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Wake JL, Chung B, Bottoni CR, Zhou L. Management Considerations for Unicompartmental Osteoarthritis in Athletic Populations: A Review of the Literature. J Knee Surg 2024; 37:693-701. [PMID: 35798349 DOI: 10.1055/s-0042-1750750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Unicompartmental osteoarthritis in the young athlete poses a challenge for both patients and providers. Coronal plane malalignment is frequently a concomitant finding that adds to the complexity of management. Military surgeons are presented unique challenges, in that they must consider optimal joint-preservation methods while returning patients to a high-demand occupational function. Management options range from lifestyle changes to surgical interventions. We present a concise review of the available literature on this subject, with a specific focus on indications and outcomes within the military and young athletic population.
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Affiliation(s)
- Jeffrey L Wake
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| | - Brandon Chung
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| | - Craig R Bottoni
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
| | - Liang Zhou
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii
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Lott A, James MG, Kaarre J, Höger S, Kayaalp ME, Ollivier M, Getgood A, Hughes JD, Musahl V. Around-the-knee osteotomies part II: Surgical indications, techniques and outcomes - State of the art. J ISAKOS 2024; 9:658-671. [PMID: 38604568 DOI: 10.1016/j.jisako.2024.04.002] [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: 10/30/2023] [Revised: 03/24/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
Recent advances in surgical techniques and planning for knee-based osteotomies have led to improvements in addressing lower extremity malalignment. Part 1 of this review presented the biomechanical and clinical rationale of osteotomies, emphasizing the importance of osteotomies for restoring normal knee kinematics. In Part 2 of this review, indications, surgical technique and outcomes of osteotomies to correct coronal, sagittal and axial plane deformities will be examined. Traditional high tibial and distal femoral osteotomies will be discussed in addition to more recent advanced techniques including biplanar corrections and double-level osteotomies, as well as slope-correcting osteotomies. Patient-specific instrumentation and its use in more complex corrections will also be addressed.
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Affiliation(s)
- Ariana Lott
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael G James
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Svenja Höger
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Enes Kayaalp
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA; Department of Orthopaedics and Traumatology, Istanbul Kartal Training and Research Hospital, Istanbul, Turkey
| | | | - Al Getgood
- Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Center, University of Pittsburgh, Pittsburgh, PA, USA.
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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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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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Machado A, Micicoi L, Ernat J, Schippers P, Bernard de Dompsure R, Bronsard N, Gonzalez JF, Micicoi G. Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4276-4284. [PMID: 37326635 DOI: 10.1007/s00167-023-07465-1] [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: 01/28/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO. METHODS This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed. RESULTS The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = - 0.15, p = 0.04) and function IKS (R = - 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°. CONCLUSION Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Axel Machado
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Lolita Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Justin Ernat
- University of Utah Health, Salt Lake City, Utah, USA
| | - Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Régis Bernard de Dompsure
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Grégoire Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, voie Romaine, 06000, Nice, France.
- Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
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Lee S, Brown JR, Bartolomei C, Turnbull T, Miles JW, Dornan GJ, Frank RM, Vidal AF. Effects of Lateral Opening-Wedge Distal Femoral Osteotomy on Meniscal Allograft Transplantation: A Biomechanical Evaluation. Orthop J Sports Med 2023; 11:23259671231156639. [PMID: 37347021 PMCID: PMC10280523 DOI: 10.1177/23259671231156639] [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: 10/28/2022] [Accepted: 12/08/2022] [Indexed: 06/23/2023] Open
Abstract
Background Lateral meniscal deficiency with valgus malalignment increases the rate of lateral compartment osteoarthritis. Lateral meniscal allograft transplantation (LMAT) with a concomitant varus-producing opening-wedge distal femoral osteotomy (DFO) is an option yet to be evaluated biomechanically. Purpose/Hypothesis The purpose of this study was to clarify the biomechanical effects of the realignment procedure in the setting of LMAT. We hypothesized that (1) given the dependence of the lateral compartment on the lateral meniscus, a DFO and increasing degrees of varus would be insufficient to restore lateral compartment pressures to normal from a lateral meniscus-deficient state, and that (2) LMAT would restore lateral compartment pressures to the intact state while DFO would decrease lateral compartment pressures for any given state of the meniscus. Study Design Controlled laboratory study. Methods Ten cadaveric knees underwent opening-wedge varus-producing DFO secured by an external fixator. Anatomic alignment was standardized to 6° of mechanical valgus, and each joint was tested in full extension. Submeniscal placement of thin film pressure sensors allowed for the recording of contact pressure, peak contact pressure, and contact area. The specimens were loaded on a biaxial dynamic testing machine with loading angles between 9° valgus and 6° varus of mechanical alignment. Conditions tested included intact meniscus, meniscal deficiency, and meniscal transplantation. Results Isolated varus-producing DFO to 6° in the meniscus-deficient state failed to restore joint pressures and contact areas to the intact state, with significant changes in mean contact pressure (175%), mean peak contact pressure (135%), and contact area (-41%) (all P < .05 vs intact), while LMAT restored all outcome measures (all P > .05 compared with intact). After LMAT, every additional 1° of DFO correction contributed to a decrease in the mean contact pressure, peak pressure, and contact area of 5.6% (-0.0479 N/mm2), 5.9% (-0.154 N/mm2), and 1.4% (-6.99 mm2) for the lateral compartment and 7.3% (+0.034 N/mm2), 12.6% (+0.160 N/mm2), and 4.3% (+20.53 mm2) for the medial compartment, respectively. Conclusion Isolated DFO was inadequate to restore load distribution in meniscus-deficient knees, while concomitant LMAT restored near normal forces and improved the lateral compartment biomechanical profile. Clinical Relevance Our findings support the concomitant use of LMAT and varus-producing DFO in the setting of lateral meniscal deficiency with valgus malalignment. This study provides tools for the orthopaedic surgeon to individualize the correction for each patient.
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Affiliation(s)
- Simon Lee
- Steadman Philippon Research Institute,
Vail, Colorado, USA
| | | | | | | | - Jon W. Miles
- Steadman Philippon Research Institute,
Vail, Colorado, USA
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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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9
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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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10
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Plancher KD, Briggs KK, Chinnakkannu K, Dotterweich KA, Commaroto SA, Wang KH, Petterson SC. Isolated Lateral Tibiofemoral Compartment Osteoarthritis: Survivorship and Patient Acceptable Symptom State After Lateral Fixed-Bearing Unicompartmental Knee Arthroplasty at Mean 10-Year Follow-up. J Bone Joint Surg Am 2022; 104:1621-1628. [PMID: 35766399 DOI: 10.2106/jbjs.21.01523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral unicompartmental knee arthroplasty (UKA) is an excellent option to alleviate disability and restore function in patients with lateral compartment knee osteoarthritis (OA). The purpose of the present study was to determine the survivorship and long-term outcomes in both younger/middle-aged and older patients with lateral compartment OA following non-robotically-assisted, fixed-bearing lateral UKA and to determine if an acceptable symptom state can be achieved. METHODS All patients were managed with fixed-bearing lateral UKA by a single surgeon utilizing a lateral parapatellar approach without robotic assistance. The primary outcome variables were the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living (ADL) and Sport subscale scores. In addition, the other KOOS subscores, the Lysholm score, the achievement of the Patient Acceptable Symptom State (PASS), and the Veterans RAND (VR-12) Physical Component Summary score (PCS) and Mental Component Summary score (MCS) were collected. Failure was defined as conversion to total knee arthroplasty (TKA). Patients were divided into 2 cohorts: younger/middle-aged patients (<60 years of age) and older patients (≥60 years of age). RESULTS A cohort of 256 patients underwent medial (n = 193) or lateral (n = 63) UKA. Sixty-one patients met the inclusion criteria. At mean of 10 years (range, 4 to 17 years) of follow-up, there were no significant differences between the groups in terms of any patient-reported outcome measures (p > 0.05). The percentage of patients in whom PASS was achieved on the KOOS ADL and Sport subscores was 82% and 88%, respectively, in the younger cohort and 80% and 80%, respectively, in the older cohort. The mean survival estimate of the prothesis was 15.3 years (95% confidence interval [CI], 14.5 to 16.2 years) for the entire cohort. The estimated rate of implant survival in the younger cohort was 100% at 5 and 10 years, and the estimated rate of implant survival in the older cohort was 98% at 5 years and 96% at 10 years. CONCLUSIONS Lateral fixed-bearing, non-robotic UKA for the treatment of isolated lateral compartment OA resulted in >80% of patients reaching an acceptable symptom state in terms of both activities of daily living and sporting activities. UKA provides an excellent option that provides longevity with high PASS rates and return to activities with a low risk of complications and failure. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.,Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY.,Plancher Orthopaedics & Sports Medicine, New York, NY.,Orthopaedic Foundation, Stamford, Connecticut
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11
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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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12
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Kerzner B, Fortier LM, Swindell HW, McCormick JR, Kasson LB, Hevesi M, LaPrade RF, Mandelbaum BR, Chahla J. An Update on the Use of Orthobiologics Combined with Corrective Osteotomies for Osteoarthritis: Osteotomy Site and Intra-Articular Efficacy. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Ciolli G, Proietti L, Mercurio M, Corona K, Maccauro G, Schiavone Panni A, Cerciello S. Return to sport following distal femur osteotomy: a systematic review. Orthop Rev (Pavia) 2022; 14:33774. [PMID: 35774926 PMCID: PMC9239358 DOI: 10.52965/001c.33774] [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: 11/04/2021] [Accepted: 01/04/2022] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Distal femur osteotomies (DFOs) are well-accepted procedures in treating unicompartmental knee osteoarthritis associated with valgus malalignment. This study aims to investigate the Return to sport (RTS) after DFO. MATERIALS AND METHODS We conducted a systematic review of the literature according to the PRISMA guidelines, including all articles published in English, with no time limit, excluding double-level knee osteotomies. RESULTS Five articles were included for an overall cohort of 76 patients. The mean follow-up was 45.53 months. The mean age of the patients at the time of surgery was 33.87 years, and the mean malalignment was 5.59° in valgus. In 70 cases, patients received a lateral DFO, while in 6 cases, a medial closing-wedge DFO. An RTS of 86.1% was observed after DFO and a mean time to RTS of 12.3 months. 76.8% of patients recovered to a level equal to or higher than that practiced before the onset of symptoms. No statistically significant differences were observed in the RTS rate between those who performed lateral or medial DFO. CONCLUSIONS RTS after DFO is ubiquitous and occurs around one year after surgery. In most cases, patients report improved performance compared to what they experienced before the onset of symptoms. Unfortunately, while athletes often have RTS at a similar or better level, other patients often see a return to lower impact sports.
