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Petersen W, Mustafa HA, Häner M, Buitenhuis J, Braun K. [Medial closing wedge osteotomy for correction of valgus deformity]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024:10.1007/s00064-024-00855-9. [PMID: 39152349 DOI: 10.1007/s00064-024-00855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 08/19/2024]
Abstract
OBJECTIVE Correction of a proximal tibial valgus deformity. INDICATIONS Lateral osteoarthritis of the knee or cartilage damage in a valgus deformity > 5° with a medial proximal tibial angle (MPTA) > 90°. CONTRAINDICATIONS Medial proximal tibial angle < 90°, medial cartilage damage, medial meniscus loss. SURGICAL TECHNIQUE Skin incision medial of the tibial tuberosity approximately 8-10 cm. Insertion of two converging guidewires directly above the pes anserinus, ascending obliquely, and ending at the tip of the fibula. Control of the wire position with the image intensifier. Osteotomy with an oscillating saw. Removal of the wedge and closure of the osteotomy. Osteosynthesis with a medial angle-stable plate. POSTOPERATIVE MANAGEMENT Partial load bearing with 10-20 kg for 2 weeks, then step-wise increase in load. Mobility: free. RESULTS We performed this surgery in the manner described in 21 patients with lateral osteoarthritis or cartilage damage (17 men, 4 women, average age: 51 years). The valgus deformity was reduced from an average of 5.6 to -0.5°. The KOOS-PS (Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-form) score decreased significantly from 39.1 ± 14 to 25.8 ± 20 points.
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Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland.
| | - Hasan Al Mustafa
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
| | - Matin Häner
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
| | - Johannes Buitenhuis
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
| | - Karl Braun
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyss Str. 27-33, 14193, Berlin, Deutschland
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Petersen W. [Osteotomies around the knee-part 1]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024; 36:81-82. [PMID: 38609502 DOI: 10.1007/s00064-024-00846-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Wolf Petersen
- Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland.
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Ismailidis P, Schmid C, Werner J, Nüesch C, Mündermann A, Pagenstert G, Egloff C. Distal femoral osteotomy for the valgus knee: indications, complications, clinical and radiological outcome. Arch Orthop Trauma Surg 2023; 143:6147-6157. [PMID: 37278744 PMCID: PMC10491530 DOI: 10.1007/s00402-023-04923-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of this study was to describe the indications and technical aspects of medial closing and lateral opening distal femoral osteotomy (MCDFO and LODFO) for patients with a valgus knee and to report clinical and radiological outcomes and complications. METHODS Over 6 years, 28 DFOs (22 MCDFO, 6 LODFO) were performed in 22 Patients. In this cohort study, we retrospectively analyzed clinical and radiological outcome measures as well as complications. RESULTS The median (range) age was 47 (17-63) years, height 1.68 (1.56-1.98) m, body mass 80 (49-105) kg, and body mass index (BMI) 27.4 (18.6-37.0) kg/m2. The clinical follow-up was 21 (7-81) months, the need for total or unicompartmental knee arthroplasty (TKA/UKA) and hardware removal was followed up for 59 (7-108) months postoperatively. Preoperatively, hip-knee-ankle angle (HKA, negative values denote varus) was 7.0 (2.0-13.0)°, mechanical lateral distal femoral angle (mLDFA) was 83.7 (79.9-88.2)°, and mechanical proximal tibial angle (MPTA) was 89.0 (86.6-94.5)°. Postoperatively, HKA was -1.3 (-9.0-1.2)° and mLDFA was 90.8 (87.3-97.3)°. The incidence of minor and major complications was 25% and 14%, the incidence of delayed and nonunion was 18% and 4%, respectively. At the last follow-up, 18% of the patients had pain at rest, 25% during activities of daily living, and 39% during physical activity, and 71% were satisfied with the outcome. 