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Kuwashima U, Nejima S, Maiotti M, Ahrend MD, Schröter S. Surgical Technique and Preliminary Outcomes of Double-Level Osteotomy for Valgus Deformity. Orthop J Sports Med 2024; 12:23259671241252167. [PMID: 38840790 PMCID: PMC11151774 DOI: 10.1177/23259671241252167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 10/24/2023] [Indexed: 06/07/2024] Open
Abstract
Background Data are limited regarding the surgical technique or outcomes of double-level osteotomy (DLO) combining medial closing-wedge distal femoral osteotomy and medial closing-wedge high tibial osteotomy in patients with moderate-to-severe valgus deformity. Purpose/Hypothesis To describe the surgical technique and assess the short-term outcomes and surgical accuracy of DLO in patients with a moderate or severe valgus deformity. It was hypothesized that this technique would result in good clinical outcomes with precise deformity correction. Study Design Case series; Level of evidence, 4. Methods Eight patients (mean age, 44.2 ± 10.9 years) with a moderate or severe valgus knee treated with DLO (9 knees; mechanical tibiofemoral angle [mTFA], 10.3°± 3.5°) were included. The mean follow-up was 25.1 ± 11.1 months. Preoperative to postoperative changes in radiographic parameters (mTFA, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, joint line convergence angle) and clinical scores (Hospital for Special Surgery score, Oxford Knee Score, Lysholm score) were assessed. Surgical accuracy was calculated by subtracting the achieved postoperative correction from the preoperatively planned targeted correction. Results The mTFA changed significantly from 10.3°± 3.5° preoperatively to -1.8°± 3.4° postoperatively (P < .001); the mechanical lateral distal femoral angle and mechanical medial proximal tibial angle changed significantly by 5.1°± 2.7° and 5.9°± 2.2°, respectively (P < .001 for both); and the posterior distal femoral angle decreased significantly from 85.9°± 3.1° to 84.2°± 2.4° (P < .01). There was no significant difference between pre- and postoperative joint line convergence angles (3.3°± 2.3° to 2.6°± 2.1°). The accuracy of the correction was high: the mTFA achieved postoperatively differed from the mTFA planned preoperatively by a mean of 2.7°± 1.9° (range, 0.6°-6.6°). Significant pre- to postoperative improvement was seen for all outcome scores (Hospital for Special Surgery, from 67 ± 11 to 93 ± 4; Oxford Knee Score, from 29 ± 7 to 43 ± 3; Lysholm, from 41 ± 24 to 89 ± 8; P < .001 for all). Conclusion High surgical accuracy was achieved, and patients who underwent varus DLO for valgus knees showed improved knee function at short-term follow-up. Varus DLO can be a surgical option to restore the optimal alignment and joint line obliquity in patients with moderate or severe valgus malalignment.
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Affiliation(s)
- Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
- Osteotomie Komitee der Deutschen Knie Gesellschaft, München, Germany
| | - Marco Maiotti
- Shoulder Unit Villa Stuart Clinic (Rome)–Orthopedics, Rome, Italy
| | - Marc-Daniel Ahrend
- Osteotomie Komitee der Deutschen Knie Gesellschaft, München, Germany
- Department of Traumatology and Reconstructive Surgery, BG Klinik Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Steffen Schröter
- Osteotomie Komitee der Deutschen Knie Gesellschaft, München, Germany
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Sano S, Matsushita T, Nagata N, Tokura T, Nukuto K, Nakanishi Y, Nishida K, Nagai K, Kanzaki N, Hoshino Y, Matsumoto T, Kuroda R. Morphological analysis of the distal femur as a surgical reference in biplane distal femoral osteotomy. Sci Rep 2024; 14:12130. [PMID: 38802483 PMCID: PMC11130220 DOI: 10.1038/s41598-024-62988-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
Distal femoral osteotomy (DFO) is performed alone or with high tibial osteotomy (HTO) for patients with osteoarthritis and distal femur deformities. DFO is technically demanding, particularly when creating an anterior flange. Herein, we examined the morphological characteristics of the distal femur based on the cortical shape as a surgical reference for biplanar DFO. Computed tomography images of 50 valgus and 50 varus knees of patients who underwent biplanar DFO or total knee arthroplasty were analyzed. Axial slices at the initial level of the transverse osteotomy in the DFO and slices 10 mm proximal and 10 mm distal to that level were selected. The medial and lateral cortical angles and heights (MCLA, LCLA, MCH, and LCH) were measured on axial slices. Statistical comparisons were performed between the medial and lateral cortices and valgus and varus knees. MCLA and MCH were significantly smaller and lower, respectively, than LCLA and LCH (P < 0.01). The MCLA and MCH of varus knees were significantly smaller and lower, respectively, than those of valgus knees (P < 0.01). Surgeons should carefully observe morphological differences in the distal femur cortex, distinguishing between medial and lateral knees and varus and valgus knees during the creation of the anterior flange in the DFO.
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Affiliation(s)
- Shohei Sano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Naosuke Nagata
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takeo Tokura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Koji Nukuto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuta Nakanishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Kuwashima U, Itoh M, Itou J, Okazaki K. Impact of support instruments in medial closed-wedge distal femoral osteotomy: a finite element analysis. Arch Orthop Trauma Surg 2024; 144:1039-1045. [PMID: 38110736 DOI: 10.1007/s00402-023-05152-x] [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: 03/31/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Medial closed-wedge distal femoral osteotomy (MCWDFO) is a valuable treatment approach for lateral knee osteoarthritis with femoral valgus deformity. Improved results have been reported with the upgrade of surgical techniques and locking plates. However, the risk of nonunion and loss of correction increases in cases of lateral hinge fractures. This study aimed to evaluate the mechanical impact of hinge fractures and support instruments in MCWDFO using finite element analysis (FEA). MATERIALS AND METHODS Five femur models were developed using Mechanical Finder 11.0 FEA software. We simulated the following models: only a medial locking plate (MLP) (group A); an MLP with a lateral support screw (group B); and an MLP with a lateral support plate (group C). The equivalent stress around the hinge was evaluated and the percentage of the plastic deformation zone was calculated for the hinge area in the no-hinge fracture model. The equivalent stress of the MLP and the degree of displacement were calculated using the hinge fracture model. RESULTS The percentages of the plastic deformation zone in groups A, B, and C were 18.0 ± 11.7%, 3.3 ± 2.4%, and 2.3 ± 2.8%, respectively. The percentages tended to be lower in groups B and C than in group A. In the hinge fracture model, the mean equivalent stress of the MLP in group C was significantly less than that in group A. In terms of the mean degree of displacement, group A showed more than 1 mm of displacement, which was significantly larger than that of the other groups. CONCLUSION The support instruments provided stability to the hinge site and reduced the equivalent stress of the main plate in the MCWDFO with hinge fractures. No significant difference was observed between the two instruments in terms of stability.
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Affiliation(s)
- Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
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Peez C, Grosse-Allermann A, Deichsel A, Raschke MJ, Glasbrenner J, Briese T, Wermers J, Herbst E, Kittl C. Additional Plate Fixation of Hinge Fractures After Varisation Distal Femoral Osteotomies Provides Favorable Torsional Stability: A Biomechanical Study. Am J Sports Med 2023; 51:3732-3741. [PMID: 37936394 PMCID: PMC10691291 DOI: 10.1177/03635465231206947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/23/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Hinge fractures are considered risk factors for delayed or nonunion of the osteotomy gap in distal femoral osteotomies (DFOs). Limited evidence exists regarding the treatment of hinge fractures after DFO, which could improve stability and thus bone healing. PURPOSE To (1) examine the effect of hinge fractures on the biomechanical properties of the bone-implant construct, (2) evaluate the biomechanical advantages of an additional fixation of a hinge fracture, and (3) test the biomechanical properties of different types of varisation DFOs. STUDY DESIGN Controlled laboratory study. METHODS A total of 32 fresh-frozen human distal femora equally underwent medial closing wedge DFO or lateral opening wedge DFO using a unilateral locking compression plate. The following conditions were serially tested: (1) preserved hinge; (2) hinge fracture along the osteotomy plane; (3) screw fixation of the hinge fracture; and (4) locking T-plate fixation of the hinge fracture. Using a servo-hydraulic materials testing machine, we subjected each construct to 15 cycles of axial compression (400 N; 20 N/s) and internal and external rotational loads (10 N·m; 0.5 N·m/s) to evaluate the stiffness. The axial and torsional hinge displacement was recorded using a 3-dimensional optical measuring system. Repeated-measures 1-way analysis of variance and post hoc Bonferroni correction were used for multiple comparisons. Statistical significance was set at P < .05. RESULTS Independent from the type of osteotomy, a fractured hinge significantly (P < .001) increased rotational displacement and reduced stiffness of the bone-implant construct, resulting in ≥1.92 mm increased displacement and ≥70% reduced stiffness in each rotational direction, while the axial stiffness remained unchanged. For both procedures, neither a screw nor a plate could restore intact rotational stiffness (P < .01), while only the plate was able to restore intact rotational displacement. However, the plate always performed better compared with the screw, with significantly higher and lower values for stiffness (+38% to +53%; P < .05) and displacement (-55% to -72%; P < .01), respectively, in ≥1 rotational direction. At the same time, the type of osteotomy did not significantly affect axial and torsional stability. CONCLUSION Hinge fractures after medial closing wedge DFO and lateral opening wedge DFO caused decreased bone-implant construct rotational stiffness and increased fracture-site displacement. In contrast, the axial stiffness remained unchanged in the cadaveric model. CLINICAL RELEVANCE When considering an osteosynthesis of a hinge fracture in a DFO, an additional plate fixation was the construct with the highest stiffness and least displacement, which could restore intact hinge rotational displacement.