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Affiliation(s)
- Gianluca Ciolli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Sacred Heart Catholic University, Rome, Italy
| | - Lorenzo Proietti
- Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Sacred Heart Catholic University, Rome, Italy
| | - Alfredo Schiavone Panni
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simone Cerciello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Sacred Heart Catholic University, Rome, Italy; Marrelli Hospital, Crotone, Italy
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14
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Agarwal S, Jayadeep JS. Adult Pathology: Knee. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1007/978-3-030-78529-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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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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16
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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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17
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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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18
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Zitsch BP, Stannard JP, Worley JR, Cook JL, Leary EV. Patient-Reported Outcomes for Large Bipolar Osteochondral Allograft Transplantation in Combination with Realignment Osteotomies for the Knee. J Knee Surg 2021; 34:1260-1266. [PMID: 32369842 DOI: 10.1055/s-0040-1710361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Effective treatment for bipolar articular cartilage lesions in the knee remains a clinical challenge. Lower extremity malalignment is a risk factor for treatment failures, which can be addressed by tibial or femoral osteotomy. The purpose of this study was to compare outcomes among patients who underwent knee joint restoration by osteochondral allograft (OCA) transplantation with concurrent or staged realignment osteotomy. With Institutional Review Board approval, patients undergoing bipolar OCA transplantation with concurrent or staged distal femoral osteotomy (DFO) or high tibial osteotomy (HTO) were analyzed. Patients were categorized by osteotomy type (DFO and HTO) and timing (concurrent and staged). Patient-reported outcome measures (PROMs), revisions, failures, and complications were examined preoperatively (baseline), 3, 6, 12, and 24 months after OCA transplantation; change scores from preoperative values were used for analysis. A total of 23 patients met inclusion criteria (15 males); 13 (56.5%) received HTO (5 concurrent), while 10 (43.5%) received DFO (5 concurrent). There were no significant differences in complication rates between concurrent and staged osteotomies. Primary bipolar OCA transplantation with osteotomy was associated with successful outcomes in 70% of patients; four patients underwent revision (17.4%) and three (13.0%) failed and were treated by total knee arthroplasty. Further, the four patients undergoing revision met functional criteria for success at final follow-up, resulting in a 2-year functional survival rate of 87.4%. Aside from Patient-Reported Outcomes Measurement Information System (PROMIS) physical function, all PROMs for concurrent and staged osteotomies improved from baseline to 2 years postoperatively. Concurrent osteotomies of both types were associated with significantly lower pain scores at 12 months (p = 0.04), compared with staged osteotomies. Apart from Single Assessment Numerical Evaluation (SANE), more PROM improvement was observed for concurrent osteotomies at 2 years. Improvements in PROMs for patients undergoing OCA transplantation combined with osteotomy were observed at 2-year follow-up. PROMs for concurrent osteotomy were consistently greater than staged osteotomy, lending support to addressing lower extremity malalignment with bipolar OCA transplantation in the knee during a single surgery when possible.
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Affiliation(s)
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - John R Worley
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
| | - Emily V Leary
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
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19
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Peng H, Ou A, Huang X, Wang C, Wang L, Yu T, Zhang Y, Zhang Y. Osteotomy Around the Knee: The Surgical Treatment of Osteoarthritis. Orthop Surg 2021; 13:1465-1473. [PMID: 34110088 PMCID: PMC8313165 DOI: 10.1111/os.13021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 12/22/2022] Open
Abstract
Osteoarthritis causes joint pain and functional disorder, of which knee osteoarthritis is the most common. Nowadays, clinically effective treatments mainly include conservative treatment, arthroplasty, and osteotomy. However, conservative treatment only offers symptomatic relief and arthroplasty is limited to the patients with a moderate to severe degree of osteoarthritis. For relatively young patients who require greater knee preservation, a surgical treatment with low operation trauma and revision rate is needed. Osteotomy around the knee, based on the notion of “knee preservation,” has been chosen as an alternative surgical treatment. Cutting and realigning the bones corrects the mechanical line of lower limb force bearing. As such, osteotomy around the knee retains normal anatomical structure and obtains good functional recovery of the knee joint. The techniques of osteotomy around the knee includes anti‐varus deformity and anti‐valgus deformity osteotomy, aiming to reallocate the force bearing in the compartment of the knee joint. By choosing the surgical section of the lower limbs, the osteotomy around the knee can achieve the correction of mechanical axis, such as the high tibial osteotomy (HTO), proximal fibular osteotomy (PFO), and distal femur osteotomy (DFO). Numerous modified techniques have been developed to meet the demands of patients based on traditional methods. These modified osteotomy have their own advantages and indications. This paper aims to guide clinical treatment by reviewing different types of osteotomies, and their effects, that have been studied and applied widely in clinical practices.