7% of the cases received a TKA/UKA, 71% received a hardware removal. CONCLUSION DFO is a reasonable treatment for lateral osteoarthritis in younger patients to avoid disease progression and the need for an UKA/TKA. However, there is a long rehabilitation time, a considerable risk for complications, and a high need for hardware removal. While many patients experienced symptoms at the long-term follow-up, most were satisfied with the outcome. Appropriate patient information is essential. Level of evidence Level IV, Case Series. Trial registration number NCT04382118, clinicaltrials.gov, May 11, 2020.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
| | - Corinna Schmid
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Julika Werner
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
- Knee Institute Basel, Clarahof, Clinic of Orthopaedic Surgery, Clarahofweg 19a, 4058, Basel, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
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Schröter S, Konrads C, Maiotti M, Mederake M, Fischer C, Ahrend M, Schüll D. In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided. Knee Surg Sports Traumatol Arthrosc 2023; 31:3992-3999. [PMID: 37149824 DOI: 10.1007/s00167-023-07449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE The purpose of the study was to investigate the influence of the mLDFA (mechanical lateral distal femur angle) as a parameter in varus realignment osteotomies for valgus deformities of the knee. We hypothesized that joint line obliquity with mLDFA > 90° after distal femur osteotomy (DFO) is associated with inferior clinical outcome. METHODS In a retrospective study, a total of 52 patients with isolated femoral valgus deformities were included in the study. The mean postoperative follow-up was 70.5 (SD 33.3) months (standard deviation SD±33.3). In all patients, a distal femur osteotomy was performed. A clinical examination and survey of questionnaires was conducted with the HSS (Hospital for Special Surgery), LG (Lysholm-Gilquist), and KOOS (Knee Injury and Osteoarthritis Outcome Score) scores. Several radiological parameters were assessed on long-standing x-rays: mechanical tibio-femoral angle (mTFA), mLDFA, mechanical medial proximal tibia angle (mMPTA), joint-line convergence angle (JLCA). The t test was used for normally distributed data. The Mann-Whitney U test was performed in non-normally distributed data. RESULTS The mLDFA was 84.9° (SD±2.3) preop and changed to 91.9° (SD±3, 22.9) postop. The mTFA (mechanical tibio-femoral angle) was 5.2° (SD±2.9°) preop and - 1.8° (SD±2.9) postop demonstrating a difference of 6.7°. For analysis, the data was divided into two groups based on postop mLDFA. Group 1: mLDFA ≤ 90°; Group 2: > 90°. Postoperatively, a mean mLDFA of 88.6° (SD±1.4°) was measured in group 1 and 93.9° (SD±2.1) in group 2. The change in mLDFA was 4.7° (SD±1.6) in group 1 and 8.4° (SD±2.8) in group 2. Preoperatively, the mTFA was 4.8° (SD±1.9) in group 1 and 5.5° (SD±3.3) in group 2. Postoperatively, the mTFA decreased in group 1 by 4.8° (SD±2.3) to - 0.1° (SD±2.1). In group 2, the mTFA decreased by 8.2° (SD±3.8) to - 2.8° (SD±2.9). Regarding the HSS, group 1 showed a 10.4 points better score than group 2 (p<0.01). Also, regarding the Lysholm, a significant difference of 16.9 points was found (p<0.01). CONCLUSION Correction of valgus knees using closed wedge DFO leads to good clinical results. A postoperative mLDFA of 85-90° results in superior clinical outcome compared to mLDFA > 90°. Joint-line obliquity should be avoided using double level osteotomy, if needed. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Steffen Schröter
- Department of Orthopaedics and Traumatology, Diakonie Klinikum GmbH Jung-Stilling, Siegen, Germany.