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Affiliation(s)
- Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Arian Grosse-Allermann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Jens Wermers
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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Kaibara T, Kondo E, Matsuoka M, Iwasaki K, Onodera T, Momma D, Iwasaki N. Medial closed-wedge distal femoral osteotomy with local bone grafts for large collapsed steroid-induced osteonecrosis of the lateral femoral condyle: A case report. J Orthop Sci 2023; 28:1470-1477. [PMID: 34364755 DOI: 10.1016/j.jos.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/01/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Takuma Kaibara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Koji Iwasaki
- Department of Functional Reconstruction for the Knee Joint, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Daisuke Momma
- Centre for Sports Medicine, Hokkaido University Hospital, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
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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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Meisterhans M, Flury A, Zindel C, Zimmermann SM, Vlachopoulos L, Snedeker JG, Fucentese SF. Finite element analysis of medial closing and lateral opening wedge osteotomies of the distal femur in relation to hinge fractures. J Exp Orthop 2023; 10:33. [PMID: 36973592 PMCID: PMC10043162 DOI: 10.1186/s40634-023-00597-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE Intraoperative hinge fractures in distal femur osteotomies represent a risk factor for loss of alignment and non-union. Using finite element analysis, the goal of this study was to investigate the influence of different hinge widths and osteotomy corrections on hinge fractures in medial closed-wedge and lateral open-wedge distal femur osteotomies. METHODS The hinge was located at the proximal margin of adductor tubercle for biplanar lateral open-wedge and at the upper border of the lateral femoral condyle for biplanar medial closed-wedge distal femur osteotomies, corresponding to optimal hinge positions described in literature. Different hinge widths (5, 7.5, 10 mm) were created and the osteotomy correction was opened/closed by 5, 7.5 and 10 mm. Tensile and compressive strain of the hinge was determined in a finite element analysis and compared to the ultimate strain of cortical bone to assess the hinge fracture risk. RESULTS Doubling the correction from 5 to 10 mm increased mean tensile and compressive strain by 50% for lateral open-wedge and 48% for medial closed-wedge osteotomies. A hinge width of 10 mm versus 5 mm showed increased strain in the hinge region of 61% for lateral open-wedge and 32% for medial closed-wedge osteotomies. Medial closed-wedge recorded a higher fracture risk compared to lateral open-wedge osteotomies due to a larger hinge cross-section area (60-67%) for all tested configurations. In case of a 5 mm hinge, medial closed-wedge recorded 71% higher strain in the hinge region compared to lateral open-wedge osteotomies. CONCLUSION Due to morphological features of the medial femoral condyle, finite element analysis suggests that lateral-open wedge osteotomies are the preferable option if larger corrections are intended, as a thicker hinge can remain without an increased hinge fracture risk.
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Affiliation(s)
- Michel Meisterhans
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Andreas Flury
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan M Zimmermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G Snedeker
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Diaz CC, Lavoie-Gagne OZ, Knapik DM, Korrapati A, Chahla J, Forsythe B. Outcomes of Distal Femoral Osteotomy for Valgus Malalignment: A Systematic Review and Meta-analysis of Closing Wedge Versus Opening Wedge Techniques. Am J Sports Med 2023; 51:798-811. [PMID: 35156408 DOI: 10.1177/03635465211051740] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. PURPOSE To perform a systematic review and meta-analysis for patients with valgus knee deformity undergoing DFO to determine differences in patient-reported outcome measures (PROMs), complications, and survival rates, comparing CW versus OW DFO. STUDY DESIGN Systematic review, Level of evidence, 4. METHODS A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. Inclusion criteria consisted of studies reporting outcomes in patients undergoing CW or OW DFO for the treatment of valgus knee deformities with symptomatic lateral compartment pathology with a minimum 2-year follow-up. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. Long-term survival data, defined as conversion to total knee arthroplasty, were analyzed using a multiple metaregression model as a function of individual study follow-up time points and surgical technique. RESULTS In total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. Good to excellent clinical outcomes were reported in PROMs when compared with preoperative values with both techniques, while no significant differences between techniques were appreciated on functional Knee Society Scores and Tegner scores. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). Pain requiring hardware removal was the most commonly reported complication in both groups. The survival rate for CW DFO was 81.5% (mean follow-up, 8.8 ± 4.3 years) compared with 90.5% for OW DFO (mean follow-up, 4.5 ± 1.5 years). Multiple metaregression demonstrated that patient follow-up (P < .001) was significantly associated with knee survival, while surgical technique (P = .810) was not a predictor of clinical failure. CONCLUSIONS Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. Pain requiring hardware removal was the most common complication in both techniques, while long-term survivability was found to be a function of follow-up and not surgical technique. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity.
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Affiliation(s)
| | | | | | | | - Jorge Chahla
- Midwest Orthopaedics at Rush Chicago, Illinois, USA
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Pioger C, Mabrouk A, Siboni R, Jacquet C, Seil R, Ollivier M. Double-level knee osteotomy accurately corrects lower limb deformity and provides satisfactory functional outcomes in bifocal (femur and tibia) valgus malaligned knees. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07325-y. [PMID: 36705689 DOI: 10.1007/s00167-023-07325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Double-level knee osteotomy (DLO) is a challenging procedure that requires precision in preoperative planning and intraoperative execution to achieve the desired correction. It is indicated in cases of severe varus or valgus deformities where a single-level osteotomy would yield significantly tilted joint line obliquity (JLO). This study aimed to evaluate the effectiveness of DLO in achieving accurate correction without compromising JLO, using patient-specific cutting guides (PSCGs), in cases of bifocal valgus maligned knees. METHODS A single-centre, retrospective analysis of prospectively collected data for a total of 26 patients, who underwent DLO by PSCGs for valgus malaligned knees, between 2015 and 2020. Post-operative alignment was evaluated and the delta for different lower limb0.05, not statistically significant (ns)). All KOOS subs alignment parameters was calculated; the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), and lateral distal femoral angle (ΔLDFA). At the two-year follow-up, changes in the KOOS sub-scores, UCLA scores, lower limb discrepancy (LLD), and mean time to return to work and sport were recorded. All intraoperative and postoperative complications were recorded. The Mann-Whitney U test with a 95% confidence interval (95% CI) was used to evaluate the differences between two variables; one-way ANOVA between more than two variables and the paired Student's t-test was used to estimate the evolution of functional outcomes. RESULTS The postoperative mean ΔHKA was 0.9 ± 0.9°, the mean ΔMPTA was 0.7 ± 0.7°, and the mean ΔLDFA was 0.7 ± 0.8° (all values with p > 0.05, not statistically significant (ns)). All KOOS subscore's mean values were improved to an extent two-fold superior to the reported minimal clinically important difference (MCID) (all with p < 0.0001). There was a significant increase in the UCLA score at the final follow-up (5.4 ± 1.5 preoperatively versus 7.7 ± 1.4, p < 0.01). The mean time to return to sport and work was 4.7 ± 1.1 and 4.3 ± 2.1 months, respectively. There was an improvement in Lower-limb discrepancy preoperative (LLD = 1.3 ± 2 cm) to postoperative measures (LLD = 0.3 ± 0.4 cm), ns. Complications were 2 femoral hinge fractures, 2 deep vein thromboses, 1 delayed tibial healing, and 1 hardware removal for hamstring irritation syndrome. CONCLUSION DLO is effective and safe in achieving accurate correction in bifocal valgus malaligned knees with maintained lower limb length and low complication rate with no compromise of JLO. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Charles Pioger
- Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, 9, Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
| | - Ahmed Mabrouk
- Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, France
| | - Renaud Siboni
- Department of Orthopaedic Surgery, Reims Teaching Hospital, Hôpital Maison Blanche, 45 Rue Cognacq-Jay, 51092, Reims, France
| | - Christophe Jacquet
- Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, France
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
| | - Matthieu Ollivier
- Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, France
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10
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Distalization of hinge site with use of hinge wire reduces hinge fracture rates in closing wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07286-8. [PMID: 36562809 DOI: 10.1007/s00167-022-07286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Closing wedge distal femoral osteotomies (CWDFO) are attractive treatment options for unicompartmental knee osteoarthritis with coronal plane deformity. However, it has been traditionally associated with high rates of hinge fracture that can adversely impact recovery and patient outcomes. Appropriate siting of hinge point can be an effective method of reducing the incidence of hinge fractures. This study aims to illustrate a case series of CWDFO with low rates of hinge fracture utilising our preferred hinge point site. METHODS A retrospective study of a cohort of 39 CWDFO was performed between May 2019 and May 2022. Both medial and lateral CWDFO were included. The hinge point in all cases was placed at the level of the inferior margin of the metaphyseal flare, and inferior to the gastrocnemius origin, with a hinge thickness of 10 mm. Post-operative radiographs were obtained at 2, 4 and 8 weeks after surgery to assess for hinge fracture and union. RESULTS Thirty-nine cases of CWDFO were performed, consisting of eighteen cases of valgus malalignment that underwent medial CWDFO and twenty-one cases of varus malalignment that underwent lateral CWDFO. At surgery, the mean age was 47.6 (± 13.9) years and mean BMI was 29.4 (± 4.9). There were 23 men and 16 women. Three cases of hinge fractures occurred intraoperatively, translating into a hinge fracture rate of 7.69%. However, union was achieved in all three cases and all patients in this case series were able to progress to weight bear as tolerated at 2 months post-osteotomy. CONCLUSION Distal placement of the hinge at the level of the inferior metaphyseal flare margin with the use of a hinge wire can greatly reduce the rates of hinge fracture in CWDFO. LEVEL OF EVIDENCE Level III.
