Numa Mercier

Centre Hospitalier Universitaire de Grenoble, Grenoble, Rhône-Alpes, France

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Publications (23)38.69 Total impact

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    ABSTRACT: Arthroscopic Bankart repair alone cannot restore shoulder stability in patients with glenoid bone loss involving more than 20% of the glenoid surface. Coracoid transposition to prevent recurrent shoulder dislocation according to Bristow-Latarjet is an efficient but controversial procedure.
    Clinical Orthopaedics and Related Research 06/2014; · 2.79 Impact Factor
  • D Saragaglia, R-C Rouchy, N Mercier
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    ABSTRACT: The study sought to assess the functional results and complications of osteosynthesis using the Lambda(®) plate (Zimmer, Étupes, France) in treating fracture of the distal extremity of the humerus. The initial series comprised 115 patients (116 fractures), treated between 1992 and 2008. Forty-one (mainly foreigners) were lost to follow-up. The final series thus comprised 74 patients (75 fractures): 44 female and 30 male, with a mean age of 46±23 years (range, 16-95 years), 22 (29%) being aged 65 years or over. According to AO classification, 22 of the fractures of the distal extremity of the humerus (29%) were diaphyseal-metaphyseal, corresponding to a particular grade of type A2, 12 (16%) were type A2 or A3, six (8%) type B, and 35 (47%) type C. Eight were open fractures: seven grade 1 and one grade IIa on Gustilo's classification. The Lambda(®) plate is an inverted Y shape, with a stem of up to ten holes and sectile arms that can be remodeled to adapt perfectly to the type of fracture and the shape of the distal end of the humerus. A posterior approach was used in all cases: in 26 cases, an extra-articular transolecranal approach and otherwise a transtricipital approach, either vertical for diaphyseal-metaphyseal fracture or inverted V for type-C fracture. Mean follow-up was 115±64 months (range, 24-227 months). There were no cases of infection, non-union of olecranial osteotomy or disassembly of the internal fixation; there was, on the other hand, one case of non-union of the lateral condyle and one of the distal extremity of the humerus, two cases of dysesthesia in the ulnar nerve territory and one in the radial nerve territory (following preoperative paralysis), and four cases of stiffness requiring surgical arthrolysis between 6 and 12 months postoperatively. At follow-up, mean active elbow flexion was 133°±13° (range, 90°-150°) and active extension -12°±14° (range, -45°-0°). Mean elbow flexion range of motion exceeded 100° in 58 patients (77%), was between 50° and 100° in 16 (21%) and was less than 50° in one. Mean Mayo Elbow Performance Score (MEPS) was 97±7 points (range, 40-100), and mean Quick DASH Score (converted as a score out of 100) was 10±18 (range, 0-54). There were 67 excellent results (MEPS, 90-100 points), five good (75-89), two moderate and one poor. The 35 type-C fractures displayed no significant differences from the series as a whole (P=1.24 for MEPS). Osteosynthesis using the Lambda(®) plate gave excellent medium-term results in terms of both fixation stability and recovery of elbow function after fracture of the distal extremity of the humerus, even in elderly osteoporotic patients. Level IV: retrospective study.
    Orthopaedics & Traumatology Surgery & Research 09/2013; · 1.06 Impact Factor
  • Revue de Chirurgie Orthopédique et Traumatologique 09/2012; 98(5):540–541.
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    ABSTRACT: PURPOSE: The present study was designed to evaluate the mid-term (5- to 8-year) survival rate of a new total knee replacement (TKR) with a single-radius femoral component and a multidirectional, highly congruent tibial component, in comparison with an historical group (TKR with multi-radius design and fixed bearing). METHODS: Four hundred and thirty patients were included, of which 369 patients (86 %) completed the 5-year follow-up with Knee Society Score evaluation and radiograph examination (study group = 387, control group = 83). RESULTS: There was a significant improvement for all analysed items between pre-operative status and late follow-up. Mean knee score was 93 ± 9 points in the study group and 88 ± 16 points in the control group (p < 0.001). Mean flexion angle was not different (118 ± 11 vs. 114 ± 13 degrees). Mean functional score was 87 ± 16 points in the study group and 71 ± 24 points in the control group (p < 0.001). Survival rate at 5-year follow-up was 98.8 % (vs. 98.0 %) for mechanical revisions only, and 96.4 % (vs. 98.1 %) for all revisions. CONCLUSIONS: The new TKR allowed obtaining significantly better results than the fixed-bearing TKR. These results are in line with the best series published in the current literature, but there was no evidence of any superiority of this TKR against already published standards. LEVEL OF EVIDENCE: Case series with comparison group, Level III.