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Affiliation(s)
- Haining Peng
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Aichun Ou
- Department of Operating Room, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaohong Huang
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, China
| | - Chen Wang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lei Wang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tengbo Yu
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Sports Medicine and Rehabilitation, Qingdao University, Qingdao, China
| | - Yingze Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Zhang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Sports Medicine and Rehabilitation, Qingdao University, Qingdao, China.,Shandong Institute of Traumatic Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
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20
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Sim HS, Ang KXM, How CH, Loh SYJ. Management of knee osteoarthritis in primary care. Singapore Med J 2020; 61:512-516. [PMID: 33225367 DOI: 10.11622/smedj.2020147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hui Shan Sim
- Care and Health Integration, Changi General Hospital, Singapore
| | | | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore
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Kandhari V, Angadi D, Myat D, Fritsch B, Parker D, Coolican M. Resultados a longo prazo de osteotomia varizante femoral distal (OVFD) com cunha de abertura lateral para artrose do compartimento lateral do joelho utilizando navegação computadorizada. Rev Bras Ortop 2020; 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] [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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Mayfield CK, Bolia IK, Mayer EN, Heidari KS, Heckmann N, Pannell WC, Hill JR, McKnight B, Vangsness CT, Hatch GF, Weber AE. Factors Associated With Distal Femoral Osteotomy Survivorship: Data From the California Office of Statewide Health Planning and Development (OSHPD) Registry. Orthop J Sports Med 2020; 8:2325967120951554. [PMID: 33029543 PMCID: PMC7522844 DOI: 10.1177/2325967120951554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Malalignment of the lower extremity can lead to early functional impairment and degenerative changes. Distal femoral osteotomy (DFO) can be performed with arthroscopic surgery to correct lower extremity malalignment while addressing intra-articular abnormalities or to help patients with knee osteoarthritis (OA) changes due to alignment deformities. Purpose: To examine survivorship after DFO and identify the predictors for failure. Study Design: Case series; Level of evidence, 4. Methods: Data from the California Office of Statewide Health Planning and Development, a statewide discharge database, were utilized to identify patients between the ages of 18 and 40 years who underwent DFO from 2000 to 2014. Patients with a history of lower extremity trauma, infectious arthritis, rheumatological disease, skeletal dysplasia, congenital deformities, malignancy, or concurrent arthroplasty were excluded. Failure was defined as conversion to total or unicompartmental knee arthroplasty, and the identified cohort was stratified based on whether they went on to fail. Age, sex, race, diagnoses, concurrent procedures, and comorbidities were recorded for each admission. Statistically significant differences between patients who required arthroplasty and those who did not were identified using the Student t test for continuous variables and a chi-square test for categorical variables. Kaplan-Meier survivorship curves were constructed to estimate 5- and 10-year survival rates. A Cox proportional hazards model was used to analyze the risk for conversion to arthroplasty. Results: A total of 420 procedures were included for analysis. Overall, 53 knees were converted to arthroplasty. The mean follow-up time was 4.8 years (range, 0.0-14.7 years). The 5-year survivorship was 90.2% (range, 85.7%-93.4%), and the 10-year survivorship was 73.2% (range, 64.7%-79.9%). The mean time to failure was 5.9 years (range, 0.4-13.9 years). Survivorship significantly decreased with increasing age (P = .004). Hypertension and a primary diagnosis of osteoarthrosis were significant risk factors for conversion to arthroplasty (odds ratio [OR], 3.12 [95% CI, 1.38-7.03]; P = .006, and OR, 2.42 [95% CI, 1.02-5.77]; P = .045, respectively), along with a primary diagnosis of traumatic arthropathy (OR, 10.19 [95% CI, 1.71-60.65]; P = .01) and a comorbid diagnosis of asthma (OR, 2.88 [95% CI, 1.23-6.78]; P = .02). Patients with Medicaid were less likely (OR, 0.11 [95% CI, 0.01-0.88]; P = .04) to undergo arthroplasty compared with patients with private insurance, while patients with workers’ compensation were 3.1 times more likely (OR, 3.08 [95% CI, 1.21-7.82]; P = .02). Conclusion: Older age was an independent risk factor for conversion to arthroplasty after DFO in patients ≥18 years but ≤60 years. Hypertension, asthma, and a diagnosis of osteoarthrosis or traumatic arthropathy at the time of surgery were predictors associated with failure, reinforcing the need for careful patient selection. The high survivorship rate of DFO in this analysis supports this procedure as a reasonable alternative to arthroplasty in younger patients with valgus deformities about the knee and symptomatic unicompartmental OA.
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Affiliation(s)
- Cory K Mayfield
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Erik N Mayer
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Keemia Soraya Heidari
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - William C Pannell
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Jeffrey Ryan Hill
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Braden McKnight
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - C Thomas Vangsness
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - George F Hatch
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, California, USA
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Álvarez-Lozano E, Luna-Pizarro D, Meraz-Lares G, Quintanilla-Loredo R, Cerdá-García MV, Forriol F. Two-stage bone and meniscus allograft and autologous chondrocytes implant for unicompartmental osteoarthritis: midterm results. Musculoskelet Surg 2020; 106:133-143. [PMID: 32845424 DOI: 10.1007/s12306-020-00680-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 08/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND We analyzed the clinical and radiographic evolution of patients with knee unicompartmental osteoarthritis and axis alteration and osteochondral lesions in the femoral condyle, treated with tibial plateau and meniscus allograft and cultured autologous chondrocyte implantation in the femur in two steps. PURPOSE To analyze the clinical results with the first patients treated with this two-stage technique to avoid knee prosthesis in patients with unicompartmental osteoarthritis. MATERIAL AND METHODOLOGY Sixteen patients, average age 56 years, were included in a cohort study. We performed an osteotomy with tibia plateau allograft, including the meniscus. In a second surgery, the chondrocyte fibrin scaffold was placed in the femur. Clinical symptoms and function were measured using KSSR and KOOS scores. Wilcoxon's test was performed to compare the results over the 2-year follow-up period. RESULTS Mean KSSR before surgery was 35.69 (SD: 3.75) points, rising to 67 (SD: 15.42) at 3 months, 95.88 at 12 months (SD: 2.68) and 96.31 at 24 months (SD: 2.24). The KOOS before surgery was 65.14 (SD: 16.34), rising to 72.68 after 3 months (SD: 19.15), 76.68 at 12 months (SD: 18.92) and 64.28 at 24 months (SD: 11.79). Four of 5 patients returned to engaging in the activity that they had stopped practicing. Three patients experienced collapse of the tibia allograft, and they needed later a prosthesis. CONCLUSIONS Simultaneous tibia plateau allograft and autologous chondrocyte implantation in the femur, after correction of the angular deformity, were performed, restoring the anatomy of the medial compartment and knee function in 82% of the patients 2 years after the operation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Álvarez-Lozano
- Department of Traumatology and Orthopedics, Hospital Universitario Dr. Jose E. González, Universidad Autónoma de Nuevo León (UANL), Monterrey, NL, Mexico
| | - D Luna-Pizarro
- Department of Traumatology and Orthopedics, Hospital Universitario Dr. Jose E. González, Universidad Autónoma de Nuevo León (UANL), Monterrey, NL, Mexico.,Department of Research Division, Mexican Institute of Social Security (IMSS), Hospital of Traumatology and Orthopedics "Lomas Verdes", Médica Sur Private Hospital, Ciudad de México (CDMX), Mexico
| | - G Meraz-Lares
- Department of Traumatology and Orthopedics, Hospital Universitario Dr. Jose E. González, Universidad Autónoma de Nuevo León (UANL), Monterrey, NL, Mexico.,Department of Traumatology and Orthopedics, Medica Sur Private Hospital, Ciudad de México (CDMX), México
| | - R Quintanilla-Loredo
- Department of Traumatology and Orthopedics, Hospital Universitario Dr. Jose E. González, Universidad Autónoma de Nuevo León (UANL), Monterrey, NL, Mexico
| | - M V Cerdá-García
- Department of Traumatology and Orthopedics, Hospital Universitario Dr. Jose E. González, Universidad Autónoma de Nuevo León (UANL), Monterrey, NL, Mexico.,Department of Traumatology and Orthopedics, Medica Sur Private Hospital, Ciudad de México (CDMX), México
| | - F Forriol
- Department of Clinical Sciences, School of Medicine, University CEU - San Pablo, Campus Monteprincipe, Madrid, Spain.
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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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25
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Akaoka Y, Nakayama H, Iseki T, Kanto R, Tensho K, Yoshiya S. Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees. Knee Surg Relat Res 2020; 32:15. [PMID: 32660561 PMCID: PMC7219206 DOI: 10.1186/s43019-020-00035-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/26/2020] [Indexed: 01/21/2023] Open
Abstract
Purpose To evaluate the postoperative change in patellar position after medial closed distal femoral osteotomy (DFO) performed for valgus osteoarthritic knees. Methods The study included 21 consecutive knees in 20 patients undergoing DFO. A minimum of 2-year follow-up data was obtained for all subjects with a mean follow-up period of 42 months (range 31–59 months). The patellar position was evaluated on plain radiographs preoperatively, 1-year postoperatively, and 2-year postoperatively. For patellar height, the modified Insall–Salvati Index (mISI), modified Caton–Deschamps Index (mCDI) and modified Blackburne–Peel Index (mBPI) were measured on the standing lateral radiographs. Patellofemoral alignment on the axial plane was assessed on skyline views with 30° flexion based on the measurements for lateral patellar tilt (LPT) and lateral patellar shift (LPS). Measured values at pre- and postoperative phases were statistically compared using a two-way analysis of variance. Results All indices including mISI, mCDI, mBPI, LPT and LPS showed no statistically significant postoperative changes. Conclusion Medial closed-wedge DFO performed for valgus osteoarthritic knees did not significantly influence patellofemoral alignment either on the sagittal or axial plane. Therefore, to highlight the clinical relevance of our findings, medial closed-wedge DFO for the valgus knee does not adversely affect the patellofemoral joint. Level of evidence Level IV, case series.