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11
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Nha KW, Kim HS, Jin DU, Bae JH, Patel JM, Kim SG. Predictive Factors for Lateral Hinge Fracture in Medial Closing Wedge Distal Femoral Osteotomy. Am J Sports Med 2022; 50:3819-3826. [PMID: 36326293 DOI: 10.1177/03635465221131527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recent studies have reported that lateral hinge fracture (LHF) has a negative effect on bone healing at the osteotomy site after medial closing wedge distal femoral osteotomy (MCDFO). However, limited evidence exists in the literature regarding the predictive factors for LHF in MCDFO. HYPOTHESIS A large medial closing gap and a lateral hinge position in the supracondylar area would increase plain radiography-based and/or computed tomography (CT)-based LHF in MCDFO. STUDY DESIGN Case control study; Level of evidence, 3. METHODS We retrospectively evaluated 67 knees of 53 patients (mean age, 37.4 ± 16.9 years) who underwent MCDFO between May 2009 and June 2021. The surgical indications for MCDFO were genu valgum deformity combined with either lateral compartment osteoarthritis or recurrent patellar dislocation. The presence of LHF was evaluated based on immediate postoperative plain radiography and CT scans. The predictive factors for LHF in MCDFO were investigated using multivariate logistic regression analysis. RESULTS LHFs were identified in 21 knees (31.3%) through plain radiography and in 40 knees (59.7%) through CT. Multivariate logistic regression analysis showed that the medial closing gap and lateral hinge position were predictive factors for plain radiography- and CT-based LHF after MCDFO. Controlling for other variables, we found that an increase in the medial opening gap by 1 mm increased the likelihood of plain radiography-based LHF by a factor of 1.805 (95% CI, 1.291-2.525; P = .001) and CT-based LHF by 1.333 (95% CI, 1.003-1.772; P = .048). Moreover, a lateral hinge position in the supracondylar area increased the likelihood of plain radiography-based LHF by a factor of 9.870 (95% CI, 2.179-44.720; P = .003) and CT-based LHF by 5.686 (95% CI, 1.124-28.754; P = .036). CONCLUSION A large medial closing gap and lateral hinge position in the supracondylar area are associated with LHF in MCDFO. Care should be taken to prevent LHF in MCDFO with a large medial closing gap. Moreover, a lateral hinge position in the supracondylar area should be avoided to decrease the incidence of LHF in MCDFO.
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Affiliation(s)
- Kyung Wook Nha
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Gyeongki-do, Republic of Korea
| | - Hyung Suh Kim
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Gyeongki-do, Republic of Korea
| | - Dong Uk Jin
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Bae
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jaykumar M Patel
- Department of Orthopaedic Surgery, Jay Orthopaedic Hospital and Arthroscopy Centre, Shahibaug, Ahmedabad City, India
| | - Sang-Gyun Kim
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
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12
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Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. Arch Orthop Trauma Surg 2022; 142:2303-2312. [PMID: 35676376 DOI: 10.1007/s00402-022-04495-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To compare bone union after medial closing wedge distal femoral osteotomy (MCWDFO) with that after lateral closing wedge distal femoral osteotomy (LCWDFO) using a novel scoring system. MATERIALS AND METHODS The data of 30 patients who received biplanar MCWDFO for valgus knees (MCWDFO group) were retrospectively examined and compared to that of 22 patients (25 knees) who underwent biplanar LCWDFO via a double-level osteotomy (DLO) for varus knees (LCWDFO group). The progression of bone union of the transverse osteotomy plane in the femur was assessed using a newly developed scoring system using radiographs taken immediately after surgery and 3 and 6 months postoperatively. The scoring system is based on a scale of zero to six points with higher scores indicating better bone union. The incidence of hinge fractures was assessed using CT images, and the rates of reoperation were evaluated using medical record data. RESULTS The mean bone union score was significantly lower in the MCWDFO group than in the LCWDFO group 3 months (2.1 ± 1.9 vs. 3.7 ± 1.7, P < 0.01) and 6 months (3.8 ± 2.1 vs 4.9 ± 1.5, P < 0.05) postoperatively. The incidence ratio of hinge fractures was significantly higher in the MCWDFO group than in the LCWDFO group (70.0% vs. 32.0%, P < 0.01). Two patients in the MCWDFO group underwent reoperation for delayed bone union or non-union. CONCLUSION Bone union progression was slower and hinge fractures were more frequently observed after MCWDFO than after LCWDFO via DLO. MCWDFO is technically challenging, and patients must be monitored closely during and after surgery.
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Affiliation(s)
- Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Akiyoshi Mori
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shu Watanabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kiminari Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shinya Oka
- Department of Orthopaedic Surgery, Meiwa Hospital, Nishinomiya, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Correction of Severe Knees Valgus Deformities in a Patient With Renal Osteodystrophy. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202209000-00005. [PMID: 36129966 PMCID: PMC9481426 DOI: 10.5435/jaaosglobal-d-22-00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022]
Abstract
Renal osteodystrophy (ROD) is a complex and rare entity that refers to a large spectrum of abnormalities of skeletal homeostasis in patients suffering from chronic kidney disease. The goal of this study was to present the outcome of the very rare case of an adult with severe deformity of painful bilateral valgus knees due to ROD, requiring multilevel osteotomies above and below the knee. A 42-year-old male patient was admitted to our department with painful severe bilateral valgus knees deformity due to ROD. The patient underwent bilateral lateral opening-wedge osteotomy of distal femur and medial tibial closing-wedge osteotomy. The osteotomies site healed in 8 weeks without complications. The surgical treatment of lower limb valgus knee deformities secondary to ROD is a challenging and demanding procedure. In our patient, the femoral opening-wedge osteotomy with blade-plate fixation, and tibial closing-wedge osteotomy with plate fixation, restored almost normal knee congruency to prevent lateral unicompartmental degenerative deterioration of the knee.
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14
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Kandhari V, Angadi D, Myat D, Fritsch B, Parker D, Coolican M. Long Term Outcomes of Computer-Navigated Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Knee Arthrosis. Rev Bras Ortop 2022; 57:96-102. [PMID: 35198115 PMCID: PMC8856845 DOI: 10.1055/s-0040-1716765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The primary aim of the present study was to evaluate the long-term outcomes including survivorship of computer navigated distal femoral lateral opening wedge osteotomy (DFLOWO). The secondary aim was to identify the potential factors that may influence its survivorship. Methods A retrospective analysis of prospectively collected data for patients with lateral compartment arthritis who underwent navigated DFLOWO from December 2006 to November 2012 was performed. The International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were analyzed for outcome measures. Conversion to arthroplasty during the follow-up was the end point. Results A total of 19 DFLOWOs were performed in 17 patients with a mean age of 46.6 ± 6.5 years formed the study cohort. The coronal alignment was corrected from a mean of 7.1° (2-11°) valgus to a mean of 2.1° (0.5°-3°) varus. The IKDC scores improved from mean of 39 preoperatively to 53 at the mean long-term follow-up of 9.1 years. The mean KOOS scores at the long-term follow-up were pain 71, symptoms 56, activities of daily living 82, sports and recreation 59, quality of life 43. Survivorship of the DFLOWO was 78.9% at a follow-up of 9.1 years. Presence of ≥ grade 2 according to the International Cartilage Repair Society (ICRS) cartilage degeneration in the medial compartment of the knee and >7° preoperative valgus deformity were strongly correlated with conversion to total knee arthroplasty (TKA) at the long-term follow-up ( r = 0.66). Conclusions Computer navigated DFLOWO has satisfactory clinical outcomes and 79% survivorship in long-term follow-up. Presence of more than ICRS ≥ grade 2 degenerative changes in the medial compartment of knee with > 7° preoperative valgus deformity negatively affects the survivorship of DFLOWO in the long-term follow-up.
