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Drop foot after high tibial osteotomy: a prospective study of aetiological factors

  • T. Bauer
  • P. Hardy
  • J. Lemoine
  • D. F. Finlayson
  • S. Tranier
  • A. Lortat-Jacob
Knee

Abstract

Drop foot is not uncommon after high tibial osteotomy for genu varum. The authors report their results of a prospective study of 16 patients operated on between May 1990 and May 1991. All patients had medial femoro-tibial osteoarthritis with a constitutional genu varum. They all had a subtraction valgus high tibial osteotomy fixed by a blade plate. The experimental protocol included clinical review, antero-lateral compartment pressure measurements, intra- and post-operative electromyography, assessment of the post-operative drainage, serum estimation of muscle ensymes and post-operative arteriography. From their own results and a literature review, the authors consider successively the different aetiological factors for post-operative drop foot. Certain deficits occur due to direct trauma on the nerve during high osteotomy of the fibula, by local high pressure due to poor haemostasis or ineffective drainage. In addition, there are several related phenomena. The pneumatic tourniquet ssensitises the nerve to trauma, and stretching of the nerve during correction of the deformation depends on the local anatomical factors and their marked variation. In order to diminish the frequency of these post-operative complications, the authors suggest limiting the surgical approach, and limiting as far as possible the traumatic manoeuvres on the nerve by using a tibial resection jig, which allows correction without forced manoeuvres. Finally, the authors discuss the benefits of using a pneumatic tourniquet.