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Affiliation(s)
- Yusuke Akaoka
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan. .,Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Hiroshi Nakayama
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan
| | - Tomoya Iseki
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan
| | - Ryo Kanto
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan
| | - Keiji Tensho
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shinichi Yoshiya
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 653-8501, Japan
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26
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Song JS, Hong KT, Kim NM, Jung JY, Park HS, Chun YS, Kim SJ. Cartilage regeneration in osteoarthritic knees treated with distal femoral osteotomy and intra-lesional implantation of allogenic human umbilical cord blood-derived mesenchymal stem cells: A report of two cases. Knee 2019; 26:1445-1450. [PMID: 31443940 DOI: 10.1016/j.knee.2019.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 07/03/2019] [Accepted: 07/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To treat lateral compartment osteoarthritis caused by a valgus deformity, partial or total knee joint arthroplasty is recommended. However, for young patients, joint preservation surgery such as distal femoral osteotomy (DFO) can be an alternative treatment option. Combined cartilage defects of lateral compartment osteoarthritis can be restored by human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs). This case report presents the results of DFO and hUCB-MSC implantation for treating two patients with valgus deformity who had lateral compartment osteoarthritis. CASE PRESENTATION Two middle-aged patients with lateral compartment osteoarthritis and valgus deformity were treated using DFO and hUCB-MSC implantation. They recovered sufficiently to perform moderate exercise one year after surgery. The International Knee Documentation Committee, visual analog scale, and Western Ontario and McMaster Universities Osteoarthritis Index scores showed continuous improvement after surgery. Cartilage regeneration of International Cartilage Repair Society Grade 1, which was similar to normal, was observed in both patients through second-look arthroscopy. With time, the modified two-dimensional magnetic resonance observation of cartilage repair tissue scores also increased in both cases. CONCLUSION This is the first case report detailing the results of treating lateral compartment osteoarthritis using hUCB-MSCs and DFO. In conclusion, this can be considered a new treatment option for such cases.
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Affiliation(s)
- Jun-Seob Song
- Department of Orthopaedic Surgery, Gangnam JS Hospital, Seoul, Republic of Korea
| | - Ki-Taek Hong
- Department of Orthopaedic Surgery, Gangnam JS Hospital, Seoul, Republic of Korea
| | - Na-Min Kim
- Department of Orthopaedic Surgery, Gangnam JS Hospital, Seoul, Republic of Korea
| | - Jae-Yub Jung
- Department of Orthopaedic Surgery, Gangnam JS Hospital, Seoul, Republic of Korea
| | - Han-Soo Park
- Department of Orthopaedic Surgery, Gangnam JS Hospital, Seoul, Republic of Korea
| | - You Seung Chun
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Jung Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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27
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Leong NL, Southworth TM, Cole BJ. Distal Femoral Osteotomy and Lateral Meniscus Allograft Transplant. Clin Sports Med 2019; 38:387-399. [DOI: 10.1016/j.csm.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Duethman NC, Bernard CD, Camp CL, Krych AJ, Stuart MJ. Medial Closing Wedge Distal Femoral Osteotomy. Clin Sports Med 2019; 38:361-373. [PMID: 31079768 DOI: 10.1016/j.csm.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The main indication for performing a distal femoral osteotomy is valgus malalignment of the knee joint. The ideal candidates are young and active individuals with isolated lateral compartment arthritis. The goal of the procedure is to create a neutral mechanical axis of the limb to relieve pain and preserve the knee joint. The amount of correction is calculated from a preoperative, high-quality, weight-bearing radiograph from the hip to ankle. This technically challenging operation is a viable option for patients with valgus malalignment because early survivorship is strong and patient-reported outcome scores are significantly improved.
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Affiliation(s)
- Nicholas C Duethman
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Christopher D Bernard
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA; Department of Sports Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA.
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29
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Chalmers BP, Limberg AK, Athey AG, Perry KI, Pagnano MW, Abdel MP. Total knee arthroplasty after distal femoral osteotomy long-term survivorship and clinical outcomes. Bone Joint J 2019; 101-B:660-666. [DOI: 10.1302/0301-620x.101b6.bjj-2018-1334.r2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims There is little literature about total knee arthroplasty (TKA) after distal femoral osteotomy (DFO). Consequently, the purpose of this study was to analyze the outcomes of TKA after DFO, with particular emphasis on: survivorship free from aseptic loosening, revision, or any re-operation; complications; radiological results; and clinical outcome. Patients and Methods We retrospectively reviewed 29 patients (17 women, 12 men) from our total joint registry who had undergone 31 cemented TKAs after a DFO between 2000 and 2012. Their mean age at TKA was 51 years (22 to 76) and their mean body mass index 32 kg/m2 (20 to 45). The mean time between DFO and TKA was ten years (2 to 20). The mean follow-up from TKA was ten years (2 to 16). The prostheses were posterior-stabilized in 77%, varus-valgus constraint (VVC) in 13%, and cruciate-retaining in 10%. While no patient had metaphyseal fixation (e.g. cones or sleeves), 16% needed a femoral stem. Results The ten-year survivorship was 95% with aseptic loosening as the endpoint, 88% with revision for any reason as the endpoint, and 81% with re-operation for any reason as the endpoint. Three TKAs were revised for instability (n = 2) and aseptic tibial loosening (n = 1). No femoral component was revised for aseptic loosening. Patients under the age of 50 years were at greater risk of revision for any reason (hazard ratio 7; p = 0.03). There were two additional re-operations (6%) and four complications (13%), including three manipulations under anaesthetic (MUA; 10%). The Knee Society scores improved from a mean of 50 preoperatively (32 to 68) to a mean of 93 postoperatively (76 to 100; p < 0.001). Conclusion A cemented posterior-stabilized TKA has an 88% ten-year survivorship with revision for any reason as the endpoint. No femoral component was revised for aseptic loosening. Patients under the age of 50 years have a greater risk of revision. The clinical outcome was significantly improved but balancing the knee was challenging in 13% of TKAs requiring VVC. Overall, 10% of TKAs needed an MUA, and 6% of TKAs were revised for instability. Cite this article: Bone Joint J 2019;101-B:660–666.
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Affiliation(s)
- B. P. Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A. K. Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A. G. Athey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - K. I. Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M. W. Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M. P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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30
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Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg 2019; 139:519-527. [PMID: 30413943 DOI: 10.1007/s00402-018-3068-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The purpose of the study was to describe the development of the surgical technique of double level osteotomy in patients with severe varus malalignment and to investigate the clinical and radiological outcome. It was hypothesized that good clinical results without a higher complication rate can be achieved by double level osteotomy to normalize joint angles and avoid joint line obliquity even in cases of progressed osteoarthritis. MATERIALS AND METHODS Between 2011 and 2014, 33 patients (37 knees) undergoing double level osteotomies (open wedge HTO and closed wedge DFO) were included; of these, 24 patients (28 knees) were available in mean of 18 ± 10 months for the follow-up examination. Indication was symptomatic varus malalignment and medial compartment osteoarthritis. Postoperatively, these patients were assigned to 20 kg partial weight-bearing using two crutches for 6 weeks followed by full weight-bearing. No braces or casts were used. Full weight-bearing long leg anteroposterior radiographs were obtained preoperatively, after 6 weeks and at the time of final follow-up. Mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA) and medial proximal tibia angle (MPTA) were measured. Clinical outcome was evaluated using Lequesne-, Lysholm-, Oxford-, and IKDC-score at the time of follow-up. RESULTS The preoperative mTFA of - 11 ± 3° increased to 0 ± 2° at final follow-up. The difference between mTFA-planning and final follow-up was - 2 ± 3° (p < 0.0006). At final follow-up, MPTA and mLDFA were 89.2 ± 2° and 87 ± 2°, respectively. The Lysholm, Oxford, Lequesne, and IKDC scores were 88 ± 13, 44 ± 3, 2 ± 2, and 77 ± 12, respectively. CONCLUSIONS This study showed that double level osteotomy for the patients with severe varus malalignment and medial compartment osteoarthritis normalises the alignment, joint-angles, avoids joint line obliquity, and leads to good clinical results, despite progressive osteoarthritis. LEVEL OF EVIDENCE Case series, Level IV.
