Background: High tibial open wedg osteotomy is one of the most important modality for treatment of VARUS DEFORMITY in order to correct DEFORMITY and improving signs and symptoms of patients with primary degenerative osteoarthritis. The aim of this study was to investigate the results of high tibial open wedge osteotomy in patients with VARUS deformities.Methods: This retrospective study conducted on twenty nine patients (36 knees) undergone proximal tibial osteotomy operation in Shafa Yahyaian University Hospital from2004 to 2010. Inclusion criteria were: age less than 60 years, high physical activity, VARUS DEFORMITY and involvement of medical compartment of knee. Patients with obesity, smoking, patelofemoral pain, lateral compartment lesion, DEFORMITY degree more than20 degree, extension limitation and range of motion less than 90 degree were excluded. The clinical and radiologic characteristics were measured before and after operation.Results: Fourteen patients were females. All of them were younger than 50 years, with mean (±SD) 27.64 (±10.88). The mean (±SD) of follow up time was 4.33 (±1.7). All the patients were satisfied with the results of operation. Tenderness and pain decreased in all of them. In all patients autologus bone graft were used, in15 cases (42.5%) casting and in the rest T. Buttress plate were used for fixation of fractures. In both groups of primary and double VARUS the International knee documentation committee (IKDC) and modified Larson indices were improved after operation, but there was no significant difference between two groups.Conclusion: High tibial open wedge osteotomy can have satisfying results in clinical signs and symptoms of patients with primary medial joint degenerative osteoarthritis. This procedure also may correct the DEFORMITY and improves the radiologic parameters of the patients.

Background: Proximal humerus shortening and VARUS can occur secondary to neonatal shoulder septic arthritis and focal fibrocartilage dysplasia. Valgus osteotomy of the proximal humerus compensates for a little bite of shortening, and improves the shoulder joint's range of motion. Case Report: In this study, we present two patients with severe proximal humerus DEFORMITY following glenohumeral septic arthritis. Both of them underwent valgus osteotomy, and had a satisfactory result in terms of range of motions and cosmesis at five years follow-up. Conclusion: Treatment of VARUS DEFORMITY of proximal humerus is challenging issue. There are few reports of surgical treatment. Sever VARUS DEFORMITY of proximal humerus impacts the motion of shoulder. We reported a novel method of valgus osteotomy of proximal humerus in patients with severe VARUS DEFORMITY secondary to neonatal septic arthritis and long-term clinical follow-up.

Background: We aimed to better understand the outcomes/complications of pie-crusting technique using blade knife during total knee arthroplasty (TKA) in patients with knee genu varum DEFORMITY. Materials and Methods: A systematic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. English and Persian language articles were considered on the use of pie-crusting technique during TKA in patients with knee genu varum/VARUS DEFORMITY using related keywords and Medical Subject Headings terms with reported postoperative complications and outcomes. Results: Primary search resulted in 81 studies of them 9 included in our study (ages ranged: 19 years to 62 years). No perioperative complications and/or any significant differences between pie-crusting and control group were observed. Except for two studies that found no significant positive effect for the use of pie-crusting, other studies found pie-crusting a useful and promising technique. Four studies found significant improvement in pie-crusting group compared to control in terms of functional Knee Society Score (KSS), range of motion (ROM), medial gap, and the knee-specific KKS. Three records found no significant differences in terms of functional KSS, ROM,however, they reported fewer use of constrained inserts or a reasonable correction of femoral tibial angle. No serious complications were reported. Conclusions: Due to the inconsistency of the results on the efficiency and outcomes of pie-crusting, we cannot make a firm conclusion and more high-quality studies are needed in this regard. However, this method can be considered as a safe method which depends on the skill of surgeon.

Background: Genovarum is the most common knee DEFORMITY for which a variety of surgical techniques have been proposed. Objectives: We decided to share our experiences through a detailed presentation of a new and simple method called proximal tibiaosteotomy using M-W method. Methods: In this study, 68 patients (128 knees) with proximal tibia osteotomy with an average age of 34 years, who had undergoneW-M osteotomy surgery in a community hospital during 2001 and 2014, were studied using knee society score (KSS) and functionalKSS questionnaires, and their clinical results were analyzed. Results: No significant difference was obtained between patients undergoing surgery by this method in KSS before (78. 8) and after(89. 6) the surgery. Although the mean score was improved, functional KSS improved significantly after surgery. None of the patientshad peroneal nerve complication, infection, osteomyelitis, or postoperative nonunion. Moreover, no recurrence was detected in amean of 2. 7 years follow-up. Conclusions: Considering the advantages of this method, it is recommended that knee VARUS DEFORMITY be treated using thismethod, as its rate of complications is low. However, further studies should be conducted on the effectiveness of this method inthe future.