    Knee Surgery Sports Traumatology Arthroscopy 08/2012; · 2.68 Impact Factor
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    ABSTRACT: Introduction Le traitement chirurgical de l’instabilité patellaire fait appel à de multiples techniques. Nous avions remarqué que dans certaines dysplasies patellaires il existait un bombement (ou une saillie) de la partie distale de la facette médiale de la patella susceptible de s’opposer à son recentrage dans la gorge de la trochlée fémorale. Hypothèse La résection de ce bombement (patelloplastie) dans certaines dysplasies fémoropatellaires, dans la mesure où elle est associée à un programme chirurgical « à la carte », est susceptible d’améliorer la stabilité, le centrage et la bascule latérale de la patella. Patients et méthodes Cette série rétrospective est composée de 23 patients (26 genoux), 13 femmes et dix hommes, âgés en moyenne de 25,9 ± 9,01 ans (15 à 52) opérés entre 1997 et 2008. Tous les genoux avaient eu au moins une luxation de la patella et 16 d’entre eux au moins deux luxations. Le score de Kujala moyen préopératoire était de 79,1 ± 6,1 (68 à 91). Dans tous les cas, il existait un bombement de la facette médiale de la patella, associé aux critères habituels des dysplasies fémoropatellaires. À la patelloplastie nous avons associé, à chaque fois, une résection de l’aileron patellaire latéral et une médialisation de la tubérosité tibiale antérieure (avec sept abaissements), et quatre trochléoplasties selon Albee. Résultats Une récidive de luxation a été observée (4,7 %). Dix-neuf patients (22 genoux) ont été revus au recul moyen de 7,53 ± 3,27 ans (deux à 13 ans). Le score de Kujala postopératoire moyen, était de 91,8 ± 7,9 (70 à 100) et 19 genoux sur 22 (86,5 %) avaient un résultat subjectif satisfaisant ou très satisfaisant. Sur les vues axiales, 21 patellae (95,5 %) étaient centrées et une (4,5 %) présentait toujours une bascule latérale. Quinze genoux (68 %) n’avaient pas d’arthrose. Conclusion La patelloplastie de la facette médiale de la patella, dans des cas choisis, n’a pas de morbidité particulière à moyen terme. Associée à d’autres gestes, le taux de satisfaction des opérés est très élevé et particulièrement encourageant. Niveau de preuve IV ; étude rétrospective de cohorte.
    Revue de Chirurgie Orthopédique et Traumatologique 04/2012; 98(2):152–157.
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    ABSTRACT: Cartilage diseases represent a major Public Health problem that will worsen due to the ageing of the population and the obesity epidemic. The development of new diagnostic and therapeutic strategies therefore appears to be essential to address this issue. The research project “Computer Assisted Measures and Interventions for Innovative Therapeutic of Cartilage Diseases” (ANR-08-TECS-010) led to the development of a new medical device dedicated to the therapy of the cartilaginous tissue: a navigated multimodal arthroscopic environment. It combines MRI (or arthro-CT) with video and ultrasound. The first preclinical evaluations in humans have demonstrated the feasibility to objectively quantify in a reproducible way clinical parameters of a new cartilage tissue quality. The first clinical evaluations are now to consider.
    IRBM. 04/2012; 33(2):123–128.
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    ABSTRACT: Numerous procedures may be used in the surgical treatment of patellar instability. We have noticed that certain types of patellar instability result in a bulge (or protrusion) of the distal medial facet of the patella which can hinder recentering in the trochlear groove. In certain patellofemoral dysplasias, trimming down of this bulge (patelloplasty) as long as it is associated with a "à la carte surgery" program, can improve stability, centering and lateral patellar tilt. This retrospective series included 23 patients (26 knees), 13 women and 10 men, mean age 25.9±9.01 years old (15-52) operated between 1997-2008. Patellar dislocation had occurred at least once in all knees, and at least twice in 16 knees. The mean preoperative Kujala score was 79.1±6.1 points (68-91). There was a bulge on the medial facet of the patella in all cases, in particular on skyline views associated with the usual criteria for patellofemoral dysplasia. Patelloplasty was associated in all cases with resection of the lateral patellar retinaculum and anteromedialization of the tibial tubercle (7 were lowered) and four Albee trochleoplasties. Recurrent dislocation occurred in one case (4.7%). Nineteen patients (22 knees) were followed up for a mean 7.53±3.27 years (2-13 years). The mean postoperative Kujala score was 91.8±7.9 points (70-100) and the subjective results in 19/22 (86.5%) knees were satisfactory or very satisfactory. On skyline views, 21 patellae (95.5%) were well centered and one (4.5%) still presented with lateral tilt. There was no osteoarthritis in 15 knees (68%). In selected cases, patelloplasty of the medial facet of the patella has no particular morbidity at intermediate follow-up. Associated with other surgical procedures, the rate of satisfaction of patients is very high and especially encouraging. Level IV, retrospective cohort study.