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León SA, Mei XY, Safir OA, Gross AE, Kuzyk PR. Long-term results of fresh osteochondral allografts and realignment osteotomy for cartilage repair in the knee. Bone Joint J 2019; 101-B:46-52. [PMID: 30648496 DOI: 10.1302/0301-620x.101b1.bjj-2018-0407.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS The aim of this study was to report the outcome of femoral condylar fresh osteochondral allografts (FOCA) with concomitant realignment osteotomy with a focus on graft survivorship, complications, reoperation, and function. PATIENTS AND METHODS We identified 60 patients (16 women, 44 men) who underwent unipolar femoral condylar FOCA with concomitant realignment between 1972 and 2012. The mean age of the patients was 28.9 years (10 to 62) and the mean follow-up was 11.4 years (2 to 35). Failure was defined as conversion to total knee arthroplasty, revision allograft, or graft removal. Clinical outcome was evaluated using the modified Hospital for Special Surgery (mHSS) score. RESULTS A total of 14 grafts (23.3%) failed at a mean of 8.6 years (1.4 to 20.1). Graft survivorship was 87.3% (95% confidence interval (CI) 79.0 to 96.6), 85.0% (95% CI 75.8 to 95.3), 74.8% (95% CI 62.2 to 90.0), 65.2% (95% CI 49.9 to 85.2), and 59.8% (95% CI 43.5 to 82.1) at five, ten, 15, 20, and 25 years, respectively. A total of 23 patients (38.3%) developed complications, and 26 (43.3%) had a further operation. Persistent postoperative malalignment occurred more frequently in failed grafts (28.6% vs 4.3%; p = 0.023), and was a risk factor for graft failure (hazard ratio 6.55; 95% CI 1.61 27.71; p = 0.009). The mean mHSS score improved from 74.1 (40 to 91) preoperatively to 89.0 (66 to 100) at final follow-up (p < 0.001). CONCLUSION Femoral condylar FOCA with concomitant realignment osteotomy provides excellent long-term graft survival and reliable functional improvement. Persistent malalignment may increase the risk for graft failure.
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Affiliation(s)
- S A León
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Canada
| | - X Y Mei
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Canada
| | - O A Safir
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Canada
| | - A E Gross
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Canada
| | - P R Kuzyk
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Canada
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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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Wylie JD, Scheiderer B, Obopilwe E, Baldino JB, Pavano C, Macken CJ, Bell R, Mazzocca AD, Arciero RA, Imhoff FB. The Effect of Lateral Opening Wedge Distal Femoral Varus Osteotomy on Tibiofemoral Contact Mechanics Through Knee Flexion. Am J Sports Med 2018; 46:3237-3244. [PMID: 30265819 DOI: 10.1177/0363546518799353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral opening wedge distal femoral osteotomy (DFO) unloads a diseased lateral compartment of the knee in patients with genu valgum. To the best of our knowledge, there are no biomechanical studies investigating the effect of knee flexion on contact pressure and area after DFO. HYPOTHESIS As knee flexion angles increase, DFO will be less effective at unloading the lateral compartment of the knee. STUDY DESIGN Controlled laboratory study. METHODS Lateral opening wedge DFO was performed, correcting a mean of 7°, in 10 cadaveric knees using plate fixation. Tibiofemoral contact pressure was measured in 0°, 15°, 30°, 45°, 60°, and 75° of knee flexion before and after osteotomy using electronic sensors. Peak contact pressure (PCP), mean contact pressure (MCP), and contact area were measured for each condition. Anatomic dissection quantified the tibiofemoral contact position on the distal femur in all degrees of flexion. Mixed-effects regression analyses were used to compare the change in variables before and after osteotomy and between flexion angles. RESULTS One sample had to be excluded because of tibiofemoral arthritis. MCP decreased in the lateral compartment after DFO throughout all degrees of flexion (all P < .05) but to the greatest extent in 0° of flexion. When examining the percentage of MCP in the lateral compartment, this decreased after DFO at 0° (70.4% to 40.0%; P < .001), 15° (65.1% to 52.1%; P < .001), 30° (60.7% to 52.0%; P = .003), 45° (55.8% to 49.7%; P = .033), and 60° (51.9% to 44.2%; P = .010) but not at 75° (50.2% to 45.3%; P = .112). PCP decreased in the lateral compartment after DFO at 0° (2.41 to 1.34 MPa; P < .001), 15° (2.50 to 1.81 MPa; P < .001), 30° (2.28 to 1.93 MPa; P = .039), 45° (2.21 to 1.73 MPa; P = .005), 60° (2.15 to 1.71 MPa; P = .009), and 75° (1.95 to 1.49 MPa; P = .012). The percentage of contact area decreased in the lateral compartment in full extension (68.7% to 48.1%; P = .007) but not at any other degree of flexion (all P > .05). CONCLUSION DFO decreased lateral compartment pressure. However, it had the greatest effect in full knee extension. CLINICAL RELEVANCE DFO decreased contact pressure in the lateral compartment but more effectively decreased contact pressure in the more anterior aspects of the femoral articular cartilage.
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Affiliation(s)
- James D Wylie
- Orthopedic Surgery, Intermountain Healthcare, Riverton, Utah, USA
| | - Bastian Scheiderer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Joshua B Baldino
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Colin Pavano
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Craig J Macken
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Florian B Imhoff
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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Al F, Tosun B, Sinmazcelik T, Ozmen M. BIOMECHANICAL COMPARISON OF MEDIAL VERSUS LATERAL SIDED PLATING IN FEMORAL FRACTURES. ACTA ORTOPEDICA BRASILEIRA 2018; 26:265-270. [PMID: 30210258 PMCID: PMC6131281 DOI: 10.1590/1413-785220182604191645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: The aim of the present study was to determine whether the side of application of the plate itself affects the mechanical stability of the fixation. The specific question addressed is whether or not a lateral or medial plate application is biomechanically better, for the treatment of distal diaphysis fractures of the femur. Methods: Stability and stiffness of medial sided plating relative to the conventional lateral sided plating in distal diaphysis of the femur were measured by analyzing axial loading forces leading to implant failure. Sixty synthetic femurs were tested in physiological bending, to calculate the yield and ultimate load to displacement following fixation of distal diaphysis fractures of the femur by either medial or lateral sided plating. Axial loading was applied to samples using a uniaxial testing machine. Results: There was more implant deformation in the lateral sided plating group – a difference with statistical significance. Conclusion: Medial sided plating was found to be as stiff as lateral plating. Medial plating may be a reasonable treatment option that can be used safely in selected cases. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment
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Affiliation(s)
- Firat Al
- Golcuk Necati Celik State Hospital, Kocaeli, Turkey
| | | | | | - Mustafa Ozmen
- Mechanical Engineering, Kocaeli University, Kocaeli, Turkey
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Abstract
Distal femoral varus osteotomy is a well-described treatment option for patients with valgus malalignment associated with a variety of underlying conditions. This procedure may be the definitive treatment option in active patients with isolated lateral compartment osteoarthritis or posttraumatic arthritis. It may be a useful concomitant procedure in young patients with lateral meniscus deficiency, focal chondral defects, chronic medial collateral ligament insufficiency, and/or patellofemoral instability. Distal femoral varus osteotomy can be performed with medial closing wedge or lateral opening wedge techniques. Variable outcomes and complication rates have been reported. A framework for the use of distal femoral varus osteotomy can aid the orthopaedic surgeon in the evaluation and treatment of patients with symptomatic valgus malalignment.
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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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Distal Femoral Valgus and Recurrent Traumatic Patellar Instability: Is an Isolated Varus Producing Distal Femoral Osteotomy a Treatment Option? J Pediatr Orthop 2018; 38:e162-e167. [PMID: 29324527 DOI: 10.1097/bpo.0000000000001128] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Genu valgum, a risk factor for recurrent patellofemoral instability, can be addressed with a varus producing distal femoral osteotomy (DFO). The purpose of this study is to report 3-year clinical and radiographic outcomes on a series of skeletally mature adolescents with traumatic patellofemoral instability and genu valgum who underwent a varus producing DFO. METHODS Consecutive patients (n=11) who underwent an isolated DFO for recurrent traumatic patellar instability over a 4-year study period (2009 to 2012) were reviewed. All patients were below 19 years of age, skeletally mature, had ≥2 patellar dislocations, genu valgum (≥ zone II mechanical axis) and failed nonoperative treatment. Exclusion criteria included less than three-year follow-up, congenital or habitual patellar instability, osteotomy indicated for pathology other than patellar instability, or biplanar osteotomies. Demographic, clinical, and radiographic data were retrospectively analyzed. Recurrence of instability and outcome measures (Kujala and Tegner Activity Scale) were collected at final followed-up prospectively. RESULTS Ten of 11 patients (average age, 16 y; range, 14 to 18 y; 4 male individuals: 7 female individuals) with an average follow-up of 4.25 years (range, 3.2 to 6.0 y) met inclusion criteria. The average body mass index (BMI) of all patients was 31.3 (range, 19.7 to 46.8) with 91% considered overweight (BMI>25) and 55% obese (BMI>30). The average preoperative lateral distal femoral angle was 75.4 degrees with an average correction of 10.4 degrees (range, 7 to 12 degrees) (P<0.001). Mean patellar height ratios were reduced; with Caton-Deschamps Index significantly reduced to 1.08 (range, 0.86 to 1.30) (P<0.005). The average postoperative Kujala score was 83.6 (range, 49 to 99) with 7 subjects (70%) reporting good to excellent function (Kujala > 80) and 8 (80%) having no further episodes of instability. The mean postoperative Tegner activity score was 5.5 (range, 3 to 7). CONCLUSIONS A distal femoral varus producing osteotomy may change radiographic parameters associated with patellar instability and improve clinical outcomes by reducing symptomatic patellofemoral instability in this patient population. LEVEL OF EVIDENCE Level IV.