| | - Christian Konrads
- Department of Orthopaedics and Traumatology, Helios Hanseatic Hospital Stralsund, Stralsund, Germany
- Medical Faculty, University of Tübingen, Tübingen, Germany
| | - Marco Maiotti
- Shoulder Unit Villa Stuart Clinic (Rome) Orthopedics, Rome, Italy
| | - Moritz Mederake
- Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Cornelius Fischer
- Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Marc Ahrend
- Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Tübingen, Germany
| | - Daniel Schüll
- Department of Orthopaedic Surgery, University of Tübingen, Tübingen, Germany
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Clinical Outcome after Medial Open-Wedge High Tibial Osteotomy: Comparison of Two Angular Stable Locking Plates—TomoFix™ versus LOQTEQ® HTO Plate. J Pers Med 2023; 13:jpm13030472. [PMID: 36983654 PMCID: PMC10053608 DOI: 10.3390/jpm13030472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
This study evaluated bony healing and clinical results after medial open-wedge HTO to compare the outcome of the LOQTEQ® HTO plate and the TomoFix™ internal plate fixator. A prospective, non-randomised, comparative study was undertaken. The same surgical technique for the medial open-wedge HTO was used in two treatment groups. In Group 1, the TomoFix™ implant was used for osteosynthesis, and, in Group 2, the LOQTEQ® HTO plate was used. All patients were examined before surgery (T0) and then at 12 months (T1) and at 24 months (T2) postoperatively. The primary outcome measure was the KOOS pain subscore. The secondary outcome criteria were other KOOS subscales, the Tegner score, radiological healing (RUST), and incision length. The KOOS pain subscale and the other KOOS subscores increased significantly in both groups from T0 to T1 and T2 without a significant group difference at each timepoint. The activity measured with the Tegner scale increased significantly from T0 to T2 without a significant group difference. No radiological signs of implant failure were observed in any case at the one-year X-ray, and no patient fulfilled the criteria for non-union. There was no significant difference in the frequency of adverse effects between the two treatment groups. The length of the incision was significantly shorter in the LOQTEQ® HTO group than in the TomoFix™ group. The results of this study show that patient-related outcome scores (KOOS, Tegner) increased after medial open-wedge HTO. There was no difference in clinical outcome or radiological healing between the treatment groups. Both plates are suitable for the osteosynthesis of open-wedge HTO.
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Petersen W, Bierke S, Häner M. Kniegelenknahe Osteotomie bei unikompartimenteller Gonarthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00378-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Imhoff FB, Schnell J, Magaña A, Diermeier T, Scheiderer B, Braun S, Imhoff AB, Arciero RA, Beitzel K. Single cut distal femoral osteotomy for correction of femoral torsion and valgus malformity in patellofemoral malalignment - proof of application of new trigonometrical calculations and 3D-printed cutting guides. BMC Musculoskelet Disord 2018; 19:215. [PMID: 29996839 PMCID: PMC6042371 DOI: 10.1186/s12891-018-2140-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/18/2018] [Indexed: 01/17/2023] Open
Abstract
Background The purpose of this study was to perform a derotational osteotomy at the distal femur, as is done in cases of patellofemoral instability, and demonstrate the predictability of three-dimensional (3D) changes on axes in a cadaveric model by the use of a new mathematical approach. Methods Ten human cadaveric femurs, with increased antetorsion, underwent a visually observed derotational osteotomy at the distal femur by 20°, as is commonly done in clinics. For surgery, a single cut osteotomy with a defined cutting angle was calculated and given using a simple 3D-printed cutting guide per specimen, based on a newly-created trigonometrical model. To simulate post-operative straight frontal alignment in a normal range, a goal for the mechanical lateral distal femur angle (mLDFA) was set to 87.0° for five specimens (87-goal group) and 90.0° for five specimens (90-goal group). Specimens underwent pre- and post-operative radiographic analysis with CT scan for torsion and frontal plane x-ray for alignment measurements of mLDFA and anatomical mechanical angle (AMA). Results Performed derotation showed a mean of 19.69° ±1.08°SD (95% CI: 18.91° to 20.47°). Regarding frontal alignment, a mean mLDFA of 86.9° ±0.66°SD (87-goal-group) and 90.42° ±0.25° SD (90-goal group), was observed (p = 0.008). Overall, the mean difference between intended mLDFA-goal and post-operatively achieved mLDFA was 0.14° ±0.56° SD (95% CI: -0.26° to 0.54°). Conclusion A preoperative calculated angle for single cut derotational osteotomy at the distal femur leads to a clinically precise post-operative result on torsion and frontal alignment when using this approach.