    Orthopaedics & Traumatology Surgery & Research 02/2012; 98(2):167-72. · 1.06 Impact Factor
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    ABSTRACT: Peroneal tendon pathology is rare, but is probably underestimated because it is frequently undiagnosed. It should always be in the differential diagnosis of lateral ankle pain. Surgical treatment of peroneal tendinopathy is indicated after failure of conservative measures. The aim of this retrospective study is to evaluate the medium-term clinical results of 17 patients operated for peroneal tendinopathy without tendon subluxation. A series of 17 patients composed of 7 women and 10 men with a mean age of 53.6 ± 4.6 (range 45 to 60) years were reviewed. The mean preoperative Kitaoka score was 46.7 ± 17.1 (range 25 to 69) points. All patients had radiological evaluation, which demonstrated hindfoot varus in 6 of the 17. Surgical interventions comprised synovectomy, debridement, suture-tubularization, fibrous resection, or tenodesis depending on the preoperative findings and also a valgus osteotomy (Dwyer) in 6 cases and ankle ligament reconstruction (modified Blanchet) in 1 case. All patients were reviewed clinically with a mean follow-up of 4.3 ± 3.8 years (range 16 months to 14 years). Average time to return to sport was 8.5 ± 10.4 months (range 3 months to 3 years). The mean time to return to work was 2.5 ± 1.9 (range 0 to 6) months. The mean postoperative Kitaoka score was 90.1 ± 11 (range 64 to 100) points with a statistically significant improvement to the preoperative score (p < .0001). Sixteen patients were satisfied or very satisfied with their treatment (94.1%). Surgical treatment of peroneal tendinopathy after failed conservative treatment leads to significantly improved function. It is a simple treatment to undertake, which gives a good outcome for both the patient and surgeon.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 11/2011; 51(1):13-9.
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    ABSTRACT: The goal of this article was to present the clinical and radiological results of 42 severe genu varum operated on between August 2001 and June 2010 using computer navigation. All the osteotomies were navigated using the Orthopilot® device (B-Braun-Aesculap, Tuttlingen, Germany). The procedure was performed such that after inserting the rigid bodies and calibrating the lower leg, we first made the femoral closing wedge osteotomy (from four to seven mm) which was fixed by an AO T-Plate, and then, after checking the residual varus, the tibial opening wedge osteotomy was made using a Biosorb® wedge (Tricalcium phosphate, SBM, Lourdes, France) and a plate (AO T-plate or C-plate). All the patients were assessed at a mean follow-up of 46 ± 27 months (range, 12-108). The mean Lyshölm-Tegner score was 83.3 ± 7.5 points (62-91) and the mean KOOS score was 95.1 ± 3.2 points (89-100). Forty patients were satisfied (22) or very satisfied (18) with the result. Regarding the radiological results, the goal was reached in 92.7% of cases and the mean HKA angle was 181.83° ± 1.80° (177-185°). At that mid-term follow-up no patient had revision to a total knee arthroplasty. Computer-assisted double level osteotomy in severe genu varum is a reliable, reproducible, and accurate technique. This procedure, which is very delicate, especially in reaching pre-operative objectives, is simplified by computer-assistance.