Keywords

High tibial osteotomy Drop foot Compartment syndrome Common peroneal nerve 

References

  1. 1.
    Aglietti P, Rinonapoli E, Taviani A (1983) Tibial osteotomy for the varus osteoarthritic knee. Clin Orthop 176:239–251PubMedGoogle Scholar
  2. 2.
    Barnes MR, Gibson MJ, Scott J, Bentley S, Allen MJ (1985) A technique for a long-term measurement of intra-compartmental pressure of the lower leg. J Biomed Eng 7:35–39PubMedGoogle Scholar
  3. 3.
    Berman AT, Bosacco SJ, Kirschner S, Avolio A (1991)Factors influencing long term results in high tibial osteotomy. Clin Orthop 272:192–198PubMedGoogle Scholar
  4. 4.
    Berry H, Richardson PM (1976) Common peroneal nerve poly: a clinical and electrophysiological review. J Neurol Neurosurg Psychiatry 39:1162–1171PubMedGoogle Scholar
  5. 5.
    Blick S, Brumback R, Poka A, Ebraheim N (1986) Compartment syndrome in open tibial fractures. J Bone Joint Surg Am 68:1348–1353PubMedGoogle Scholar
  6. 6.
    Cambier J (1981) Sémiologie de l’unité motrice. In: Godeau P, Hamburger J (eds) Traité de médecine. Flammarion Médecine Science, pp 2117–2122Google Scholar
  7. 7.
    Cass JR, Bryan RS (1988) High tibial osteotomy. Clin Orthop 230:196–199PubMedGoogle Scholar
  8. 8.
    Castaigne P, Cathala HP, Mastropaoloc, Dry J, Gras E (1966) Les réponses de nerfs et de muscles à des stimulations électriques au cours d’une épreuve de garrot pneumatique ischémique chez l’homme normal. Rev Franç Etudes Clin Biol XI:373–387Google Scholar
  9. 9.
    Coventry MB (1965) Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. J Bone Joint Surg Am 47: 985–990Google Scholar
  10. 10.
    Coventry MB, Bowman P (1982) Long term results of hypertibial osteotomy for degenerative arthritis of the knee. Acta orthop Belg 48:139–156PubMedGoogle Scholar
  11. 11.
    Coventry MB (1984) Upper tibial osteotomy. Clin Orthop 182:46–52PubMedGoogle Scholar
  12. 12.
    Coventry MB (1985) Upper tibial osteotomy for osteoarthritis. J Bone Joint Surg Am 67:1136–1140PubMedGoogle Scholar
  13. 13.
    Curley P, Eyres K, Brezinova V, Allen V, Chan R, Barnes M (1990) Common peroneal nerve dysfunction after high tibial osteotomy. J Bone Joint Surg Br 72:405–408PubMedGoogle Scholar
  14. 14.
    Desmedt JE (1958) Méthode d’étude neuromusculaire chez l’homme. Myogramme isométrique, électromyogramme d’excitation et topographie de l’innervation terminale. Acta Neurol Belg 58:977–990Google Scholar
  15. 15.
    Devas MB (1969) High tibial osteotomy for arthritis of the knee. J Bone Joint Surg Br 51:95–99PubMedGoogle Scholar
  16. 16.
    Don Patman R (1975) Compartmental syndromes in peripheral vascular surgery. Clin Orthop 113:103–110PubMedGoogle Scholar
  17. 17.
    Foissac J, Orgeret M, Decornet AM, Merle JP, Lorenzini JL, Caillard B (1984) Les modifications biologiques induites par la levée du garrot en chirurgie orthopédique. Cah Anesth 32:101–105PubMedGoogle Scholar
  18. 18.
    Gariepy R (1964) Genu varum treated by high tibial osteotomy. J Bone Joint Surg Br 46:783–787Google Scholar
  19. 19.
    Gibson MJ, Barnes MR, Allen MJ, Chan W (1986) Weakness of foot dorsiflexion and changes in compartment pressures after tibial osteotomy. J Bone Joint Surg Br 68:471–475PubMedGoogle Scholar
  20. 20.
    Godinger JJ, Huc de Bat JM, Lecestre P, Lortat-Jacob A, Aubert JD, Ramadier JO (1979) Syndrome ischémique post-traumatique des loges de la jambe. Rev Chir Orthop 65:221–229PubMedGoogle Scholar
  21. 21.
    Hargens A, Romine J, Side J, Evans K, Mubarak S, Akeson W (1979) Peripheral nerve-conduction block by high muscle compartment pressure. J Bone Joint Surg Am 61:192–196PubMedGoogle Scholar
  22. 22.
    Harris WR, Kostuik JP (1970) High tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am 52:330–336PubMedGoogle Scholar
  23. 23.
    Healy WL, Riley LH Jr (1986) High tibial valgus osteotomy. A clinical review. Clin Orthop 209:227–233PubMedGoogle Scholar
  24. 24.
    Holden CE (1975) Compartmental syndrome following trauma. Clin Orthop 113:95–105PubMedGoogle Scholar
  25. 25.
    Holden D, James S, Larson R, Slocum D (1988) Proximal tibial osteotomy in patients who are fifty years old or less. A long-term follow-up study. J Bone Joint Surg Am 70:977–982Google Scholar
  26. 26.
    Insall J, Hiromu S, Mayer V (1974) High tibial osteotomy: a five years evaluation. J Bone Joint Surg Am 56:1397–1405Google Scholar
  27. 27.
    Insall J, Joseph D, Msika C (1984) High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am 66:1040–1048PubMedGoogle Scholar
  28. 28.
    Ivarsson I, Myrnerts R, Gillquist J (1990) High tibial osteotomy for medial osteoarthritis of the knee. A 5 to 7 and 11 year follow-up. J Bone Joint Surg Br 72:238–244PubMedGoogle Scholar
  29. 29.
    Jabre JF (1980) Ulnar nerve lesions at the wrist: new technique for recording from the sensory dorsal branch of the ulnar nerve. Neurology 30:873–876PubMedGoogle Scholar
  30. 30.