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Affiliation(s)
- Florian B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany. .,Department of Orthopaedic Surgery, University of Connecticut, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Joscha Schnell
- Department of Mechanical Engineering, Institute for Machine Tools and Industrial Management, Technical University Munich, Boltzmannstr. 15, 85748, Garching, Munich, Germany
| | - Alejandro Magaña
- Department of Mechanical Engineering, Institute for Machine Tools and Industrial Management, Technical University Munich, Boltzmannstr. 15, 85748, Garching, Munich, Germany
| | - Theresa Diermeier
- Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Orthopaedic Surgery, University of Connecticut, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Sepp Braun
- Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Imhoff FB, Beitzel K, Zakko P, Obopilwe E, Voss A, Scheiderer B, Morikawa D, Mazzocca AD, Arciero RA, Imhoff AB. Derotational Osteotomy of the Distal Femur for the Treatment of Patellofemoral Instability Simultaneously Leads to the Correction of Frontal Alignment: A Laboratory Cadaveric Study. Orthop J Sports Med 2018; 6:2325967118775664. [PMID: 29900182 PMCID: PMC5985607 DOI: 10.1177/2325967118775664] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Derotational osteotomy of the distal femur allows the anatomic treatment of patellofemoral maltracking due to increased femoral antetorsion. However, such rotational osteotomy procedures have a high potential of intended/unintended changes of frontal alignment. Purpose/Hypothesis: The purpose of this study was to perform derotational osteotomy of the distal femur and to demonstrate the utility of a novel trigonometric approach to address 3-dimensional (3D) changes on 2-dimensional imaging (axial computed tomography [CT] and frontal-plane radiography). The hypothesis was that 1-step single-cut osteotomy can simultaneously correct torsion and frontal alignment based on preoperatively calculated cutting angles. Study Design: Controlled laboratory study. Methods: Eight human cadaveric whole legs (4 lower limb torsos) underwent derotational osteotomy of the distal femur of 20°. A straight leg axis, determined as a mechanical femorotibial angle (mFTA) of 0°, was chosen as a goal for postoperative frontal alignment. The inclination of the cutting angle from the lateral view was calculated individually for each cadaveric leg and was represented by a simple 3D-printed cutting guide for surgery. Specimens underwent CT for the measurement of torsion, while the frontal leg axis was determined on an upright radiograph preoperatively and postoperatively. Preoperative and postoperative angles were compared with the mathematical prediction model. Results: The preoperative mFTA ranged from –3.9° (valgus) to +3.4° (varus) (mean, –0.2° ± 2.6°). A postoperative mean mFTA of 0.37° ± 0.69° (95% CI, –0.22° to 0.95°) was achieved (P = .01). Derotation showed a mean of 19.1° ± 2.1° (95% CI, 17.3°-20.8°). The oblique cutting plane for the correction of valgus legs showed a mean of 5.9° ± 6.8° and, for the correction of varus legs, a mean of –10.0° ± 4.5° projected on the perpendicular plane to the virtual anatomic shaft axis from the sagittal view. Conclusion: Single-cut distal femoral osteotomy can be performed to simultaneously address rotational as well as frontal alignment using a preoperatively defined oblique cut, as determined by the presented reproducible calculation model. Clinical Relevance: This study adds important knowledge to the technique of derotational osteotomy. This approach provides an individual, oblique single cut for the correction of torsion and frontal axis within a clinically insignificant margin. Simplified tables for calculation and a surgical reference make this model reproducible and safe.