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Affiliation(s)
- Vikram Kandhari
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - Darshan Angadi
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - Darli Myat
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - Brett Fritsch
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - David Parker
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
| | - Myles Coolican
- Departamento de Cirurgia Ortopédica do Joelho, Instituto de Pesquisa Ortopédica de Sydney, Chatswood, Sydney, NSW, Austrália
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15
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刘 云, 谢 雪, 罗 从. [Research progress of osteotomy around knee in the treatment of valgus knee osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:111-116. [PMID: 35038808 PMCID: PMC8844620 DOI: 10.7507/1002-1892.202108009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To review the research progress of surgical methods of osteotomy around the knee in the treatment of valgus knee osteoarthritis. METHODS The relevant literature on the surgical treatment of valgus knee osteoarthritis at home and abroad in recent years was reviewed, and the advantages, disadvantages, and effectiveness of different surgical methods of osteotomy around the knee were summarized. RESULTS For young and active patients with symptomatic valgus knee osteoarthritis, osteotomy around the knee is a safe and reliable treatment option. At present, the main surgical methods include medial closing wedge distal femoral osteotomy, lateral opening wedge distal femoral osteotomy, medial closing wedge high tibial osteotomy, and lateral opening wedge high tibial osteotomy. The indications, advantages, and disadvantages of different osteotomies are different, and the selection of appropriate surgical method is the key to achieve good effectiveness. CONCLUSION There are many osteotomies in the treatment of valgus knee osteoarthritis. In order to achieve good results, improve survival rate, and reduce postoperative complications, the most reasonable surgical strategy needs to be developed according to different situations.
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Affiliation(s)
- 云飞 刘
- 南京医科大学附属苏州科技城医院骨科(江苏苏州 215000)Department of Orthopedics, the Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou Jiangsu, 215000, P. R. China
| | - 雪涛 谢
- 南京医科大学附属苏州科技城医院骨科(江苏苏州 215000)Department of Orthopedics, the Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou Jiangsu, 215000, P. R. China
| | - 从风 罗
- 南京医科大学附属苏州科技城医院骨科(江苏苏州 215000)Department of Orthopedics, the Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou Jiangsu, 215000, P. R. China
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Matsushita T, Akiyama T, Osano K, Yokoyama Y, Okazaki K. Biomechanical analysis of the role of hinge support fixators on hinge stability in medial closing wedge distal femoral osteotomy. Clin Biomech (Bristol, Avon) 2022; 91:105528. [PMID: 34808426 DOI: 10.1016/j.clinbiomech.2021.105528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to examine the hinge-stabilizing biomechanical effects of hinge support fixators, applied for lateral hinge fractures sustained following distal femoral osteotomy. METHODS Medial closing wedge distal femoral osteotomy was performed using a locking plate on 10 cadaveric limbs. The limbs were divided into two groups: the non-fracture group and the lateral hinge fracture group. A cyclic axial load of 400 N was applied to the knee to keep it extended and flexed at 45°. The hinge-stabilizing effects of adding a screw or a short support plate to the lateral fracture site were examined by measuring the translation and rotational angles of the anterodistal and posterodistal hinge positions as well as the surface strains of the medial locking plate. FINDINGS Translation and rotation in the fracture group were significantly more pronounced than in the non-fracture group, at the anterodistal and posterodistal positions. Translations at both positions were significantly reduced, by adding the support plate, during both extension and 45-degree flexion in the fracture group. The rotation at the posterodistal position upon extension and the anterodistal position upon 45-degree flexion was significantly reduced by the support plate. The surface strain of the medial plate in the fracture group was significantly reduced by the support plate upon both extension and 45-degree flexion. INTERPRETATION Lateral hinge fractures caused abnormal hinge movements, which were significantly reduced by the short support plate. A short support plate could be used if a hinge fracture occurs during distal femoral osteotomy, to improve lateral hinge stability.
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Affiliation(s)
- Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | | | - Kei Osano
- Joint Reconstruction Center, Fukuoka Mirai Hospital, Fukuoka, Japan
| | | | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical, Tokyo, Japan
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Dislocated hinge fractures are associated with malunion after lateral closing wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2022; 30:982-992. [PMID: 33638683 PMCID: PMC8901490 DOI: 10.1007/s00167-021-06466-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/19/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the incidence, morphology, and associated complications of medial cortical hinge fractures after lateral closing wedge distal femoral osteotomy (LCW-DFO) for varus malalignment and to identify constitutional and technical factors predisposing for hinge fracture and consecutive complications. METHODS Seventy-nine consecutive patients with a mean age of 47 ± 12 years who underwent LCW-DFO for symptomatic varus malalignment at the authors' institution between 01/2007 and 03/2018 with a minimum of 2-year postoperative time interval were enrolled in this retrospective observational study. Demographic and surgical data were collected. Measurements evaluating the osteotomy cut (length, wedge height, hinge angle) and the location of the hinge (craniocaudal and mediolateral orientation, relation to the adductor tubercle) were conducted on postoperative anterior-posterior knee radiographs and the incidence and morphology of medial cortical hinge fractures was assessed. A risk factor analysis of constitutional and technical factors predisposing for the incidence of a medial cortical hinge fracture and consecutive complications was conducted. RESULTS The incidence of medial cortical hinge fractures was 48%. The most frequent morphological type was an extension fracture type (68%), followed by a proximal (21%) and distal fracture type (11%). An increased length of the osteotomy in mm (53.1 ± 10.9 vs. 57.7 ± 9.6; p = 0.049), an increased height of the excised wedge in mm (6.5 ± 1.9 vs. 7.9 ± 3; p = 0.040) as well as a hinge location in the medial sector of an established sector grid (p = 0.049) were shown to significantly predispose for the incidence of a medial cortical hinge fracture. The incidence of malunion after hinge fracture (14%) was significantly increased after mediolateral dislocation of the medial cortical bone > 2 mm (p < 0.05). CONCLUSION Medial cortical hinge fractures after LCW-DFO are a common finding. An increased risk of sustaining a hinge fracture has to be expected with increasing osteotomy wedge height and a hinge position close to the medial cortex. Furthermore, dislocation of a medial hinge fracture > 2 mm was associated with malunion and should, therefore, be avoided. LEVEL OF EVIDENCE Prognostic study; Level IV.
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Osteotomies for lateral compartment knee osteoarthritis. J Clin Orthop Trauma 2021; 25:101726. [PMID: 34956830 PMCID: PMC8671116 DOI: 10.1016/j.jcot.2021.101726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/23/2022] Open
Abstract
Lateral compartment osteoarthritis (LCOA) is often associated with valgus deformity of the knee. The concept of correcting the alignment by performing distal femoral varus osteotomy (DFVO) to unload the lateral compartment is well accepted and it is viewed as the preferred option for young active patients due to dissatisfaction from arthroplasty under 55 years of age or if they wish to remain active. Beyond this there is no consensus on patient selection, preoperative assessment, techniques to achieve correction, end point of correction, return to work or sports post-surgery, and survivorship of osteotomy with conversion to a total knee replacement as the end point due to heterogenous, retrospective studies. Here, we review relevant literature to help patient selection, preoperative work up, techniques, and outcomes.
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Nha KW, Kim KW, Bae JH, Jang KM, Kim SG. Detection of Lateral Hinge Fractures After Medial Closing Wedge Distal Femoral Osteotomy: Computed Tomography Versus Plain Radiography. Am J Sports Med 2021; 49:3350-3356. [PMID: 34398724 DOI: 10.1177/03635465211031434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited evidence exists in the literature regarding the detection rates of lateral hinge fracture (LHF) on computed tomography (CT) after medial closing wedge distal femoral osteotomy (MCDFO). Moreover, the effect of LHF on bone healing after MCDFO remains unclear. HYPOTHESIS The detection rates of LHF after MCDFO would be higher on CT than on plain radiography. The incidence of problematic bone healing would be higher in the knees with LHF than in those without LHF. STUDY DESIGN Cohort study (diagnosis), Level of evidence, 3. METHODS Patients who underwent MCDFO between May 2009 and July 2019 were retrospectively evaluated. The presence of LHF was evaluated using immediate postoperative plain radiography and CT. The detection rates of LHF on plain radiography and CT were compared. The incidence of problematic bone healing (nonunion, delayed union, and loss of correction) was also compared between the knees with LHF and those without LHF. RESULTS A total of 55 knees of 43 patients (mean age, 37.7 ± 16.7 years) were included in the study. Although 33 LHFs were detected on CT, only 19 LHFs were detected on plain radiography. The detection rate of LHF was significantly higher on CT than on plain radiography (60% vs 34.5%; P = .008). At 1-year follow-up, 10 cases of problematic bone healing (1 nonunion, 4 delayed unions, and 5 losses of correction) were identified. The incidence of problematic bone healing was significantly higher in the knees with LHF than in those without LHF as shown on plain radiography (36.8% vs 8.3%; P = .001) and CT (30.3% vs 0%; P = .004). CONCLUSION LHF can be detected better on CT than on plain radiography and has a negative effect on bone healing after MCDFO. For patients with LHF detected on either plain radiography or CT, careful rehabilitation with close follow-up is recommended.