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Arnal-Burró J, Pérez-Mañanes R, Gallo-Del-Valle E, Igualada-Blazquez C, Cuervas-Mons M, Vaquero-Martín J. Three dimensional-printed patient-specific cutting guides for femoral varization osteotomy: Do it yourself. Knee 2017; 24:1359-1368. [PMID: 28978460 DOI: 10.1016/j.knee.2017.04.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/10/2016] [Accepted: 04/26/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In valgus knees of young patients, opening-wedge distal femoral osteotomy is a valid treatment option for axial corrections. It allows the surgeon to achieve accurate correction, which is directly related to the functional outcome and survivorship of the osteotomy. This study presents a new technique based on three-dimensional (3D)-printed cutting guides for opening-wedge distal femoral osteotomies, in which pre-operative planning and intraoperative executional accuracy play a major role. MATERIAL AND METHODS Pursuing axial correction accuracy, 3D-printed patient-specific positioning guides and wedge spacers were both created and used by the surgeon to implement the femoral osteotomy. The proposed technique was performed in 12 consecutive patients (cases). The results were compared with 20 patients (controls) in which opening-wedge distal femoral osteotomies were performed following the traditional technique. Accuracy of the axial correction, surgical time, fluoroscopic time and costs were measured. RESULTS More accurate axial correction with reduced surgical time (32min less), intraoperative fluoroscopic images (59 images less) and costs (estimated €412 less) were achieved with the use of the customized guides when compared with the traditional technique. DISCUSSION Accurate correction of the axial alignment of the limb is a critical step in survivorship of the osteotomy. Improving the technique to enhance accuracy focused on this issue. CONCLUSIONS The use of patient-customized cutting guides minimised human error; therefore, surgical time was reduced and accurate axial correction was achieved. The surgeon mastered all steps in a do-it-yourself philosophy style.
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Affiliation(s)
- Juan Arnal-Burró
- Department of Orthopaedic and Trauma Surgery, General University Hospital Gregorio Marañón, Madrid, Spain.
| | - Rubén Pérez-Mañanes
- Department of Orthopaedic and Trauma Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Eudaldo Gallo-Del-Valle
- Department of Orthopaedic and Trauma Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Cristina Igualada-Blazquez
- Department of Orthopaedic and Trauma Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Manuel Cuervas-Mons
- Department of Orthopaedic and Trauma Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Vaquero-Martín
- Department of Orthopaedic and Trauma Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
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Sabbag OD, Woodmass JM, Wu IT, Krych AJ, Stuart MJ. Medial Closing-Wedge Distal Femoral Osteotomy with Medial Patellofemoral Ligament Imbrication for Genu Valgum with Lateral Patellar Instability. Arthrosc Tech 2017; 6:e2085-e2091. [PMID: 29349001 PMCID: PMC5766318 DOI: 10.1016/j.eats.2017.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/04/2017] [Indexed: 02/03/2023] Open
Abstract
A varus-producing distal femoral osteotomy (DFO) is an effective technique for the treatment of lateral patellar instability (LPI) in patients with concomitant moderate to severe valgus malalignment. Patellar maltracking and subluxation are corrected via neutralization of some of the laterally directed forces on the patella due to the valgus deformity. This can be accomplished with a distal femoral lateral opening-wedge or medial closing-wedge osteotomy and medial soft tissue stabilization. A medial closing-wedge osteotomy offers the advantages of immediate weight bearing and a single incision in cases requiring patellofemoral soft tissue stabilization. In this article, we describe our preferred operative technique for a medial closing-wedge DFO using a femoral locking plate and medial patellofemoral ligament imbrication for the correction of LPI.
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Affiliation(s)
| | | | | | - Aaron J. Krych
- Address correspondence to Aaron J. Krych, M.D., Mayo Clinic, Orthopedic Surgery, 200 First Street SW, Rochester, MN 55905, U.S.A.Mayo ClinicOrthopedic Surgery200 First Street SWRochesterMN55905U.S.A.
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Hoorntje A, Witjes S, Kuijer PPFM, Koenraadt KLM, van Geenen RCI, Daams JG, Getgood A, Kerkhoffs GMMJ. High Rates of Return to Sports Activities and Work After Osteotomies Around the Knee: A Systematic Review and Meta-Analysis. Sports Med 2017; 47:2219-2244. [PMID: 28401426 PMCID: PMC5633634 DOI: 10.1007/s40279-017-0726-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Knee osteotomies are proven treatment options, especially in younger patients with unicompartmental knee osteoarthritis, for certain cases of chronic knee instability, or as concomitant treatment for meniscal repair or transplantation surgery. Presumably, these patients wish to stay active. Data on whether these patients return to sport (RTS) activities and return to work (RTW) are scarce. OBJECTIVES Our aim was to systematically review (1) the extent to which patients can RTS and RTW after knee osteotomy and (2) the time to RTS and RTW. METHODS We systematically searched the MEDLINE and Embase databases. Two authors screened and extracted data, including patient demographics, surgical technique, pre- and postoperative sports and work activities, and confounding factors. Two authors assessed methodological quality. Data on pre- and postoperative participation in sports and work were pooled. RESULTS We included 26 studies, involving 1321 patients (69% male). Mean age varied between 27 and 62 years, and mean follow-up was 4.8 years. The overall risk of bias was low in seven studies, moderate in ten studies, and high in nine studies. RTS was reported in 18 studies and mean RTS was 85%. Reported RTS in studies with a low risk of bias was 82%. No studies reported time to RTS. RTW was reported in 14 studies; mean RTW was 85%. Reported RTW in studies with a low risk of bias was 80%. Time to RTW varied from 10 to 22 weeks. Lastly, only 15 studies adjusted for confounders. CONCLUSION Eight out of ten patients returned to sport and work after knee osteotomy. No data were available on time to RTS. A trend toward performing lower-impact sports was observed. Time to RTW varied from 10 to 22 weeks, and almost all patients returned to the same or a higher workload.
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Affiliation(s)
- Alexander Hoorntje
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne Witjes
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, Amphia Hospital, Foundation FORCE (Foundation for Orthopedic Research Care and Education), Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Joost G Daams
- Medical Library, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Alan Getgood
- Department of Orthopaedic Surgery, Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, ACES (Academic Centre for Evidence-based Sports medicine), ACHSS (Amsterdam Collaboration for Health and Safety in Sports), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Mirouse G, Dubory A, Roubineau F, Poignard A, Hernigou P, Allain J, Flouzat Lachaniette CH. Failure of high tibial varus osteotomy for lateral tibio-femoral osteoarthritis with<10° of valgus: Outcomes in 19 patients. Orthop Traumatol Surg Res 2017; 103:953-958. [PMID: 28527700 DOI: 10.1016/j.otsr.2017.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/06/2017] [Accepted: 03/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteotomy is a rational approach to slowing knee osteoarthritis progression by modifying loads, thereby avoiding joint replacement in younger individuals. Varus femoral osteotomy is recommended only in patients with more than 10° of valgus. The objective here was to assess outcomes of tibial varus osteotomy in patients with lateral compartment tibio-femoral osteoarthritis and less than 10° of valgus. The hypothesis was that high tibial varus osteotomy produces satisfactory and long-lasting improvements. MATERIAL AND METHODS A single-centre retrospective study was conducted in 19 consecutive patients managed by high tibial varus osteotomy between January 2005 and May 2012. Mean age was 54.5years. The clinical IKS knee and function scores and radiological parameters were determined pre-operatively then after 6 and 12months and at last follow-up. The primary outcome measure was the global IKS score. Failure was defined as a global IKS score <140 or total knee arthroplasty (TKA). Secondary outcome measures were a post-operative hip-knee-ankle (HKA) angle between 180° and 183° and less than 10° of joint line obliquity. The hypothesis was that high tibial varus osteotomy produced satisfactory and long-lasting improvements in lateral compartment tibio-femoral osteoarthritis. RESULTS After the mean follow-up of 4.3years (range, 2-9years), 10/19 patients had a global IKS score <140. Among them, 7 underwent TKA after a mean of 5.0±2.7years. Varus tibial osteotomy was followed by significant improvements in the IKS knee and function scores from baseline to last follow-up (P<0.05). A global IKS<140 predicted TKA. Mean HKA angle values were 186.3±2.9° pre-operatively and 181.3°± 3.9°at last follow-up (P<0.05); the HKA angle was within the 180°-183° range in 8 (42.1%) patients. Mean post-operative joint line obliquity was 7.8±3.0°. An HKA angle outside the 180-183° range and joint line obliquity >10° were associated with poor outcomes. DISCUSSION High tibial varus osteotomy produces unsatisfactory medium-term outcomes, with an overall failure rate of 52%. At present, high tibial varus osteotomy has no role in the management of lateral compartment tibio-femoral osteoarthritis with <10° of valgus. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- G Mirouse
- Département de chirurgie orthopédique et traumatologie, groupe hospitalier Henri-Mondor, AP-HP, université Paris-Est Créteil, 94000 Créteil, France; Service de chirurgie orthopédique et traumatologie du sport, clinique Saint-Privat, 34500 Béziers, France.