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Affiliation(s)
- Florian B Imhoff
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Philip Zakko
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Andreas Voss
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Daichi Morikawa
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.,Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Imhoff FB, Scheiderer B, Zakko P, Obopilwe E, Liska F, Imhoff AB, Mazzocca AD, Arciero RA, Beitzel K. How to avoid unintended valgus alignment in distal femoral derotational osteotomy for treatment of femoral torsional malalignment - a concept study. BMC Musculoskelet Disord 2017; 18:553. [PMID: 29284442 PMCID: PMC5747093 DOI: 10.1186/s12891-017-1904-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/11/2017] [Indexed: 12/20/2022] Open
Abstract
Background Defining the optimal cutting plane for derotational osteotomy at the distal femur for correction of torsion in cases of patellofemoral instability is still challenging. This preliminary study investigates changes of frontal alignment by a simplified trigonometrical model and demonstrates a surgical guidance technique with the use of femur cadavers. The hypothesis was that regardless of midshaft bowing, a cutting plane perpendicular to the virtual anatomic shaft axis avoids unintended valgus malalignment due to derotation. Methods A novel mathematical model, called the Pillar-Crane-Model, was developed to forecast changes on frontal alignment of the femur when a perpendicular cutting plane to the virtual anatomical shaft was chosen. As proof of concept, eight different torsion angles were assessed on two human cadaver femora (left and right). A single cut distal femoral osteotomy perpendicular to the virtual anatomical shaft was performed. Frontal plane alignment (mLDFA, aLDFA, AMA) was radiographically analyzed before and after rotation by 0°, 10°, 20°, and 30°. Measurements were compared to the model. Results The trigonometrical equation from the Pillar-Crane-Model provides mathematical proof that slight changes into varus occur, seen by an increase in AMA and mLDFA, when the cutting plane is perpendicular to the virtual anatomical shaft axis. A table with standardized values is provided. Exemplarily, the specimens showed a mean increase of AMA from 4.8° to 6.3° and mLDFA from 85.2° to 86.7 after derotation by 30°. Throughout the derotation procedure, aLDFA remained at 80.4° ± 0.4°SD. Conclusions With the use of this model for surgical guidance and anatomic reference, unintended valgus changes on frontal malalignment can be avoided. When the cutting plane is considered to be perpendicular to the virtual anatomical shaft from a frontal and lateral view, a slight increase of mLDFA results when a derotational osteotomy of the distal femur is performed.
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Affiliation(s)
- Florian B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany. .,Uconn Health, Department of Orthopaedic Surgery, Farmington, CT, USA.
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.,Uconn Health, Department of Orthopaedic Surgery, Farmington, CT, USA
| | - Philip Zakko
- Uconn Health, Department of Orthopaedic Surgery, Farmington, CT, USA
| | - Elifho Obopilwe
- Uconn Health, Department of Orthopaedic Surgery, Farmington, CT, USA
| | - Franz Liska
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | | | - Robert A Arciero
- Uconn Health, Department of Orthopaedic Surgery, Farmington, CT, USA
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
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Eberbach H, Mehl J, Feucht MJ, Bode G, Südkamp NP, Niemeyer P. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. Am J Sports Med 2017; 45:909-914. [PMID: 28125900 DOI: 10.1177/0363546516676266] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. PURPOSE The purposes of this study were (1) to analyze the coronal geometry of patients with valgus malalignment and identify the location of the underlying deformity and (2) to investigate the proportion of cases that require realignment osteotomy at the tibia, the femur, or both locations to avoid an oblique joint line. