTS is recommended to avoid inadvertent slope change.
When performing total knee arthroplasty (TKA) in the setting of osteoarthritis with valgus deformities, the surgeon can choose whether to approach the joint via a standard medial parapatellar approach, or via a lateral parapatellar approach. Keblish  recommended a lateral parapatellar approach for knees with a fixed valgus deformity as this method provides direct access to the lateral structures, facilitating ligament balance. But for many authors, the lateral approach is considered difficult, and is associated with greater complication rates. The purpose of this single center study was to compare surgical factors and short-term clinical and radiographic outcomes of the medial and lateral approach for TKA in knees with moderate valgus (<10°).
Four hundred and twenty four knees undergoing TKA with a pre-operative valgus deformity between 3 and 10 degrees were identified through queries of a prospectively collected TKA database. 109 knees were treated via a medial approach and 315 knees were treated via a lateral approach. The Tornier HLS TKA system was used for all knees. Intra-operative variables that were assessed included surgical time, tourniquet time, the type of lateral releases that were performed, and whether a tibial tubercle osteotomy was required. International Knee Society (IKS) knee and functional scores and radiographic alignment were compared post-operative with a minimum of two years follow-up. Fisher’s exact tests were used to compare categorical variables, and t-tests were used for continuous variables, with statistical significance defined as p < 0.05.
Tourniquet time (p=0.25) and surgical time (p=0.62) were not significantly different between the two groups. The popliteus tendon was released more frequently in the medial approach group (p=0.04), while the iliotibial band was released more frequently in the lateral approach group (p<0.001). A tibial tuberosity osteotomy was performed more frequently in the lateral approach group than in the medial approach group (20.8% vs 8%). At final follow-up, no significant differences in limb alignment (p=0.78), IKS knee (p=0.32) or function (p=0.47) scores were noted based on surgical approach. The complication rates were similar in the two groups (p=0.53).