    International Orthopaedics 09/2011; 36(5):999-1003. · 2.32 Impact Factor
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    ABSTRACT: The objective of this work was firstly to evaluate the long-term results of medial opening wedge high tibial osteotomy (HTO) and secondly to evaluate the tolerance and integration of a Biosorb® wedge (β Tricalcium Phosphate, SBM Company, Lourdes, France). The series consisted of 124 knees in 110 patients, 74 men and 36 women, with mean age of 53.23±10.68 years (range 32-74) and treated between June 1995 and November 2000 for medial compartment knee osteoarthritis by the senior author. The mean preoperative Lysholm and Tegner functional score was 65.44±13.32 (range 27-80) and the preoperative HKA angle was 172.51°±3.8° (range 162-179°). According to the modified Ahlbäck classification there were 27 stage I, 42 stage II, 44 stage III and 11 stage IV knees. All patients were reviewed clinically and radiologically with a mean follow-up of 10.39±1.98 years (range 8-14 years). Immediate postoperative complications consisted of nine undisplaced lateral tibial plateau fractures of no clinical significance, two deep vein thromboses and three pulmonary emboli which resolved with appropriate treatment. At a later stage, there were seven delayed unions without development of pseudarthrosis, and three screw breakages when the AO T-plate was used, leading to a secondary angulation in one case, requiring revision by femoral osteotomy. Postoperative mean weightbearing HKA angle was 182°±1.8° (range 178-186°) and 73.4% of axes were 184°±2°. Fifteen knees (12.1%) underwent total knee arthroplasty (TKA) after a mean delay of 8.87±3.04 years and were excluded from the final analysis. Concerning the long-term results (n = 107 knees), the mean Lysholm-Tegner score was 88±12.7 points (51-100) and the KOOS score was 86±14.6 points (25-100) with 94 patients satisfied or very satisfied (87.85%). In terms of the HTO survivorship curve, with failure consisting of revision to TKA or another operation, survival was 88.8% at five years and 74% at ten years. Concerning Biosorb®, this was completely integrated in 100% of cases and there was complete resorption in 12.1% of cases and greater than 50% resorption in 52.3% of cases.
    International Orthopaedics 08/2011; 35(8):1151-6. · 2.32 Impact Factor
  • Resuscitation 01/2011; 97(7). · 4.10 Impact Factor
  • Resuscitation 01/2011; 97(7). · 4.10 Impact Factor
  • R. Bouchet, N. Mercier, D. Saragaglia
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    ABSTRACT: Introduction La luxation des prothèses totales de hanche est une complication fréquente chez les personnes âgées, tout particulièrement lorsque la voie d’abord est postérieure. Pour ces dernières, les cupules à double mobilité mises au point par Gilles Bousquet en 1975 peuvent trouver une indication de choix afin de limiter le risque de luxation. Hypothèse Les cupules à double mobilité permettent, sur une série mono-opérateur sur des prothèses primaires par voie postérieure, de diminuer le taux de luxation. Objectif Tester cette hypothèse au moyen d’une étude cas témoin permettant de comparer le taux de luxation des prothèses totales implantées chez des sujets de plus de 50 ans avec, soit une cupule à double mobilité, soit une cupule traditionnelle à frottement métal–polyéthylène en diamètre 28 mm. Patients et méthodes Les deux séries consécutives de prothèses primaires avaient été implantées par un seul opérateur par voie postérolatérale, sans section du piriforme. La première série (série DM) était composée de 105 patients opérés entre janvier 2005 et juin 2007 avec une cupule à double mobilité (60 femmes et 45 hommes âgés en moyenne de 76,6 ± 5,65 ans [53–93]). La deuxième (série S), composée de 108 patients opérés entre janvier 2003 et juin 2005, constituait la série témoin (56 femmes et 52 hommes, âgés en moyenne de 74,19 ± 5,9 ans [53–87]). Toutes les prothèses étaient en calibre 28 mm avec un couple de friction métal–polyéthylène et un cône morse 12–14. Les deux groupes étaient comparables pour le sexe, le diagnostic, l’indice de masse corporelle, le type d’anesthésie et la répartition selon le score American Society of Anesthesiologists (ASA). Un recul minimal supérieur à un an était requis pour inclure les patients. Résultats Il n’y a eu aucune luxation dans la série DM contre cinq luxations précoces (avant le troisième mois) pour la série S, soit un taux de 4,63 %. Bien que le taux de luxation soit supérieur dans la série S (4,63 versus 0 %), la différence était à la limite de la significativité (p = 0,0597). Discussion En comparant l’incidence des luxations après PTH à simple ou à double mobilité, nous avons montré l’avantage de la double mobilité en termes de stabilité, avec une absence de luxation postopératoire malgré l’usage d’une voie postérieure et un âge élevé des patients. Si le seuil de significativité est limite, des séries plus importantes devraient confirmer cette impression favorable. Dans cette série et dans l’état actuel des connaissances, la double mobilité n’engendre pas de morbidité supplémentaire. Niveau de preuve III : étude cas témoin rétrospective.
