Caviglia et al [13] published the most extensive series with 19

Caviglia et al. [13] published the most extensive series with 19 patients who underwent extension osteotomies during a 30-year period. In six patients with fixed knees in flexion, the

range of motion was not regained. The arc of movement did not change in six, Cell Cycle inhibitor decreased in four and increased in the three remaining patients by only 10°. Postoperative bleeding, temporary proneal nerve paralysis, genu recurvatum and relapsed flexion deformity were the reported complications. They concluded that although this operation aligns the limb, it hardly influences the range of motion. Mortazavi et al. [14] reported the outcome of 11 trapezoid supracondylar extension osteotomy during a 5-year period. The patients were followed JQ1 in vitro up for an average 43.4 months after surgery. They showed that all of the patients gained the ability to function more independently after the operation; they could walk, climb the stairs, bathe and use public means of transportation by themselves. The arc of motion increased in all of the knees which had some range of motion before surgery. This was in contrast

to results of previous studies on V-shaped osteotomies. Using rigid internal fixation and early physiotherapy range of motion may well be a reason, but they proposed that the higher degrees of release of extensor mechanism gained by femoral shortening in trapezoid osteotomy compared with V-shaped ones could be another mechanism for this difference. This shortening may also reduce the risk of neurovascular complications. There were few minor postoperative complications and this operation seems to be safe. The trapezoid supracondylar femoral extension osteotomy could be considered an alternative in the management of severe,

fixed flexion contracture of the knee joint that is unresponsive to conservative measures in patients with haemophilia. The knee is the most commonly involved joint in haemophilia and the most responsible for long-term disability. Most patients with serious complications of haemophilic arthroplasthy are treated with elective total joint arthroplasty to reduce the rates of haemarthrosis, pain and functional impairment. There 上海皓元 are significant challenges facing the surgeon undertaking total knee replacement in the patient with haemophilic arthropathy; notably, the frequent coexistence of articular contractions of the knee. By that point, the synovium progresses from a hypervascular, hyperplastic synovium to one that is largely fibrous tissue. Generally, this results in a fixed flexion deformity and associated reduction in the range of flexion. It is not unusual for the flexion deformity to be complicated by posterior subluxation and external rotation of the tibia. This poses significant challenges in terms of surgical exposure and performance of joint replacement, and also in terms of obtaining adequate functional range of motion, postoperatively.

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