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Affiliation(s)
- Kyung Wook Nha
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Kun Woo Kim
- Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Ji Hoon Bae
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang-Gyun Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
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Patient-Specific Instrument Guided Double Chevron-Cut Distal Femur Osteotomy. J Pers Med 2021; 11:jpm11100959. [PMID: 34683100 PMCID: PMC8538705 DOI: 10.3390/jpm11100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Abstract
The risk of non-union and prolonged periods of protected weight-bearing still remain unsolved issues after distal femur osteotomy (DFO). To improve the stability, we developed the double chevron-cut technique, which is a modified medial closing-wedge DFO guided by a patient-specific instrument. The purpose of this study was to investigate the feasibility and outcome of this operative approach. Twenty-five knees in twenty-three consecutive patients with genu valgum and lateral compartment osteoarthritis that received double chevron-cut DFO were included. The target of correction was 50% on the weight-bearing line (WBL) ratio. Patient-reported outcomes included the Oxford Knee Score (OKS) and the 2011 Knee Society Score (KSS). The mean of the WBL ratio was corrected from 78.7% ± 12.0% to 48.7% ± 2.9% postoperatively. The mean time to full weight bearing was 3.7 ± 1.4 weeks. Union of the osteotomy was achieved at 11.3 ± 2.8 weeks. At a mean follow-up of 17 months, the OKS improved from a mean of 27.6 ± 11.7 to 39.1 ± 7.5 (p = 0.03), and the KSS from a mean of 92.1 ± 13.0 to 143.9 ± 10.2 (p < 0.001). Three patients developed complications, including one case of peri-implant fracture, one of loss of fixation, and one of non-union. The double chevron-cut DFO followed by immediate weight-bearing as tolerated is effective in treating genu valgum deformity and associated lateral compartment osteoarthritis.
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Uboldi FM, Travi M, Tradati D, Maione A, Manunta AF, Berruto M. Medial closure supracondylar femoral osteotomy: an effective solution for long-term treatment of arthritic valgus knee? J Orthop Traumatol 2021; 22:35. [PMID: 34524550 PMCID: PMC8443729 DOI: 10.1186/s10195-021-00600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose The aim of this work was to retrospectively analyze the clinical, subjective, and radiological results of medial closing-wedge distal femur osteotomy (MCW-DFO) for the treatment of osteoarthritis (OA) in valgus knee at medium- to long-term follow-up. Materials and methods A total of 57 patients (62 knees) treated with MCW-DFO between 1984 and 2018 were included in the study. Patient age at the time of the surgery ranged between 28 and 61 years (average: 48 years). All patients with a minimum follow-up of 4 years were contacted to request for them to undergo clinical, subjective, and radiological evaluation. Preoperative hip–knee–ankle (HKA) angle (i.e., preoperative valgus malalignment) was 8.6° ± 2°. Patients were evaluated using the following scales: the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Knee Society Score (KSS), the International Knee Documentation Committee (IKDC), the Visual Analog Scale (VAS), and the Numeric Rating Scale 11 (NRS-11). Results Mean follow-up was 11.6 ± 4.9 years, and a total of 17 patients (20 knees) were available for the last examination. At maximum follow-up, 4 patients underwent conversion to a total knee replacement (20%); their survival rate was 100% at 10 years and 66.7% at 15 years, as estimated using the Kaplan–Meier curve. The subjective Knee Society Score improved on average from 37.7 ± 10 to 63.9 ± 15.4. The objective Knee Society Score improved on average from 42.2 ± 11.7 to 75 ± 22.5. The pain detected through the VAS and NRS-11 scales improved from 56.7 ± 12.9 to 42 ± 17.1 and from 5.8 ± 1.1 to 4.4 ± 1.7, respectively. Thirteen patients (70%) required hardware removal at an average time of 19 ± 4 months due to a local nuisance. Conclusions MCW-DFO can improve symptoms in patients with osteoarthritis in a valgus knee at medium- to long-term follow-up, reducing the progression of osteoarthritis in properly selected patients.
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Affiliation(s)
- Francesco Mattia Uboldi
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Università Degli Studi Di Milano, P.zza A. Ferrari 1, 20122, Milan, Italy. .,ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, U.O.C. Ortopedia e Traumatologia Pediatrica, P.zza A. Ferrari 1, 20122, Milan, Italy.
| | - Martino Travi
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Università Degli Studi Di Milano, P.zza A. Ferrari 1, 20122, Milan, Italy
| | - Daniele Tradati
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Università Degli Studi Di Milano, P.zza A. Ferrari 1, 20122, Milan, Italy
| | - Alessio Maione
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Università Degli Studi Di Milano, P.zza A. Ferrari 1, 20122, Milan, Italy
| | - Andrea Fabio Manunta
- Università Degli Studi Di Sassari, AOU Sassari, V.le San Pietro 43b, 07100, Sassari, Italy
| | - Massimo Berruto
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Università Degli Studi Di Milano, P.zza A. Ferrari 1, 20122, Milan, Italy
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Ten-year survival rate of 89% after distal femoral osteotomy surgery for lateral compartment osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2021; 29:594-599. [PMID: 32285155 DOI: 10.1007/s00167-020-05988-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to assess the accuracy, safety, and survival of distal femoral osteotomy (DFO) surgery for lateral compartment OA of the knee. METHODS A retrospective cohort study was conducted at a single UK centre, using prospectively collected data over an 8-year period (2009-2017). All patients had pre-operative radiographic analysis and digital planning of their deformity correction in addition to post-operative analysis of the achieved correction and yearly face-to-face follow-up. Complications (defined as an undesirable medical or surgical event as a direct result of the operation), reoperations, and failure (defined as conversion to arthroplasty or revision) were recorded. RESULTS From a total of 83 patients, 81 patients undergoing 86 primary DFOs were included in this study, with a mean follow-up of 99 months (SD 27 months). The mean pre-operative percentage Mikulicz point was 78.7% (SD 19.1%) and post-operative 35.9% (SD 14.8%). The mean accuracy of correction (intended correction - achieved correction) was an 8.2% overcorrection (SD 13.7%). The complication rate was 4.7%. Using Kaplan-Meier analysis, the mean survival was 113 months (95% CI 106-120) with the probability of surviving 10 years 89%. CONCLUSION DFO for valgus alignment and lateral compartment arthritis is associated with low complications, long-term joint preservation, and the prevention of arthroplasty surgery. However, the accuracy of correction still requires improvement in intra-operative technique. LEVEL OF EVIDENCE IV.
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Winkler PW, Rupp MC, Lutz PM, Geyer S, Forkel P, Imhoff AB, Feucht MJ. A hinge position distal to the adductor tubercle minimizes the risk of hinge fractures in lateral open wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc 2021; 29:3382-3391. [PMID: 32833073 PMCID: PMC8458183 DOI: 10.1007/s00167-020-06244-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the incidence and morphology of medial cortical hinge fractures in lateral open wedge distal femoral osteotomy (LOW-DFO) and to determine a safe zone for the position of the osteotomy hinge to minimize the risk of hinge fractures. METHODS Consecutive patients who underwent LOW-DFO for symptomatic valgus malalignment were screened for eligibility for this retrospective observational cohort study. Demographical and surgical data were collected. The incidence and morphology of medial cortical hinge fractures were evaluated on standard postoperative anterior-posterior knee radiographs. Comprehensive measurements evaluating the osteotomy gap and the position of the osteotomy hinge were taken. Additionally, each osteotomy hinge was assigned to a corresponding sector of a proposed five-sector grid of the distal medial femur. RESULTS A total of 100 patients (60% female) with a mean age of 31 ± 13 years were included. The overall incidence of medial cortical hinge fractures was 46% and three distinct fracture types were identified. The most frequently observed fracture type was extension of the osteotomy gap (76%), followed by a proximal (20%) and distal (4%) course of the fracture line in relation to the hinge. Group comparison (hinge fracture vs. no hinge fracture) showed statistically significant higher values for the height of the osteotomy gap (p = 0.001), the wedge angle (p = 0.036), and the vertical distance between the hinge and the proximal margin of the adductor tubercle (AT; p = 0.002) in the hinge fracture group. Furthermore, a significantly lower horizontal distance between the hinge and the medial cortical bone (p = 0.036) was observed in the hinge fracture group. A statistically significant higher incidence of medial cortical hinge fractures was observed when the position of the osteotomy hinge was proximal compared to distal to the proximal margin of the AT (53% vs. 27%; p = 0.023). CONCLUSION Medial cortical hinge fractures in LOW-DFO are a common finding with three distinct fracture types. To minimize the risk of medial cortical hinge fractures, it is recommended to aim for a position of the osteotomy hinge at the level of or distal to the proximal margin of the adductor tubercle. LEVEL OF EVIDENCE Prognostic study; Level III.