| | - A Dubory
- Département de chirurgie orthopédique et traumatologie, groupe hospitalier Henri-Mondor, AP-HP, université Paris-Est Créteil, 94000 Créteil, France
| | - F Roubineau
- Département de chirurgie orthopédique et traumatologie, groupe hospitalier Henri-Mondor, AP-HP, université Paris-Est Créteil, 94000 Créteil, France
| | - A Poignard
- Département de chirurgie orthopédique et traumatologie, groupe hospitalier Henri-Mondor, AP-HP, université Paris-Est Créteil, 94000 Créteil, France
| | - P Hernigou
- Département de chirurgie orthopédique et traumatologie, groupe hospitalier Henri-Mondor, AP-HP, université Paris-Est Créteil, 94000 Créteil, France
| | - J Allain
- Département de chirurgie orthopédique et traumatologie, groupe hospitalier Henri-Mondor, AP-HP, université Paris-Est Créteil, 94000 Créteil, France
| | - C H Flouzat Lachaniette
- Département de chirurgie orthopédique et traumatologie, groupe hospitalier Henri-Mondor, AP-HP, université Paris-Est Créteil, 94000 Créteil, France
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Cheikh AB, Maitigue MB, Masmoudi K, Mouelhi T, Naouar N, Grissa Y, Bouattour K, Osman W, Ben Ayeche ML. [Femoral varising osteotomy by external opening for the treatment of lateral femorotibial gonarthroses associated with idiopathic genu valgum: a retrospective a study of 10 cases]. Pan Afr Med J 2017; 28:22. [PMID: 29138658 PMCID: PMC5681007 DOI: 10.11604/pamj.2017.28.22.12014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022] Open
Abstract
Femoral varus osteotomy is a conservative treatment for external single-compartment gonarthrosis. This surgical procedure is little used and outcomes are little studied.This study aimed to assess the clinical and radiological results of femoral varising osteotomy in subjects with external femorotibial gonarthrosis associated with idiopathic genu valgum whose data were recorded over a period of 21 years (1992- 2013) in the Department of Orthopedics at Sahloul University Hospital, Sousse. The clinical evaluation of patients was performed using the IKS score (International Knee Society). Radiological assessment was based on pre-operative work-up and final follow-up assessment. We here report a case series of 9 patients (and 10 knees) whose average age was 45.2 years, with a sex ratio of 0.5. Mean follow-up was 99-months. Average knee score ranged from 48.4 points preoperatively to 73.5 points at the final follow-up assessment, with a statistically significant improvement (p<10-3). Medium functional score significantly improved, with a preoperative value of 49.5 points and a value of 72 points at the final follow-up assessment. Final correction helped to reduce valgus condition with an average of 3.7° and a preoperative value of 14°. This study, as well as the analysis of literature, indicates that femoral varising osteotomy is the treatment of choice for invalidating genu valgum of femoral origin, without any rheumatoid arthritis, overweight, internal femorotibial nor severe femoropatellar arthritis.
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Affiliation(s)
- Asma Ben Cheikh
- Service d'Hygiène Hospitalière, CHU Farhat Hached de Sousse, Faculté de Médecine de Sousse, CP 4000, Sousse, Tunisie
| | - Mahmoud Ben Maitigue
- Service de Chirurgie Orthopédique et Traumatologique, Faculté de Médecine de Sousse, CHU Sahloul, Hammam Sousse CP 4011, Sousse, Tunisie
| | - Karim Masmoudi
- Faculté de médecine de Sousse, Avenue Mohamed Karoui, CP 4000, Sousse, Tunisie
| | - Thabet Mouelhi
- Service de Chirurgie Orthopédique et Traumatologique, Faculté de Médecine de Sousse, CHU Sahloul, Hammam Sousse CP 4011, Sousse, Tunisie
| | - Nader Naouar
- Service de Chirurgie Orthopédique et Traumatologique, Faculté de Médecine de Sousse, CHU Sahloul, Hammam Sousse CP 4011, Sousse, Tunisie
| | - Yamen Grissa
- Service de Chirurgie Orthopédique et Traumatologique, Faculté de Médecine de Sousse, CHU Sahloul, Hammam Sousse CP 4011, Sousse, Tunisie
| | - Karim Bouattour
- Service de Chirurgie Orthopédique et Traumatologique, Faculté de Médecine de Sousse, CHU Sahloul, Hammam Sousse CP 4011, Sousse, Tunisie
| | - Walid Osman
- Service de Chirurgie Orthopédique et Traumatologique, Faculté de Médecine de Sousse, CHU Sahloul, Hammam Sousse CP 4011, Sousse, Tunisie
| | - Mohamed Laziz Ben Ayeche
- Service de Chirurgie Orthopédique et Traumatologique, Faculté de Médecine de Sousse, CHU Sahloul, Hammam Sousse CP 4011, Sousse, Tunisie
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Park KH, Kim JW, Kim HJ, Kyung HS, Oh JK, Cho TJ, Seo I, Oh CW. Corrective osteotomy of the distal femur with fixator assistance: A novel technique of minimally invasive osteosynthesis. J Orthop Sci 2017; 22:474-480. [PMID: 28129945 DOI: 10.1016/j.jos.2016.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 11/27/2016] [Accepted: 12/20/2016] [Indexed: 02/09/2023]
Abstract
PURPOSE Varus or valgus deformity of the distal femur may progress into knee osteoarthritis. To delay or prevent this, various types of corrective osteotomy techniques have been used to shift the mechanical axis from the diseased compartment to the healthy one. We introduced a new, minimally invasive osteotomy of the distal femur with the assistance of temporary external fixation. METHODS We retrospectively studied 25 legs that underwent open-wedge osteotomy of the distal femur, involving insertion of a Schanz pin at the medial femoral condyle and another pin at the distal diaphysis of the femur. At the meta-diaphyseal junction, osteotomy was performed. After achieving angular correction, two pins were locked for temporary external fixation and a locking plate was fixed at the lateral side of the femur submuscularly. Radiological and functional outcomes were evaluated, including mechanical lateral distal femoral angle (m-LDFA), mechanical axis deviation, tibiofemoral angle, osseous union, and knee joint motion. RESULTS The minimum follow-up was 12 months (mean, 39 months; range, 12-88 months). Bone healing occurred in all legs, with an average of 16.6 weeks. The m-LDFA was corrected from 77.7° (18 valgus) and 104.6° (7 varus) to 88.1° after surgery, with an average correction of 12.9°. At the final follow-up, the mechanical axis deviation averaged 7.6 mm and the tibia-femoral angle averaged 5.6°. Most of legs (88%) achieved acceptable m-LDFA (87° ± 3°). CONCLUSIONS A new, minimally invasive osteotomy of the distal femur offers excellent bone healing with few complications, attributable to preserved blood supply.