    Resuscitation 01/2011; 97(1):2-7. · 4.10 Impact Factor
  • Resuscitation 01/2011; 97(7). · 4.10 Impact Factor
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    Numa Mercier, Dominique Saragaglia
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    ABSTRACT: Anterior shoulder instability is a common problem. The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability. The purpose of this paper is to explain our surgical procedure titled "Mini-open Latarjet Procedure." We detailed patient positioning, skin incision, subscapularis approach, and coracoid fixation. Then, we reviewed the literature to evaluate the clinical outcomes of this procedure.
    Advances in orthopedics. 01/2011; 2011:656205.
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    R Bouchet, N Mercier, D Saragaglia
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    ABSTRACT: Dislocation is a frequent complication of total hip arthroplasties (THA) especially in older patients, especially when using a posterior approach. In these cases, dual mobility (DM) cups developed by Gilles Bousquet in 1975 can be indicated to reduce this complication risk. Dual mobility cups reduce the rate of dislocation in primary total hip arthroplasty using posterior approach in a single-surgeon series. Test this hypothesis in a controlled study to compare the rate of dislocation in primary total hip arthroplasties done in patients over 50 years old either with a dual mobility cup or a conventional metal-on-polyethylene 28-mm diameter head. Two consecutive series of primary total hip replacements were performed by a single surgeon using a posterolateral approach. The piriformis tendon was left intact. The DM series included 105 patients who underwent arthroplasty between January 2005 and June 2007 with a dual mobility cup (60 women and 45 men, mean age 76.6±5.65 years old [53-93]). The control series (S series) included 108 patients who underwent arthroplasty (56 women and 52 men, mean age 74.2±5.9 years old [53-87]) with a conventional 28-mm polyethylene cup between January 2003 and June 2005. All hip replacements included a 28-mm metal-polyethylene cup and a 12-14-mm Morse taper. Both groups were comparable for gender, diagnosis, body mass index, type of anesthesia and ASA score distribution. All patients included in this series had a minimum follow-up of 1 year. There were no dislocations in the DM series and five early dislocations (before the third month) in the S series for a rate of 4.63%. Although the rate of dislocation was higher in the S series (4.63% vs 0%), the difference was barely significant (P=0.0597). This study comparing the incidence of dislocations after THA with conventional or dual mobility cups, shows that even using a posterior approach and in older patients, dual mobility cups increase stability with no postoperative dislocations. Although results are barely significant, a larger series should confirm the benefit of this implant. In this series, morbidity was not increased with dual mobility cups. Level III: retrospective case-control study.
    Orthopaedics & Traumatology Surgery & Research 12/2010; 97(1):2-7. · 1.06 Impact Factor
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    ABSTRACT: To evaluate the reproducibility and safety of a novel arthroscopic technique combining a Bristow-Latarjet procedure with a Bankart repair and to report the early clinical and radiologic results. Forty-seven consecutive patients with glenoid bone loss and capsular deficiency were treated with this all-arthroscopic technique; six patients had a failed arthroscopic capsulolabral repair. The coracoid fragment was osteotomized, passed with the conjoined tendon through the subscapularis muscle, and fixed in the standing position with a cannulated screw on the abraded glenoid neck. The capsule and labrum were then reattached on the glenoid rim, leaving the coracoid bone block in an extra-articular position. Potential intraoperative and postoperative complications were recorded. All patients were reviewed and had postoperative radiographs; 35 had computed tomography scans. The procedure was performed entirely arthroscopically in 41 of 47 patients (88%); a conversion to open surgery was needed in 6 patients (12%). The axillary nerve was identified in all cases, and no neurologic injuries were observed. No patient had any recurrence of instability at the most recent follow-up (mean, 16 months). The mean Rowe score was 88 ± 16.7, and the mean Walch-Duplay score was 87.6 ± 12.9. The Subjective Shoulder Value was 87.5% ± 12.7%. The bone block was subequatorial in 98% of the cases (46 of 47) and flush to the glenoid surface in 92% (43 of 47); it was too lateral in 1 (2%) and too medial (>5 mm) in 3 (6%). There was 1 bone block fracture and 7 migrations. The arthroscopic Bristow-Latarjet-Bankart procedure is reproducible and safe. This procedure allows restoration of shoulder stability in patients with glenoid bone loss and capsular deficiency, as well as in the case of failed capsulolabral repair. Arthroscopy offers the advantage of providing adequate visualization of both the glenohumeral joint and the anterior neck of the scapula, allowing accurate placement of the bone block and screw. Surgeons should be aware that the procedure is technically difficult and potentially dangerous because of the proximity of the brachial plexus and axillary vessels. Training on cadaveric specimens and transition from open to mini-open and, finally, to all arthroscopic is recommended. Level IV, therapeutic case series.