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Affiliation(s)
- Philipp W. Winkler
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marco C. Rupp
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Patricia M. Lutz
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Philipp Forkel
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias J. Feucht
- Department for Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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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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Ogawa H, Matsumoto K, Akiyama H. Effects of lateral opening wedge and medial closing wedge distal femoral osteotomies on axial load stability. Knee 2020; 27:760-766. [PMID: 32563434 DOI: 10.1016/j.knee.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/27/2020] [Accepted: 04/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The stability of the current distal femoral osteotomy is insufficient for early weight bearing and bone healing. The purpose of this study was to test the stability of medial closing wedge- (MCW-) and lateral opening wedge-distal femoral osteotomies (LOW-DFO), which have improved with the recent advances in technology. METHODS We used composite bone models with MCW-DFO, improved with biplanar osteotomy technique and a Tomofix™ MDF plate, or LOW-DFO improved with biplanar osteotomy technique, a Tomofix™ LDF plate, and a β-TCP bone substitute, BONISH® graft. A cyclic axial loading test was employed to evaluate the strain on a plate and hinge point. The breaking axial load was measured. RESULTS Tensile strain on the plate produced by cyclic axial loading was significantly lower for LOW-DFO (2.0 ± 0.8 MPa) than for MCW-DFO (3.9 ± 1.6 MPa, P < .05). Compressive strain on the hinge point produced by cyclic axial loading was lower for LOW-DFO (6.6 ± 2.9 MPa) than for MCW-DFO (7.7 ± 4.6 MPa,). The maximum breaking axial load was significantly higher for LOW-DFO (5511 ± 945 N) than for MCW-DFO (4303 ± 518 N, P < .05). CONCLUSIONS LOW-DFO improved with recent advanced technology was superior to MCW-DFO improved with advanced technology in both cyclic axial loading test and breaking axial load test. This suggests that LOW-DFO facilitates earlier weight bearing and bone healing than does MCW-DFO.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan; Department of Advanced Joint Reconstructive Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Barnavon T, Odri GA, Vendeuvre T, Labrada-Blanco O, Bordes M, Renard G, Rouvillain JL, Severyns M. Medial closing-wedge distal femoral varus osteotomy: Symptoms and functional impact in cases of associated patellofemoral osteoarthritis. A two-year follow-up prospective pilot study. Knee 2020; 27:615-623. [PMID: 32563415 DOI: 10.1016/j.knee.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 12/07/2019] [Accepted: 02/05/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To date, indications for distal femoral varus osteotomy (FVO) in cases of associated patellofemoral osteoarthritis (PFO) have yet to be clarified. The purpose of this prospective study is to assess the short-term symptoms, functional and radiological impact of a medial closing-wedge femoral varus osteotomy on the patellofemoral joint in patients with valgus deformities who are afflicted with lateral tibiofemoral osteoarthritis (LTFO) associated with PFO. METHODS Fourteen patients (15 knees) received a medial closing-wedge femoral varus osteotomy. The functional impact of an FVO on the patellofemoral joint was assessed based on the KOOS-PF (Knee Injury and Osteoarthritis Outcome Score-Patellofemoral Subscale), the Kujala score and the patellofemoral symptoms. Realignment of the patella was measured by the Merchant's patellofemoral congruence angle. The pre- and post-operative symptoms and functional scores were compiled prospectively and compared two years after the surgery. RESULTS The Kujala patellofemoral functional scores and the KOOS-PF showed considerable improvement with a differential of +37.5 points ± 20.4 and +42.7 points ± 19.3 (p < .01) respectively. The average Merchant's congruence angle went from 8.8° laterally to 3.6° medially, resulting in medialization of the patella, with a significant difference (p < .01). Based on the specific clinical analysis of the patellar joint, preoperative J-sign was identified in 26.7% of patients (n = 4) and was not found during postoperative examination (p = .1). Preoperative apprehension test was identified in 33.3% of patients (n = 5) against 13.3% (n = 2) after surgery (p = .39). Preoperative pain extension test was identified in 40% of patients (n = 6) against 20% during postoperative clinical analysis (p = .43). DISCUSSION Although the threshold of significance for patellofemoral symptoms was not reached, the medial closing-wedge femoral varus osteotomy induces a significant medialization of the patella (Merchant's congruence angle) and improves short-term functional results even with co-existing patellofemoral osteoarthritis. Due to the lack of specificity of the patellofemoral scores, patellofemoral osteoarthritis improvement is difficult to determine on its own, but does not represent a contraindication to FVO. LEVEL OF EVIDENCE III. Prospective clinical study.
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Affiliation(s)
- T Barnavon
- CHU Martinique (University Hospital of Martinique), Orthopaedic and Traumatologic Department, F-97200 Fort-de-France, Martinique, France
| | - G A Odri
- CHU Lariboisière, Orthopaedic and Traumatologic Department, F-75010 Paris, France
| | - T Vendeuvre
- CHU Poitiers, Orthopaedic and Traumatologic Department, F-86021 Poitiers, France
| | - O Labrada-Blanco
- CHU Martinique (University Hospital of Martinique), Orthopaedic and Traumatologic Department, F-97200 Fort-de-France, Martinique, France
| | - M Bordes
- CHU Martinique (University Hospital of Martinique), Orthopaedic and Traumatologic Department, F-97200 Fort-de-France, Martinique, France
| | - G Renard
- CHU Martinique (University Hospital of Martinique), Orthopaedic and Traumatologic Department, F-97200 Fort-de-France, Martinique, France
| | - J L Rouvillain
- CHU Martinique (University Hospital of Martinique), Orthopaedic and Traumatologic Department, F-97200 Fort-de-France, Martinique, France
| | - M Severyns
- CHU Martinique (University Hospital of Martinique), Orthopaedic and Traumatologic Department, F-97200 Fort-de-France, Martinique, France.
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Asopa V, Atkinson H. Complications in knee surgery. ORTHOPAEDICS AND TRAUMA 2019; 33:372-377. [DOI: 10.1016/j.mporth.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Vitaloni M, Botto-van Bemden A, Sciortino Contreras RM, Scotton D, Bibas M, Quintero M, Monfort J, Carné X, de Abajo F, Oswald E, Cabot MR, Matucci M, du Souich P, Möller I, Eakin G, Verges J. Global management of patients with knee osteoarthritis begins with quality of life assessment: a systematic review. BMC Musculoskelet Disord 2019; 20:493. [PMID: 31656197 PMCID: PMC6815415 DOI: 10.1186/s12891-019-2895-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is a prevalent form of chronic joint disease associated with functional restrictions and pain. Activity limitations negatively impact social connectedness and psychological well-being, reducing the quality of life (QoL) of patients. The purpose of this review is to summarize the existing information on QoL in KOA patients and share the reported individual factors, which may influence it. Methods We conducted a systematic review examining the literature up to JAN/2017 available at MEDLINE, EMBASE, Cochrane, and PsycINFO using KOA and QOL related keywords. Inclusion criteria were QOL compared to at least one demographic factor (e.g., age, gender), lifestyle factor (e.g., functional independence), or comorbidity factor (e.g., diabetes, obesity) and a control group. Analytical methods were not considered as part of the original design. Results A total of 610 articles were reviewed, of which 62 met inclusion criteria. Instruments used to measure QoL included: SF-36, EQ-5D, KOOS, WHOQOL, HAS, AIMS, NHP and JKOM. All studies reported worse QoL in KOA patients when compared to a control group. When females were compared to males, females reported worse QOL. Obesity as well as lower level of physical activity were reported with lower QoL scores. Knee self-management programs delivered by healthcare professionals improved QoL in patients with KOA. Educational level and higher total mindfulness were reported to improve QoL whereas poverty, psychological distress, depression and lacking familial relationships reduce it. Surgical KOA interventions resulted in good to excellent outcomes generally; although, results varied by age, weight, and depression. Conclusion KOA has a substantial impact on QoL. In KOA patients, QoL is also influenced by specific individual factors including gender, body weight, physical activity, mental health, and education. Importantly, education and management programs designed to support KOA patients report improved QoL. QoL data is a valuable tool providing health care professionals with a better comprehension of KOA disease to aid implementation of the most effective management plan.