Background: The preoperative identification of patients who might need Constrained Condylar Knee (CCK) prosthesis in Total Knee Arthroplasty (TKA), is essential to ensure the availability of equipment and to address the patients’ expectations accurately. Objectives: In this study, we aimed at investigating if the preoperative features of the patients can provide this data. Methods: A total of 30 patients who underwent primary TKA for severe osteoarthritic genu varum DEFORMITY (VARUS angle ≥ 20º ) were evaluated in this retrospective study. Prosthesis selection was based on preoperative and intraoperative information. Demographic data, preoperative correctability of the DEFORMITY, and intraoperative information, including the reduction osteotomy, soft-tissue release, and pie-crust technique, were retrospectively collected. Soft-tissue release was performed in a sequential manner in 3 steps. Results: The study population included 4 males and 26 females with a Mean± SD age of 64. 6± 8. 7 years. A CCK prosthesis was used in 11 (36. 7%) cases. A significant association was found between the preoperative correctability and the type of prosthesis. In other words, all CCK prostheses were used in patients who were preoperatively non-correctable (P<0. 001). Also, the step of release was significantly associated with the type of prosthesis, and CCK prosthesis was used in all patients with step 3 release (P<0. 001). Preoperative correctability was significantly related to the step of release, as well. It means that all deformities with step 3 release were preoperatively non-correctable (P=0. 008). Conclusion: The preoperative clinical evaluation of correctability could be used in the identification of patients who might need a CCK prosthesis.

Diagnosis of knee osteoarthritis can be confirmed based on clinical and/or radiological features. The potential of progressive disease can be prevented or decreased by earlier recognition and correction of associated factors. Obesity and alignment especially VARUS malalignment are recognized factors of progressive disease.Both nonpharmalogical as well as pharmacological modalities of treatment are useful in managing the symptoms of knee osteoarthritis. Surgery should be considered only in patients who do not respond to medical therapy. Prevalence and risk factors of knee osteoarthritis have been described in the first part of this review. In this issue, the diagnosis progressive factors and management of knee osteoarthritis are discussed.

Background: In total knee arthroplasty (TKA), the optimum kinematic and functional outcomes are achieved by restoring the balance between the medial and lateral compartment. In case of encountering VARUS alignment, the medial collateral ligament (MCL) and medial soft tissue release are often required to obtain the balance (1). Using the pie-crusting technique for MCL release for VARUS DEFORMITY correction during TKA has gained popularity among some surgeons recently (2-4). However, algorithmic medial pie-crusting technique has not become widespread achieving balanced medial and lateral soft tissue during TKA due to the risk of technique induced mid-substance superficial medial collateral ligament (sMCL) tear. Moreover, progressive mechanical weakening of the MCL can result in knee instability (5, 6). However, there is no clinical data available to validate the safety of this technique. . .

Background: High Tibial Osteotomy (HTO) is an approved surgical technique for VARUS knee DEFORMITY. For open wedge HTO multiple fixation methods and devices have been used. Advantages and disadvantages of these methods and devices are reported in various studies. Few studies have been conducted on use and final outcome of correction of VARUS knee DEFORMITY by implementation of non locking plates and benefits of this method is not fully evaluated. Objectives: To assess clinical and radiographic features of non-locking 4. 5 millimeter L-buttress plate and T-buttress plate, which is used in open wedge High Tibial Osteotomy (HTO), and to find out whether this device is efficient enough or not. Methods: This cross-sectional study was conducted on 39 patients with tibial DEFORMITY recruited from a referral orthopedic hospital in Iran. Patients’ information, including their baseline characteristics, Range of Motion (ROM) of the knee, comorbidities, time of weight-bearing, union time in x-ray, graft type, and time of follow-up were reported at two stages: before and after the operation. Radiographic images were taken from their legs in both stages. Although different surgeons operated on the cases, they all used the same method. After the surgery, they were checked up in 2, 6, 12, and 24 weeks and a second alignment view was taken from the patients. Results: Thirty-nine patients underwent surgery for the correction of genu VARUS DEFORMITY and the follow-up time was between 6-48 months. There was no case of non-union and the ROM was perfectly restored in all the patients. Conclusion: Although the rate of the success in the use of the locking plate in HTO is higher, the use of a 4. 5-mm non-locking plate seems to have decent results, too; therefore, it could be used as an alternative yet functional fixation tool in HTO.