Unexplained proximal tibiofibular joint pain after high tibial osteotomy

Problems of the proximal tibiofibular joint (pTFj) after high tibial osteotomy (HTO) are rare. With this case report, we strive to highlight the importance of investigating the pTFj in patients with unexplained knee pain after HTO. A 44 year old male patient presented with diffuse pain on his left k...

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Autores principales: Testa, Enrique Adrian, Haeni, David L, Behrens, Gerrit, Hirschmann, Michael T
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4052038/
https://www.ncbi.nlm.nih.gov/pubmed/24932045
http://dx.doi.org/10.4103/0019-5413.129453
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author Testa, Enrique Adrian
Haeni, David L
Behrens, Gerrit
Hirschmann, Michael T
author_facet Testa, Enrique Adrian
Haeni, David L
Behrens, Gerrit
Hirschmann, Michael T
author_sort Testa, Enrique Adrian
collection PubMed
description Problems of the proximal tibiofibular joint (pTFj) after high tibial osteotomy (HTO) are rare. With this case report, we strive to highlight the importance of investigating the pTFj in patients with unexplained knee pain after HTO. A 44 year old male patient presented with diffuse pain on his left knee 3 years after medial opening wedge HTO due to medial compartment overloading in a varus knee. Patient described persistent anterior tibial and lateral knee pain. 2 years after HTO, patient underwent implant removal but the knee pain persisted. As the reason for the persistent pain was not identified, further radiological evaluation was done. Single photon emission computerized tomography/computerized tomography (SPECT/CT) revealed that there was no increased uptake within the tibiofemoral joint, indicating a biologically well performed correction of the varus deformity. However, markedly increased tracer uptake was found at the pTFj. On the inherent axial CT scans, it was seen that the proximal screws were too long and placed within the pTFj. Along with this a severe osteoarthritis of the pTFj was identified. The cause of the patient's pain was then confirmed by a CT guided infiltration of local anesthetic. An arthrodesis of the pTFj was performed and at 12 months followup after the arthrodesis the patient was pain free. This case highlights how important it is to evaluate the pTFj in patients with unexplained pain after HTO. SPECT/CT was helpful in identifying the patient's problem in this challenging case.
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spelling pubmed-40520382014-06-13 Unexplained proximal tibiofibular joint pain after high tibial osteotomy Testa, Enrique Adrian Haeni, David L Behrens, Gerrit Hirschmann, Michael T Indian J Orthop Case Report Problems of the proximal tibiofibular joint (pTFj) after high tibial osteotomy (HTO) are rare. With this case report, we strive to highlight the importance of investigating the pTFj in patients with unexplained knee pain after HTO. A 44 year old male patient presented with diffuse pain on his left knee 3 years after medial opening wedge HTO due to medial compartment overloading in a varus knee. Patient described persistent anterior tibial and lateral knee pain. 2 years after HTO, patient underwent implant removal but the knee pain persisted. As the reason for the persistent pain was not identified, further radiological evaluation was done. Single photon emission computerized tomography/computerized tomography (SPECT/CT) revealed that there was no increased uptake within the tibiofemoral joint, indicating a biologically well performed correction of the varus deformity. However, markedly increased tracer uptake was found at the pTFj. On the inherent axial CT scans, it was seen that the proximal screws were too long and placed within the pTFj. Along with this a severe osteoarthritis of the pTFj was identified. The cause of the patient's pain was then confirmed by a CT guided infiltration of local anesthetic. An arthrodesis of the pTFj was performed and at 12 months followup after the arthrodesis the patient was pain free. This case highlights how important it is to evaluate the pTFj in patients with unexplained pain after HTO. SPECT/CT was helpful in identifying the patient's problem in this challenging case. Medknow Publications & Media Pvt Ltd 2014 /pmc/articles/PMC4052038/ /pubmed/24932045 http://dx.doi.org/10.4103/0019-5413.129453 Text en Copyright: © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Testa, Enrique Adrian
Haeni, David L
Behrens, Gerrit
Hirschmann, Michael T
Unexplained proximal tibiofibular joint pain after high tibial osteotomy
title Unexplained proximal tibiofibular joint pain after high tibial osteotomy
title_full Unexplained proximal tibiofibular joint pain after high tibial osteotomy
title_fullStr Unexplained proximal tibiofibular joint pain after high tibial osteotomy
title_full_unstemmed Unexplained proximal tibiofibular joint pain after high tibial osteotomy
title_short Unexplained proximal tibiofibular joint pain after high tibial osteotomy
title_sort unexplained proximal tibiofibular joint pain after high tibial osteotomy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4052038/
https://www.ncbi.nlm.nih.gov/pubmed/24932045
http://dx.doi.org/10.4103/0019-5413.129453
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