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The analysis included 420 standing full-leg radiographs of patients with valgus malalignment (mechanical femorotibial angle [mFTA], ≥4°). A systematic analysis of the coronal leg geometry was performed including the mFTA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). The localization of the deformity was determined according to the malalignment test described by Paley, and patients were assigned to 1 of 4 groups: femoral-based valgus deformity, tibial-based valgus deformity, femoral- and tibial-based valgus deformity, or intra-articular/ligamentary-based valgus deformity. Subsequently, the ideal osteotomy site was identified with the goal of a postoperative change of the joint line of two different maximum values, ±2° and ±4°, from its physiological varus position of 3°. RESULTS Measurements of the coronal alignment revealed a mean (±SD) mFTA of 7.4° ± 4.3° (range, 4°-28.2°). The mean mLDFA and mean mMPTA were 84.8° ± 2.4° and 90.9° ± 2.6°, respectively. The mean JLCA was 1.2° ± 3.1°. The majority (41.0%) of valgus deformities were tibial based, 23.6% were femoral based, 26.9% were femoral and tibial based, and 8.6% were intra-articular/ligamentary based. To achieve a straight-leg axis and an anatomic postoperative joint line with a tolerance of ±4°, the ideal site of a corrective osteotomy was tibial in 55.2% of cases and femoral in 19.5% of cases. A double-level osteotomy would be necessary in 25.2% of cases. With a tolerance of ±2°, the ideal osteotomy site was the proximal tibia in 41.0% of cases and the distal femur in 13.6% of cases; a double-level osteotomy would be necessary in 45.5% of cases. CONCLUSION In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.
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Affiliation(s)
- Helge Eberbach
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany
| | - Julian Mehl
- Department for Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany
| | - Gerrit Bode
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany.,OCM-Clinic Munich, Munich, Germany
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Midterm results following medial closed wedge distal femoral osteotomy stabilized with a locking internal fixation device. Knee Surg Sports Traumatol Arthrosc 2015; 23:2061-7. [PMID: 24676790 DOI: 10.1007/s00167-014-2953-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Aim of this study was to evaluate the subjective and radiological outcome and to evaluate the complications of a medial closing wedge osteotomy at the femur for lateral osteoarthritis with genu valgum. METHODS Twenty-three patients with grade III to IV cartilage damage and valgus knee alignment were treated with medial closing wedge osteotomy at the distal femur. The osteotomy was stabilized with an internal plate fixator. Age varied between 25 and 55 years (mean 47 years). One patient was lost to final follow-up. RESULTS After 3.5 years, all Knee Osteoarthritis Outcome Score (KOOS) subitems increased significantly. There was no significant difference in the subgroup analysis of KOOS subitems for patients with and without microfracture or age (>50 vs. <50 years). There were no perioperative complications. One patient had an overcorrection. All, but one osteotomy, showed stable bone healing. There was a loss of correction due to delayed bone healing in one case. Possible explanations for this complication were injury of the lateral cortex or smoking. This case required revision with bone graft and an additional lateral plate. In no case, a conversion to an endoprosthesis was necessary. CONCLUSION The femoral medial closing wedge osteotomy is a surgical method for improving symptoms of lateral osteoarthritis in the valgus knee. LEVEL OF EVIDENCE IV.
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Hinterwimmer S, Minzlaff P, Saier T, Niemeyer P, Imhoff AB, Feucht MJ. Biplanar supracondylar femoral derotation osteotomy for patellofemoral malalignment: the anterior closed-wedge technique. Knee Surg Sports Traumatol Arthrosc 2014; 22:2518-21. [PMID: 24748287 DOI: 10.1007/s00167-014-2993-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 04/03/2014] [Indexed: 01/29/2023]
Abstract
UNLABELLED Patellofemoral malalignment can be caused by several factors including increased internal torsion of the femur. As a causative treatment method, supracondylar femoral derotation osteotomies have been proposed. For valgus- and varus-producing supracondylar femoral osteotomies, a biplanar osteotomy has been introduced in order to enhance primary fixation stability and osseous consolidation by increased bone-to-bone contact. In this article, a modification of this technique is described, which allows for a biplanar supracondylar femoral derotation osteotomy. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Stefan Hinterwimmer
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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