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      Effect of lengthening along the anatomical axis of the femur and its clinical impact

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          Abstract

          AIM

          To review and study the effect of lengthening along the anatomical axis of long bones and its relation to the mechanical axis deviation.

          METHODS

          We try in this review to calculate and discuss the exact clinical impact of lengthening along the anatomical axis of the femur on affecting the limb alignment. Also we used a trigonometric formula to predict the change of the femoral distal anatomical mechanical angle (AMA) after lengthening along the anatomical axis.

          RESULTS

          Lengthening along the anatomical axis of the femur by 10% of its original length results in reduction in the distal femoral AMA by 0.57 degrees. There is no objective experimental scientific data to prove that the Mechanical axis is passing via the center of the hip to the center of the knee. There is wide variation in normal anatomical axis for different populations. In deformity correction, surgeons try to reproduce the normal usual bone shape to regain normal function, which is mainly anatomical axis.

          CONCLUSION

          Lengthening of the femur along its anatomical axis results in mild reduction of the distal femoral AMA. This may partially compensate for the expected mechanical axis lateralisation and hence justify its minimal clinical impact.

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          Most cited references18

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          The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus.

          Johan Bellemans, William Colyn, Hilde Vandenneucker … (2012)
          Most knee surgeons have believed during TKA neutral mechanical alignment should be restored. A number of patients may exist, however, for whom neutral mechanical alignment is abnormal. Patients with so-called "constitutional varus" knees have had varus alignment since they reached skeletal maturity. Restoring neutral alignment in these cases may in fact be abnormal and undesirable and would likely require some degree of medial soft tissue release to achieve neutral alignment.
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            Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening.

            Ashish A. Bhave, John E. Herzenberg, D Paley … (1997)
            Twenty-nine patients (thirty-two femora) had femoral lengthening over an intramedullary nail, with the nail and the external fixator applied concomitantly at the time of the femoral osteotomy. After gradual distraction at a rate of one millimeter per day, the nail was locked and the fixator was removed. The mean age was twenty-six years (range, ten to fifty-three years), and the mean amount of lengthening was 5.8 centimeters (range, two to thirteen centimeters). For comparison, thirty-one patients (thirty-two limbs) who had had standard Ilizarov femoral lengthening were matched with the group that had had lengthening over an intramedullary nail; the matching was performed on the basis of the amount of lengthening, the age of the patient, the etiology of the indication for lengthening, and the level of difficulty of the procedure. Lengthening over an intramedullary nail reduced the average duration of external fixation by almost one-half. The radiographic consolidation index (the number of months needed for radiographic consolidation for each centimeter of lengthening) for the limbs that had had lengthening over an intramedullary nail was reduced significantly (p < 0.001) compared with that for the matched-case group. The range of motion of the knee returned to normal a mean of 2.2 times faster in the group that had had lengthening over an intramedullary nail. There were six refractures of the distraction bone in the matched-case group. In the group that had had lengthening over an intramedullary nail, one nail and one proximal locking screw failed. The over-all rate of complications was 1.4 per cent in the group that had had lengthening over an intramedullary nail compared with 1.9 per cent in the matched-case group. With the numbers of patients available for study, we could not detect a significant difference between the groups with respect to the operative time (p = 0.124); however, the cost of treatment and the estimated blood loss were higher in the group that had had lengthening over an intramedullary nail. On the basis of clinical and radiographic criteria, there were twenty-three excellent, seven good, and two fair results in the group that had had lengthening over an intramedullary nail compared with twenty-six excellent, four good, and two fair results in the matched-case group (p = 0.37). The advantages of lengthening over an intramedullary nail include a decrease in the duration of external fixation, protection against refracture, and earlier rehabilitation.
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              Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality.

              Donald Eckhoff, Joel M Bach, Victor M. Spitzer … (2005)
              Article 0 comments Cited 57 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Orthop
                Journal ID (publisher-id): WJO
                Title: World Journal of Orthopedics
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 2218-5836
                Publication date Collection: 18 May 2017
                Publication date (Electronic): 18 May 2017
                Volume: 8
                Issue: 5
                Pages: 431-435
                Affiliations
                Khaled M Emara, Ahmed Nageeb Mahmoud, Ahmed K Emara, Mariam K Emara, Limb Reconstruction and Deformity Correction Unit, Orthopaedic Surgery Department, Ain Shams University Hospitals, Cairo 11566, Egypt
                Author notes

                Author contributions: Emara KM contributed to study design; Mahmoud AN contributed to literature review, research, manuscript design and writing; Emara AK contributed to writing and research; Emara MK contributed to calculation, mathematical engineering and illustrations.

                Correspondence to: Dr. Khaled M Emara, Professor, Limb Reconstruction and Deformity Correction Unit, Orthopaedic Surgery Department, Ain Shams University Hospitals, 13 B Kornesh EL Nile, Agha Khan, Cairo 11566, Egypt. kmemara@ 123456hotmail.com

                Telephone: +20-22-2055661 Fax: +20-22-2055662

                Article
                Other ID: jWJO.v8.i5.pg431
                DOI: 10.5312/wjo.v8.i5.431
                PMC ID: 5434350
                PubMed ID: 28567347
                SO-VID: 9184fd96-f5ef-48b1-be6d-330dd79a6b13
                Copyright © ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 7 November 2016
                Date revision received : 4 March 2017
                Date accepted : 16 March 2017
                Categories
                Subject: Systematic Reviews

                Keywords: bone lengthening,deformity,femoral lengthening,external fixation,intramedullary nail,axis deviation
                Data availability:
                Keywords: bone lengthening, deformity, femoral lengthening, external fixation, intramedullary nail, axis deviation

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