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Affiliation(s)
- Kyeong-Hyeon Park
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Joon-Woo Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hee-June Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hee-Soo Kyung
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Tae-Joon Cho
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Il Seo
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chang-Wug Oh
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
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Quirno M, Campbell KA, Singh B, Hasan S, Jazrawi L, Kummer F, Strauss EJ. Distal femoral varus osteotomy for unloading valgus knee malalignment: a biomechanical analysis. Knee Surg Sports Traumatol Arthrosc 2017; 25:863-868. [PMID: 25894751 DOI: 10.1007/s00167-015-3602-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the biomechanical properties of the load shifting following opening-wedge distal femoral varus osteotomies (DFVOs) and determine the osteotomy correction needed to unload the lateral compartment. METHODS Five human cadaveric knees were tested with a load of 500 N of axial compression. Medial and lateral tibiofemoral compartment contact area and pressure were assessed utilizing a modified F-scan pressure-sensitive sensor. The knees were tested in their baseline anatomic alignment, 10° valgus malalignment and following corrective DFVOs of 5°, 10° and 15°. The load shifting effect of the various DFVO correction angles was analysed using a one-way ANOVA to determine the correction angle necessary to unload the lateral compartment. RESULTS Gradually shifting the loading vector medially with increasing DFVO angles resulted in a decrease in the mean contact area and mean contact pressures in the lateral compartment with progressive increases in the medial compartment. The largest reduction in lateral compartment pressure and contact area was seen with the 15° osteotomy with a 25 % decrease in mean contact pressure and 20 % decrease in mean maximum contact pressure and mean contact area when compared to the 10° valgus-malaligned knee. For the 10° valgus knee, a 15° correction resulted in near-normal contact pressures and areas compared with the knee in normal anatomic alignment. CONCLUSION Progressive unloading of the lateral tibiofemoral compartment occurred with increasing DFVO correction angles. Clinically, when performing a DFVO for valgus malalignment, surgeons should consider overcorrecting the osteotomy by 5° to restore near-normal contact pressures and contact areas in the lateral compartment rather than the traditional teaching of correcting to neutral alignment.
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Affiliation(s)
- Martin Quirno
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - Brian Singh
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - Saqib Hasan
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - Laith Jazrawi
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - Fredrick Kummer
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA.
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Wylie JD, Maak TG. Medial Closing-Wedge Distal Femoral Osteotomy for Genu Valgum With Lateral Compartment Disease. Arthrosc Tech 2016; 5:e1357-e1366. [PMID: 28149734 PMCID: PMC5263866 DOI: 10.1016/j.eats.2016.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/09/2016] [Indexed: 02/03/2023] Open
Abstract
Lateral compartment disease combined with valgus alignment can lead to progressive knee joint degeneration. In the symptomatic patient with isolated lateral compartment disease, a varus-producing distal femoral osteotomy can unload the diseased lateral compartment. This osteotomy may be combined with other cartilage or meniscal restorative techniques to optimize knee joint preservation and pain relief. The osteotomy can be performed with a medial closing-wedge or lateral opening-wedge technique. Both techniques have been reported to improve knee-related quality of life in patients with lateral compartment disease. Advantages of the medial closing-wedge technique are direct bone apposition leading to inherent stability of the construct, as well as reliable bony healing, and less hardware irritation. Advantages of the lateral opening-wedge technique are a single bony cut and therefore more of an ability to adjust correction intraoperatively. However, this technique requires bone grafting and has a high rate of hardware irritation or removal. We present a surgical technique for the medial closing-wedge distal femoral osteotomy using an anteromedial-distal femoral locking plate.
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Affiliation(s)
| | - Travis G. Maak
- Address correspondence to Travis G. Maak, M.D., Department of Orthopaedic Surgery, University of Utah Orthopedic Center, 590 Wakara Way, Salt Lake City, UT 84106, U.S.A.Department of Orthopaedic SurgeryUniversity of Utah Orthopedic Center590 Wakara WaySalt Lake CityUT84106U.S.A.
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Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. Arthroscopy 2016; 32:2141-2147. [PMID: 27265250 DOI: 10.1016/j.arthro.2016.04.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/23/2016] [Accepted: 04/05/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To determine the radiographic correction/healing rate, patient-reported outcomes, reoperation rate, and complication rate after distal femoral osteotomy (DFO) for the valgus knee with lateral compartment pathology. (2) To summarize the reported results of medial closing wedge and lateral opening wedge DFO. METHODS We conducted a systematic review of PubMed, MEDLINE, and CINAHL to identify studies reporting outcomes of DFOs for the valgus knee. Keywords included "distal femoral osteotomy," "chondral," "cartilage," "valgus," "joint restoration," "joint preservation," "arthritis," and "gonarthrosis." Two authors first reviewed the articles; our study exclusion criteria were then applied, and the articles were included on the basis relevance defined by the aforementioned criteria. The Methodological Index for Nonrandomized Studies scale judged the quality of the literature. Sixteen studies were relevant to the research questions out of 191 studies identified by the original search. RESULTS Sixteen studies were identified reporting on 372 osteotomies with mean follow-up of 45 to 180 months. All studies reported mean radiographic correction to a near neutral mechanical axis, with 3.2% nonunion and 3.8% delayed union rates. There was a 9% complication rate and a 34% reoperation rate, of which 15% were converted to arthroplasty. There were similar results reported for medial closing wedge and lateral opening wedge techniques, with a higher conversion to arthroplasty in the medial closing wedge that was confounded by longer mean follow-up in this group (mean follow-up 100 v 58 months). CONCLUSIONS DFOs for the valgus knee with lateral compartment disease provide improvements in patient-reported knee health-related quality of life at midterm follow-up but have high rates of reoperation. No evidence exists proving better results of either the lateral opening wedge or medial closing wedge techniques. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- James D Wylie
- Department of Orthopaedic Surgery, University of Utah Salt Lake City, Utah, U.S.A
| | - Daniel L Jones
- Department of Orthopaedic Surgery, University of Utah Salt Lake City, Utah, U.S.A
| | | | - Ashley L Kapron
- Department of Orthopaedic Surgery, University of Utah Salt Lake City, Utah, U.S.A
| | | | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah Salt Lake City, Utah, U.S.A
| | - Travis G Maak
- Department of Orthopaedic Surgery, University of Utah Salt Lake City, Utah, U.S.A..
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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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Distal Femoral Osteotomy: Lateral Opening Wedge Technique. Arthrosc Tech 2016; 5:e725-e730. [PMID: 27709028 PMCID: PMC5039957 DOI: 10.1016/j.eats.2016.02.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/11/2016] [Indexed: 02/03/2023] Open
Abstract
Coronal limb malalignment is a significant contributor to asymmetric joint wear, gait abnormalities, and the development and progression of degenerative joint disease. Osteotomies about the knee were developed to realign the mechanical axis of the limb to unload the affected compartment. Valgus malalignment is less common than varus malalignment, but can contribute to a variety of clinical conditions, including lateral compartment cartilage defects and arthritis, lateral patellofemoral instability, and medial collateral ligament laxity. In this article, we describe our preferred operative technique for a lateral opening wedge varus-producing distal femoral osteotomy to correct mild to moderate valgus malalignment.
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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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Ekeland A, Nerhus TK, Dimmen S, Heir S. Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1702-9. [PMID: 26792566 DOI: 10.1007/s00167-016-3988-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/08/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the time-dependent functional outcome of patients with lateral knee osteoarthritis with increased valgus treated with lateral opening-wedge osteotomy to shift the load from the lateral to the medial compartment of the knee. METHODS Twenty-four consecutive patients with lateral knee osteoarthritis were treated with distal femoral opening-wedge varus osteotomy stabilized with the Puddu plate and bone transplantation. The mean age of the patients was 48 years (CI 40.3-55.7, range 31-62). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at 3 and 6 months, 1, 2, 5 and 10 years post-operatively. The knee osteoarthritis was graded according to the Kellgren-Lawrence radiological scoring system. The mean follow-up time was 7.9 years (CI 6.8-9.0, range 4.0-10.2). RESULTS The mean angular correction measured on pre- and post-operative radiographs was 9.6° (CI 7.7°-11.5°, range 4°-20°). All osteotomies healed. KOOS increased significantly during the first year by 28-122 % beyond the preoperative values for all the five subscores. This improvement remained at 10-year follow-up for those with surviving osteotomy. Six knees were converted to total knee arthroplasty (TKA) mean 6.4 years (CI 3.3-9.6, range 4.0-11.8) post-operatively. The osteotomy survival rate at 5 years was 88 % and at 10 years 74 %. The preoperative osteoarthritic grade did not increase significantly during the follow-up period, but was significantly correlated (r = -0.49), P = 0.019 to the KOOS subscore symptoms at the 2-year follow-up. CONCLUSION Distal femoral opening-wedge osteotomy for lateral knee osteoarthritis resulted in good functional recovery after 1 year and favourable midterm results. It may be a good treatment option for middle-aged patients with valgus knees and lateral osteoarthritis in order to prevent or postpone TKA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Arne Ekeland
- Orthopaedic Department, Martina Hansens Hospital, Box 823, 1306, Sandvika, Norway.
| | - Tor Kjetil Nerhus
- Orthopaedic Department, Martina Hansens Hospital, Box 823, 1306, Sandvika, Norway
| | - Sigbjørn Dimmen
- Orthopaedic Department, Lovisenberg Diaconal Hospital, Lovisenberggata 17, 0456, Oslo, Norway
| | - Stig Heir
- Orthopaedic Department, Martina Hansens Hospital, Box 823, 1306, Sandvika, Norway
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