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.
Background: Despite excellent long-term outcomes, posterior stabilisation by a third condyle continuesto receive unwarranted criticism regarding patellar complications and instability.
Hypothesis: Complication rates with a tri-condylar posterior-stabilised implant are similar to those withother posterior-stabilised prostheses and have diminished over time due to improvements in prosthesisdesign.
Material and methods: Post-operative complications and revision rates were assessed retrospectively ina prospective cohort of 4189 consecutive patients who had primary total knee arthroplasty (TKA) usinga tri-condylar posterior-stabilised implant (Wright-Tornier) and were then followed-up for at least 24months. The analysis included 2844 knees. The prosthesis generations were HLS1®, n = 20; HLS2®, n = 220;HLS Evolution®, n = 636; HLS Noetos®, n = 1373; and HLS KneeTec®, n = 595. Complications were comparedacross generations by applying Fisher’s exact test, and survival was compared using the Kaplan-Meiermethod.
Results: At last follow-up, there had been 341 (12%) post-operative complications in 306 (10.8%) knees,including 168 (5.9%) related to the implant, 41 (1.4%) infections, and 132 (4.6%) secondary complicationsunrelated to the implant. Re-operation was required for 200 complications (7%), including 87 (3.1%) con-sisting in revision of the prosthesis. Implant-related complications were stiffness (n = 67, 2.4%), patellarfracture (n = 34, 1.2%), patellar clunk syndrome (n = 25, 0.9%), patellar loosening (n = 3, 0.1%), tibial/femoralloosening (n = 15, 0.5%), polyethylene wear (n = 3, 0.1%), and implant rupture (n = 1, 0.04%). Significantdifferences across generations were found for stiffness (P < 0.0001), patellar fracture (P = 0.03), clunk syn-drome (P = 0.03), and polyethylene wear (P = 0.004), whose frequencies declined from one generation tothe next. Overall 10-year survival was 92% with no significant difference across generations (P = 0.1).
Discussion: Outcomes of tri-condylar posterior-stabilised TKA are similar to those obtained using otherposterior-stabilised implants. Neither patellar complications nor instability are more common, andimprovements in implant design have contributed to correct early flaws.Level of evidence: IV, historical cohort, retrospective assessment of prospectively collected data.
© 2016 Elsevier Masson SAS. All rights reserved.
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Summary: Pathologic genu recurvatum is defined by knee hyperextension in excess of 15 degrees and is usually asymmetric. This is a rare disease that can be related to bony, soft tissue or a combination of both. Patients with genu recurvatum commonly present with anterior knee pain, knee instability, ambulation difficulty on uneven ground, and patellofemoral instability. Anterior opening wedge osteotomy of the tibia is indicated when deformity in the sagittal plane emanates from the tibia (reversed posterior tibial slope) or a combination of tibia and soft tissue. The aim of this study is to present a surgical technique for anterior high tibial osteotomy, with indications, limitations, and review of the literature. We explain the different steps of the surgery with radiologic preoperative planning, skin incision and approach, osteotomy and fluoroscopic control, fixation, and bone grafting. Although this surgery is uncommon and difficult, the overall results in the literature are very positive and lead to increased patient satisfaction and function.
Key Words: genu recurvatum—opening wedge—high tibial osteotomy— tibial tubercle osteotomy—staples—bone grafting.
(Tech Orthop 2017;32: 66–73)
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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.