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Affiliation(s)
| | | | | | | | - Marco Bibas
- Osteoarthritis Foundation International OAFI, Barcelona, Spain
| | | | - Jordi Monfort
- Rheumatology Service, Del Mar Hospital, Barcelona, Spain
| | - Xavier Carné
- Clinical Pharmacology Department, Clinic Hospital, Barcelona, Spain
| | | | | | - Maria R Cabot
- Faculty of Nursing, Clinic Hospital, Barcelona, Spain
| | - Marco Matucci
- Rheumatology Service, University of Florence, Florence, Italy
| | | | - Ingrid Möller
- Poal Institute, University of Barcelona, Barcelona, Spain
| | | | - Josep Verges
- Osteoarthritis Foundation International OAFI, Barcelona, Spain
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Cabral PB, Astur DC, Freitas EV, Pavei BS, Kaleka CC, Cohen M. Closing-Wedge Distal Femoral Osteotomies-Retrospective Study. Rev Bras Ortop 2019; 54:198-201. [PMID: 31363267 PMCID: PMC6529329 DOI: 10.1016/j.rbo.2017.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022] Open
Abstract
Objective
To describe the surgical technique of distal closing-wedge femoral osteotomy and a cases series submitted to this technique.
Methods
A total of 26 patients submitted to medial closing-wedge distal femoral osteotomy from 2002 to 2013 were evaluated. All of the patients had their medical files and imaging exams reviewed to evaluate the degree of correction and their current state.
Results
Out of the 26 patients, 12 were male and 14 were female. Their mean age was 47.15 years old. In all of the cases, a neutral alignment related to the anatomical axis was achieved. Most of the patients presented bone healing at 6 weeks. There were no cases of bleeding during the surgery. One patient presented with delayed bone healing. One patient complained of plaque-related discomfort, requiring the removal of the device. One patient had a superficial infection, but no osteotomy revision was needed. There were no cases of deep venous thrombosis or of pulmonary thromboembolism. To date, there has been no conversion to total knee replacement.
Conclusion
Treatment with medial closing-wedge distal femoral osteotomy sustained the proposed correction in patients with up to 15 years of follow-up.
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Affiliation(s)
| | - Diego Costa Astur
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | | | | | | | - Moises Cohen
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Distal femoral osteotomy in a young symptomatic population: Outcomes correlate to concomitant pathology. J Orthop 2019; 16:283-288. [PMID: 31193264 DOI: 10.1016/j.jor.2019.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/15/2019] [Indexed: 11/21/2022] Open
Abstract
Background There is a paucity of literature describing distal femoral osteotomies (DFO) in regards to complications and outcomes with previously studied cohorts containing primarily older, arthritic subjects. There has been no study to date focusing on younger, pre-arthritic patients. Methods All service members indicated for distal femoral osteotomy for coronal plane malalignment were isolated from military treatment centers between 2007 and 2013. Demographic and surgical variables were extracted, and perioperative complications, clinical course, and return to military function were extracted using clinical notes and radiographs. Results A total of 22 knees in 19 patients were identified at an average 3.2 year follow-up, with the exclusion of 16 individuals. Statistical analysis revealed worse outcomes associated with smoking, over correction, breach of the medial cortex, and prior surgeries. Overall 58% of patients left the military as the result of knee dysfunction despite an average improvement in visual analog scores (VAS) from 4.0 to 1.9 (p = 0.004). Conclusions While offloading the lateral compartment improves symptoms at short to midterm follow-up preventing progression to arthroplasty, young active duty military members have suboptimal return to duty rates.
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Voleti PB, Wu IT, Degen RM, Tetreault DM, Krych AJ, Williams RJ. Successful Return to Sport Following Distal Femoral Varus Osteotomy. Cartilage 2019; 10:19-25. [PMID: 29262702 PMCID: PMC6376568 DOI: 10.1177/1947603517743545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Distal femoral varus osteotomy (DFVO) is an effective treatment for unloading valgus knee malalignment; however, there is limited evidence on the ability for patients to return to athletics following this procedure. The purpose of this study is to report the functional outcomes and rate of return to sport for athletes that underwent DFVO. DESIGN A consecutive series of athletes that had undergone DFVO were retrospectively reviewed. Radiographs were assessed to determine preoperative and postoperative alignment. Institutional registries were used to collect preoperative and postoperative Marx Activity Scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form scores, and return to sport. RESULTS Thirteen patients (8 males, 5 females) with a mean age of 24 years (range 17-35 years) and a mean follow-up of 43 months (range 24-74 months) were included in the study. Six patients underwent medial closing wedge DFVO versus 7 patients who underwent lateral opening wedge DFVO. Nine of 13 had concomitant chondral, meniscal, or ligamentous procedures performed. The mean alignment correction was 8° (range 5°-13°). All patients were able to successfully return to sport at a mean of 11 months (range 9-13 months). Furthermore, all 13 patients demonstrated an improvement in both Marx Activity Scale (4-11; P < 0.01) and IKDC scores (53-89; P < 0.01) after surgery. CONCLUSIONS Correction of valgus knee malalignment through DFVO-either medial closing wedge or lateral opening wedge-can reliably result in improvement in function and return to sport. Concomitant chondral, meniscal, and ligamentous pathology should be addressed.
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Affiliation(s)
- Pramod B. Voleti
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Isabella T. Wu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ryan M. Degen
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Danielle M. Tetreault
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Riley J. Williams
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA,Riley J. Williams III, Sports Medicine and Shoulder Service, Hospital for Special Surgery, 525 East 71st Street, 1st Floor, New York, NY 10021, USA.
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Kim YC, Yang JH, Kim HJ, Tawonsawatruk T, Chang YS, Lee JS, Bhandare NN, Kim KS, Delgado GDG, Nha KW. Distal Femoral Varus Osteotomy for Valgus Arthritis of the Knees: Systematic Review of Open versus Closed Wedge Osteotomy. Knee Surg Relat Res 2018; 30:3-16. [PMID: 29298461 PMCID: PMC5853172 DOI: 10.5792/ksrr.16.064] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/31/2016] [Accepted: 01/12/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this review is to compare the clinical and radiological outcomes between open and closed wedge distal femoral varus osteotomy (DFO). Methods A literature search of online databases (MEDLINE, EMBASE, and Cochrane Library database) was made in addition to manual search of major orthopedic journals. Data were searched from the time period of January 1990 to October 2016. A modified Coleman Methodology Score system was used to assess the methodologic quality of the included studies. A total of 20 studies were included in the review. All studies were level IV evidence. Results Comparative analysis of open and closed wedge DFO did not demonstrate clinical and radiological differences. The survival rates were also similar. Five studies (56%) on open wedge DFO mentioned the need for either bone grafting or substitute for osteotomy gap filling and reported higher incidences of reoperation for plate removal than the closed wedge DFO studies. Conclusions The present systematic review showed similar performance between open and closed wedge DFO. Outcomes including survival rates were not statistically significantly different. However, additional bone grafting or substitutes were often needed to prevent delayed union or nonunion for open wedge techniques. Additional operations for plate removal were commonly required due to plate irritation in both techniques.
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Affiliation(s)
- Young Chan Kim
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae-Hyuk Yang
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | | | - Yong Suk Chang
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jong Seong Lee
- Department of Orthopaedic Surgery, KS Hospital, Ansan, Korea
| | | | - Ki Seong Kim
- Department of Orthopaedic Surgery, Cheongju St. Mary's Hosptial, Cheongju, Korea
| | - Giorgio D G Delgado
- Department of Orthopaedic Surgery, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Kyung Wook Nha
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
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Chang CB, Shetty GM, Lee JS, Kim YC, Kwon JH, Nha KW. A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum. Yonsei Med J 2017; 58:878-883. [PMID: 28541005 PMCID: PMC5447123 DOI: 10.3349/ymj.2017.58.4.878] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/21/2017] [Accepted: 02/24/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral release for recurrent patellar instability with genu valgum. MATERIALS AND METHODS Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performed with reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view. RESULTS At a mean follow-up of 20±11.7 months (range, 12-42 months), KSS scores improved significantly, from 46.7±5.2 preoperatively to 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly, from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001). CONCLUSION Use of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, corrects deformity, and improves clinical outcomes.