    Jackson JP, Waugh W, Green JP (1969) High tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 51:88–94PubMedGoogle Scholar
  31. 31.
    Jackson JP (1958) Osteotomy for arthritis of the knee. J Bone Joint Surg Br 40:826–829Google Scholar
  32. 32.
    Jackson JP, Waugh W (1974) The technique and complications of upper tibial osteotomy, a review of 226 operations. J Bone Joint Surg Br 56:236–245PubMedGoogle Scholar
  33. 33.
    Jepson PS (1926) Ischaemic contracture: experimental study. Ann Surg 84:785Google Scholar
  34. 34.
    Kirgis A, Albrecht S (1992) Palsy of the deep peroneal nerve after proximal tibial osteotomy: an anatomical study. J Bone Joint Surg Am 74:1180–1185PubMedGoogle Scholar
  35. 35.
    Klenerman L (1962) The tourniquet in surgery. J Bone Joint Surg Br 44:937–943Google Scholar
  36. 36.
    Klenerman L, Chakrabarti R, Mackie I, Brozovic M (1977) Changes in haemostatic system after application of a tourniquet. Lancet 8019:970–972CrossRefGoogle Scholar
  37. 37.
    Langlais F, Thomazeau H (1989) Ostéotomies du genou. Techniques chirurgicales. Encycl Med Chir 44:825Google Scholar
  38. 38.
    Lerique JL (1974) A propos du garrot ischémique en chirurgie réparatrice. Ann Chir 28:327–330PubMedGoogle Scholar
  39. 39.
    Lootvoet L, Massinon A, Rossillon R, Himmer O, Lambert K, Ghosez JP (1993) Ostéotomie tibiale haute de valgisation pour gonarthrose sur genu varum: a propos d’une série de 193 cas. Rev Chir Orthop 79:375–384PubMedGoogle Scholar
  40. 40.
    Lortat-Jacob A (1981) Les syndromes de loge. In: Les cahiers d’enseignement de la SOFCOT. Expansion Scientifique Française Paris, pp 65–79Google Scholar
  41. 41.
    Mabrey JD, Mc Collum DE (1987) High tibial osteotomy, a review of 72 cases. South Med J 80:975–980PubMedGoogle Scholar
  42. 42.
    Mubarak S, Owen C, HargenS A, Garetto L, Akeson W (1978) Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg Am 60:1091–1095PubMedGoogle Scholar
  43. 43.
    Ochoa J, Fowler TJ, Gilliat RW (1972) Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet. J Anat 113:433–455PubMedGoogle Scholar
  44. 44.
    Rudan JF, Simurda MA (1991) Valgus high tibial osteotomy. A long-term follow-up study. Clin Orthop 266:139–144PubMedGoogle Scholar
  45. 45.
    Sasaki T, Yagi T, Monji J, Yasuda K, Tsuge H (1986) High tibial osteotomy combined with anterior displacement of the tibial tubercle for osteoarthritis of the knee. Int Orthop 10:31–40PubMedGoogle Scholar
  46. 46.
    Sedel L (1988) Le nerf périphérique, pathologie et traitement chirurgical. Masson, ParisGoogle Scholar
  47. 47.
    Seldinger F (1953) Catheter replacement of needle in percutaneous arteriography: a new technique. Acta Radiol 39:368PubMedGoogle Scholar
  48. 48.
    Solonen K, Hjelt L (1968) Morphological changes in striated muscle during ischaemia. Acta Orthop Scand 39:13–19PubMedGoogle Scholar
  49. 49.
    Sunderland S (1968) Nerves and nerves injuries. Williams and Williams, BaltimoreGoogle Scholar
  50. 50.
    Tubiana R (1973) L’usage du garrot au niveau des membres. Rev Chir Orthop 59:249–255Google Scholar
  51. 51.
    Tubiana R (1974) La prévention des accidents dus au garrot. Présentation d’un nouveau modèle de garrot pneumatique à pression maintenue constante. Ann Chir 28:323–326PubMedGoogle Scholar
  52. 52.
    Vainionpaa S, Laike E, Kirves P, Tiusanen P (1981) Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am 63:938–945PubMedGoogle Scholar
  53. 53.
    ValentI JR, Calvor, Lopez R, Canadeil J (1990) Long-erm evaluation of high tibial valgus osteotomy. Int Orthop14:344–349Google Scholar
  54. 54.
    Von Volkmann R (1872) Verletzungen und Krankheiten der Bewegungsorgane. Handbuch der allgemeinen und speciellen Chirurgie. Pithja Bilbroth 2:846Google Scholar
  55. 55.
    Wall J (1979) Compartment syndrome as a complication of the Hauser procedure. J Bone Joint Surg Am 61:185–191PubMedGoogle Scholar
  56. 56.
    Weill D, Schneider M, Simon G (1981) Les ostéotomies du genou dans le traitement de la gonarthrose. A propos d’une expérience de 10 ans et de plus de 400 interventions. Rev Chir Orthop Suppl II:67Google Scholar
  57. 57.
    Wiggins HE (1975) The anterior compartmental syndrome: a complication of the Hauser procedure. Clin Orthop 113:90–94PubMedGoogle Scholar
  58. 58.
    Wilgis EF (1971) Observations on the effects of tourniquet ischaemia. J Bone Joint Surg Am 53:1343–1345PubMedGoogle Scholar
  59. 59.
    Whitesides TE, Haney T, Morimoto K, Harada H (1975) Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop 113:43–51PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • T. Bauer
    • 1
  • P. Hardy
    • 1
  • J. Lemoine
    • 1
  • D. F. Finlayson
    • 1
  • S. Tranier
    • 1
  • A. Lortat-Jacob
    • 1
  1. 1.Service de Chirurgie Orthopédique et TraumatologiqueFaculté de Médecine Paris Ile-de-France Ouest, Hôpital Ambroise ParéBoulogneFrance

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