Current Trends in Orthopedics Regarding Knee Osteotomies: Frequency, Indications, and Techniques

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* 1. What geographical location do you currently practice in?

Europe

North America

South America

Asia

Africa

Australia

Other (please specify)

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* 2. How many years have you been in practice?

Resident/Fellow

0-3

4-6

7-9

10-15

16-20

21+

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* 3. How do you assess varus/valgus (coronal) alignment in your practice? (select all that apply)

Visual inspection

Physical exam (gait analysis, varus thrust)

Standard knee radiographs

Long-leg radiographs

CT scan

Do not routinely assess varus/valgus alignment

Other (please specify)

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* 4. How do you assess tibial (sagittal) slope in your practice? (select all that apply)

Visual inspection

Physical exam (recurvatum/hyperextension)

Standard lateral knee radiograph

Long leg lateral tibia radiograph

CT scan

MRI

Do not routinely assess tibial slope

Other (please specify)

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* 5. What types of osteotomies do you use in your practice? (select all that apply)

Closing-wedge distal femoral osteotomy

Opening-wedge distal femoral osteotomy

Medial closing-wedge proximal tibial osteotomy

Medial opening-wedge proximal tibial osteotomy

Lateral closing-wedge proximal tibial osteotomy

Anterior closing-wedge proximal tibial osteotomy

Anterior opening-wedge proximal tibial osteotomy

Biplanar proximal tibial osteotomy

Derotational Osteotomies

Other (please specify)

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* 6. How many osteotomies have you performed in the last year? (mark all that apply)

Opening/Closing Wedge DFO (coronal plane):

Opening/Closing Wedge PTO (coronal plane):

Opening/Closing Wedge PTO (to increase/decrease slope):

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* 7. For what indications do you use knee osteotomy? (select all that apply)

Arthritis with malalignment

Patellofemoral Instability

Coronal malalignment in setting of acute knee injury

Coronal malalignment in setting of failed prior ligament reconstruction

Increased tibial slope

Decreased tibial slope

Other (please specify)

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* 8. What is the role of unloader bracing in your practice? (select all that apply)

Unloader brace trial prior to surgical intervention to verify pain relief

Unloader brace in immediate post-operative period

Unloader brace post-operative until final bony union

No use of unloader bracing

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* 9. How, if at all, has your use of knee osteotomy changed in the last five years? (select all that apply)

Decreased overall number of osteotomies performed

Increased overall number of osteotomies performed

No significant changes

Stopped performing any knee osteotomy

Started performing knee osteotomy

Reduced the types of knee osteotomies performed

Began performing more types of knee osteotomies

Began performing knee osteotomies for more indications

Stopped performing knee osteotomies for some indications

Other (please specify)

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* 10. What is your prescribed weightbearing status following a CLOSING-WEDGE knee osteotomy?

Weightbearing as tolerated with crutches

Non-weight bearing > 6 weeks

Non-weight bearing < 6 weeks

Partial weight bearing >6 weeks

Partial weight bearing <6 weeks

Weight bearing dependent on magnitude of the correction

Other (please specify)

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* 11. What is your prescribed weightbearing status following an OPENING-WEDGE knee osteotomy?

Weightbearing as tolerated with crutches

Non-weight bearing > 6 weeks

Non-weight bearing < 6 weeks

Partial weight bearing >6 weeks

Partial weight bearing < 6 weeks

Weight bearing dependent on magnitude of the correction

Other (please specify)

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* 12. What type of hardware do you prefer for use in knee osteotomy?

Opening-wedge osteotomy: staples

Opening-wedge osteotomy: plate and screws

Closing-wedge osteotomy: staples

Closing-wedge osteotomy: plate and screws

Closing-wedge PTO specific hardware

Please specify:

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* 13. What types of bone graft do you prefer for opening-wedge osteotomies?

I do not use bone graft

Autograft: femur

Autograft: iliac crest

Autograft: tibia

Allograft

Demineralized bone matrix

Synthetics

Other (please specify)

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* 14. What type of system/program do you use to calculate osteotomy corrections?

Hand drawings

Visual inspection

PACS / digital imaging

Other (please specify)

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* 15. For knee arthritis, where in the tibia do you aim for the new weight bearing axis when performing a VALGUS producing osteotomy?

Apex of medial tibial eminence (spine)

Center of the joint

Apex of lateral tibial eminence (spine)

Fujisawa point

Other (please specify)

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* 16. For knee arthritis, where in the tibia do you aim for the new weight bearing axis when performing a VARUS producing osteotomy?

Apex of medial tibial eminence (spine)

Center of the joint

Apex of lateral tibial eminence (spine)

Fujisawa point

Other (please specify)

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* 17. For knee osteotomies for other indications than arthritis, where do you aim for the new weight bearing axis?

Apex of medial/lateral tibial eminence (spine)

Center of the joint

Fujisawa point

I do not change my procedure for knee osteotomies for arthritis or ligament instability

Other (please specify)

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* 18. For a slope changing closing-wedge PTO, when do you perform a tibial tubercle osteotomy (TTO)?

Closing wedge >10 mm

Closing wedge >15 mm

Always

Never

Other (please specify)

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* 19. How do you assess appropriate intra-operative correction/final alignment?

Do not perform intra-operative assessment. Guided by preoperative planning

Fluoroscopy with alignment rod or accessory tool

Advanced imaging such as CT scan intra-operatively

Other guidance software or robotics