Description
The video showcases a detailed lecture by Vipul Mandalia, a consultant orthopedic knee surgeon at Royal Devon and Exeter Hospital, on the intricacies of osteotomy planning. Vipul emphasizes the importance of appropriate patient selection based on thorough history-taking, examinations, and necessary investigations, including arthroscopy when needed. He discusses the four pillars of knee joint preservation—alignment, ligaments, meniscus, and cartilage pathology—highlighting how they impact surgical decisions.
In terms of surgical planning for osteotomies, he points out several key considerations such as the identification and extent of deformities, and how these deformities may contribute to significant post-operative issues, including leg length discrepancies. He also elaborates on the imaging requirements, stressing the need for clear, properly oriented bilateral weight-bearing X-ray images taken at the appropriate distance to ensure accuracy in measurements.
The presentation further delves into specific planning techniques, discussing methods such as the Miniaci technique for evaluating angular deformities and the importance of understanding the fixation characteristics of osteotomies. Additionally, Vipul discusses the complexities introduced by the posterior tibial slope and how one must balance correcting deformities while avoiding additional complications like creating new joint abnormalities. A thorough understanding of joint mechanics and patient anatomy is crucial, as well as the necessity of assessing for other factors contributing to deformities, including soft tissue laxity.
Finally, he wraps up with a reminder that while planning is essential, executing the plan in surgery is equally vital, and the use of advanced imaging software can assist in visualizing the impact of surgical interventions on joint alignment and integrity.