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Affiliation(s)
- Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University, Boramae Hospital, Seoul, Korea
| | - Gautam M Shetty
- Department of Orthopaedic Surgery, Breach Candy Hospital, Mumbai, India
| | - Jong Seong Lee
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Young Chan Kim
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Ho Kwon
- Department of Orthopedic Surgery, Barunsesang Hospital, Seongnam, Korea
| | - Kyung Wook Nha
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
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Gait analysis before and after corrective osteotomy in patients with knee osteoarthritis and a valgus deformity. Knee Surg Sports Traumatol Arthrosc 2017; 25:2904-2913. [PMID: 26891964 PMCID: PMC5570791 DOI: 10.1007/s00167-016-4045-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 02/04/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE In this prospective study, the changes in kinetics and kinematics of gait and clinical outcomes after a varus osteotomy (tibial, femoral or double osteotomy) in patients with osteoarthritis (OA) of the knee and a valgus leg alignment were analysed and compared to healthy subjects. METHODS Twelve patients and ten healthy controls were included. Both kinetics and kinematics of gait and clinical and radiographic outcomes were evaluated. RESULTS The knee adduction moment increased significantly postoperatively (p < 0.05) and almost similar to the control group. Patients showed less knee and hip flexion/extension motion and moment during gait pre- and postoperatively compared to the controls. A significant improvement was found in WOMAC [80.8 (SD 16.1), p = 0.000], KOS [74.9 (SD 14.7), p = 0.018], OKS [21.2 (SD 7.5), p = 0.000] and VAS-pain [32.9 (SD 20.9), p = 0.003] in all patients irrespective of the osteotomy technique used. The radiographic measurements showed a mean hip knee ankle (HKA) angle correction of 10.4° (95 % CI 6.4°-14.4°). CONCLUSION In patients with knee OA combined with a valgus leg alignment, the varus-producing osteotomy is a successful treatment. Postoperatively, the patients showed kinetics and kinematics of gait similar as that of a healthy control group. A significant increase in the knee adduction moment during stance phase was found, which was related to the degree of correction. The HKA angle towards zero degrees caused a medial shift in the dynamic knee loading. The medial shift will optimally restore cartilage loading forces and knee ligament balance and reduces progression of OA or the risk of OA. A significant improvement in all clinical outcomes was also found. LEVEL OF EVIDENCE III.
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Mitchell JJ, Dean CS, Chahla J, Moatshe G, Cram TR, LaPrade RF. Varus-Producing Lateral Distal Femoral Opening-Wedge Osteotomy. Arthrosc Tech 2016; 5:e799-e807. [PMID: 27709040 PMCID: PMC5040188 DOI: 10.1016/j.eats.2016.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/21/2016] [Indexed: 02/03/2023] Open
Abstract
Valgus knee alignment in excess of physiological valgus leads to excessive loading of the lateral compartment, which can potentially increase the risk of osteoarthritis and can place the medial knee structures at risk of chronic attenuation. Varus-producing distal femoral osteotomies have been proposed for correction of valgus malalignment, to relieve tension on medial-sided structures, as well as to off-load the lateral compartment. Understanding that symptomatic valgus deformity of the knee represents a complex problem that is magnified in the setting of lateral compartment arthritis or medial ligamentous incompetence, we present our preferred technique for a varus-producing distal femoral osteotomy using plate osteosynthesis and cancellous bone allograft.
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Affiliation(s)
- Justin J. Mitchell
- The Steadman Clinic, Vail, Colorado, U.S.A.,Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Chase S. Dean
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,Oslo University Hospital, Oslo, Norway
| | | | - Robert F. LaPrade
- The Steadman Clinic, Vail, Colorado, U.S.A.,Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,Address correspondence to Robert F. LaPrade, M.D., Ph.D., The Steadman Clinic, 181 W Meadow Dr., Ste 400, Vail, CO 81657, U.S.A.The Steadman Clinic181 W Meadow Dr.Ste 400VailCO81657U.S.A.
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Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. Orthop J Sports Med 2016; 4:2325967116649901. [PMID: 27331074 PMCID: PMC4900333 DOI: 10.1177/2325967116649901] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Lateral compartment osteoarthritis of the knee can be a challenging pathology in the younger, active population due to limited treatment options and high patient expectations. Distal femoral osteotomy (DFO) has been reported to be a potential treatment option. Purpose: To perform a systematic review on the survival, outcomes, and complications of DFO for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Registry of Controlled Trials, PubMed, and MEDLINE from 1980 to present. Inclusion criteria were as follows: outcomes of opening- and closing-wedge DFOs performed for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee, English language, minimum 2-year follow-up, and human studies. Data abstracted from the selected studies included type of osteotomy (opening vs closing), survival rate, patient-reported and radiographic outcomes, and complications. Results: Fourteen studies met the inclusion criteria and were considered for the review. A total of 9 closing-wedge and 5 opening-wedge DFO studies were included. All were retrospective studies and reported good to excellent patient-reported outcomes after DFO. Survival decreased with increasing time from surgery, with 1 study reporting a 100% survival rate at 6.5 years, compared with 21.5% at 20 years in another study. A low rate of complications was reported throughout the review. Conclusion: Highly heterogeneous literature exists for both opening- and closing-wedge DFOs for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment. A mean survival rate of 80% at 10-year follow-up was reported, supporting that this procedure can be a viable treatment option to delay or reduce the need for joint arthroplasty. A low complication rate was observed, with symptomatic hardware being the most prevalent postoperative complication.
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Affiliation(s)
- Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, USA
- OSTRC, The Norwegian School of Sports Sciences, Oslo, Norway
| | | | - Chase S. Dean
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F. LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
- Robert F. LaPrade, MD, PhD, Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA ()
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Özcan Ç, Sökücü S, Beng K, Çetinkaya E, Demir B, Kabukçuoğlu YS. Prospective comparative study of two methods for fixation after distal femur corrective osteotomy for valgus deformity; retrograde intramedullary nailing versus less invasive stabilization system plating. INTERNATIONAL ORTHOPAEDICS 2016; 40:2121-2126. [PMID: 27079838 DOI: 10.1007/s00264-016-3190-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim of this study was to compare the radiological and functional results of two different methods of fixation for the correction of femoral valgus deformities. METHODS Patients who had undergone osteotomy and correction of a valgus deformity from 2007 to 2013 were prospectively followed. Thirty three patients (20 females, 13 males) with 39 lower limbs were included in the study. Seventeen lower limbs were treated with retrograde intramedullary nailing (IMN) and 22 with less invasive stabilization system plating. Standing orthoroentgenograms of the lower limbs were taken pre-operatively and at the final follow-up. mLDFA, aLDFA, mechanical axis deviation (MAD) were measured in this orthoroentgenograms. Knee osteoarthritis outcome score (KOOS) and knee range of motion were used pre-operatively and at the final follow-up as part of the evaluation of the clinical results. All patients duration of surgery, length of hospital stay were assessed. Operations were performed by two orthopedic surgeons. The choice of correction method for each patient was determined by the surgeon. Pre-operative and post-operative values were simultaneously measured by two additional orthopedic surgeons. RESULTS The mean age of the patients was 26.2 years (18.0-51.0) in the plating group and 29.3 years (18.0-55.0) in the nailing group. Patients in the plating and nailing groups were followed up for 24.0 (12.0-60.0) and 27.8 (12.0-60.0) months. All patients were followed for a minimum of 12 months. No significant differences were observed between the groups in terms of age, sex, or duration of follow-up (p > 0.05) Comparison of the pre- and post-operative mLDFA, aLDFA, MAD, length of hospital stay, and duration of surgery between the plating group and nailing group, no significant difference was observed between the groups (p > 0.05). However, patients treated with retrograde IMN had significantly better post-operative results in terms of the KOOS and range of motion of the knee according to plating group (p < 0.05). CONCLUSION Retrograde IMN does not provide a radiological advantage over the LISS plating technique for valgus deformity but retrograde IMN and correction offered better functional results in cases of femoral valgus deformity than did the LISS plating method.
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Affiliation(s)
- Çağrı Özcan
- Elazığ Education and Training Hospital, İnonu Street, No 74, Elazığ, Turkey.
| | - Sami Sökücü
- Baltalimanı Bone Diseases Education and Training Hospital, Istanbul, Turkey
| | - Kubilay Beng
- Baltalimanı Bone Diseases Education and Training Hospital, Istanbul, Turkey
| | - Engin Çetinkaya
- Baltalimanı Bone Diseases Education and Training Hospital, Istanbul, Turkey
| | - Bilal Demir
- Baltalimanı Bone Diseases Education and Training Hospital, Istanbul, Turkey
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Holschen M, Lobenhoffer P. Komplikationen kniegelenknaher Umstellungsosteotomien. DER ORTHOPADE 2015; 45:13-23. [DOI: 10.1007/s00132-015-3199-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Medial Closing-Wedge Distal Femoral Osteotomy: Fixation With Proximal Tibial Locking Plate. Arthrosc Tech 2015; 4:e687-95. [PMID: 26870647 PMCID: PMC4738638 DOI: 10.1016/j.eats.2015.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 07/14/2015] [Indexed: 02/03/2023] Open
Abstract
Distal femoral varus osteotomy is a well-established procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology. Surgical techniques can be performed with a lateral opening-wedge or medial closing-wedge correction of the deformity. Fixation methods for lateral opening-wedge osteotomies are widely available, and there are various types of implants that can be used for fixation. However, there are currently only a few options of implants for fixation of a medial closing-wedge osteotomy on the market. This report describes a medial, supracondylar, V-shaped, closing-wedge distal femoral osteotomy using a locked anterolateral proximal tibial locking plate that fits anatomically to the medial side of the distal femur. This is a great option as a stable implant for a medial closing-wedge distal femoral osteotomy.
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Abstract
Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. There are few papers in the literature describing the outcomes of distal femoral osteotomy (DFO), as compared with the studies reporting on high tibial osteotomy (HTO), probably because valgus malalignment is less common than the varus one. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes.
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