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2010; 26(11):1434-50. · 3.10 Impact Factor
  • Pascal Boileau, Numa Mercier, Jason Old
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    ABSTRACT: The all-arthroscopic technique that the authors propose combines a Bristow-Latarjet procedure with a Bankart repair. This combined procedure provides a triple blocking of the shoulder (the so-called 2B3 procedure): (1) the labral repair recreates the anterior bumper and protects the humeral head from direct contact with the coracoid bone graft (Bumper effect); (2) the transferred coracoid bone block compensates for anterior glenoid bone loss (Bony effect); and (3) the transferred conjoined tendon creates a dynamic sling that reinforces the weak anteroinferior capsule by lowering the inferior part of the subscapularis when the arm is abducted and externally rotated (Belt or sling effect). The procedure combines the theoretic advantages of the Bristow-Latarjet procedure and the arthroscopic Bankart repair, eliminating the potential disadvantages of each. The extra-articular positioning of the bone block together with the labral repair and capsule retensioning allows the surgeon to perform a nearly anatomic shoulder repair. This novel procedure allows the surgeon to extend the indications of arthroscopic shoulder reconstruction to the subset of patients with recurrent anteroinferior shoulder instability with glenoid bone loss and capsular deficiency. It is an attractive surgical option to treat patients with a previous failed capsulolabral repair for which the surgical solutions are limited.
    Orthopedic Clinics of North America 07/2010; 41(3):381-92. · 1.25 Impact Factor
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    ABSTRACT: The purposes of this study were to investigate the mode of failure and survivorship of an independently performed series of medial Oxford unicompartmental knee arthroplasties. The study included 43 knees in 40 patients with a mean follow-up of 14.88 years: 13 knees (11 patients) had revision surgery (30%), and ten patients required conversion to total knee prosthesis. The mean International Knee Society (IKS) scores at the time of the revision were 145.52 [standard deviation (SD): 39.90, range: 167-200]. The overall alignment of the knee was restored to neutral, with a hip-knee-ankle (HKA) angle average of 178° (SD: 3.21°, range: 170-186°). Survivorship, as defined by an endpoint of failure for any reason, showed that the survival rate at five years was 90%, at ten years 74.7% and at 15 years 70%. Excluding inappropriate patient selection and surgeon-associated failures, our survival analysis plot is much improved: survivorship at five years is 94.5%, at ten years 85.7% and at 15 years 80.4%. The Oxford meniscal bearing arthroplasty offers long-term pain relief with good knee function. Unfortunately, we demonstrated a high complication rate, with some of the failures encountered indicating that the surgical technique is very demanding.
    International Orthopaedics 10/2009; 34(8):1137-43. · 2.32 Impact Factor
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    ABSTRACT: High tibial osteotomy (HTO) is commonly used for genu varum deformity in young and active patients. Corrective valgus osteotomy may however lead to an oblique joint line in cases of associated femur varum or absence of tibia vara. The over-correction, needed to obtain good long-term clinical results, may increase the obliquity even more. To avoid this drawback, the authors suggest use of an accurate and reproducible radiological protocol including at least a standing AP long-leg X-ray to measure not only the hip-knee-ankle (HKA) angle but also the medial distal femoral mechanical angle (MDFMA) and the medial proximal tibial mechanical angle (MPTMA). These measures will guide the surgeon to choose the best indication, including HTO, double level osteotomy (DLO) and distal femoral osteotomy (DFO). Computer-navigation of the osteotomies is the best choice to achieve the preoperative goal. This paper will present the pre- and perioperative protocols of HTO and DLO and the rationale behind this way of thinking.
    International Orthopaedics 04/2009; 34(2):185-90. · 2.32 Impact Factor