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Supracondylar femur osteotomies around the knee

Patient selection, planning, operative techniques, stability of fixation, and bone healing

Suprakondyläre Femurosteotomien in Kniegelenknähe

Patientenauswahl, Planung, Operationstechniken, Fixationsstabilität und Knochenheilung

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Abstract

Background

Similar to the re-appreciation of high tibial osteotomy (HTO), supracondylar distal femur varus osteotomy (SCO) for lateral compartment osteoarthritis (OA) of the knee has gained renewed interest as new knowledge has become available on the influence of malalignment on the development, progression and symptoms of OA. Furthermore, the less than optimal results of knee replacements (TKR) in younger patients have also led to renewed interest in joint-preserving treatment options.

Purpose

Varus SCO has not had the same success or widespread use as valgus HTO. The goal in SCO is similar to HTO, to shift the load from the diseased to the healthy compartment, in order to reduce pain, improve function and delay placement of a TKR. Valgus OA however occurs much less frequently than varus OA and varus SCO is considered a technically more demanding procedure. In the past the surgical techniques for SCO were mainly dependent on difficult-to-use implants making the procedure more complex. Complication rates related to the failure of fixation up to 16 % have been reported.

Disussion

The new biplane osteotomy technique fixated with a locking compression plate is very stable; bone healing potential is optimal using this technique and takes 6–8 weeks. Full weight bearing before full bone healing is possible without loss of correction.

Conclusion

In this article, patient selection, planning, surgical techniques, stability of fixation, and bone healing are discussed. Varus supracondylar osteotomy is a viable treatment option for a well-defined patient group suffering from valgus malalignment and lateral compartment osteoarthritis, and in addition may be considered in ligamentous imbalance and lateral patellofemoral maltracking.

Zusammenfassung

Hintergrund

In gleichem Maße wie der Stellenwert der hohen tibialen Osteotomie (HTO) gestiegen ist, hat die suprakondyläre varisierende distale Femurosteotomie (DFO) bei der Behandlung der lateralen Osteoarthrose (OA) des Kniegelenks an Bedeutung gewonnen. Zum einen zeigen neuere Studien den klaren Zusammenhang zwischen einer Fehlstellung und der Arthroseentwicklung. Zum anderen führen die nicht zufrieden stellenden Ergebnisse nach der Implantation von Kniegelenkprothesen bei jüngeren Patienten zu einem verstärkten Interesse an gelenkerhaltenden Therapieverfahren.

Zielstellung

Die Zielstellung bei der DFO ist vergleichbar mit der HTO und besteht in der Verlagerung der Belastung vom erkranktem zum gesunden Kompartiment, um eine Schmerzlinderung und Funktionsverbesserung zu bewirken. Ein weiteres Ziel ist die zeitliche Verzögerung des Einsatzes einer Kniegelenk-Endoprothese.

Diskussion

Die varisierende DFO hat nicht denselben Stellenwert und Verbreitungsgrad wie die valgisierende HTO, da die Valgusgonarthrose seltener als eine Varusgonarthrose auftritt. Die varisierende DFO gilt im Vergleich zur HTO als technisch anspruchsvolleres Verfahren.

Schlussfolgerung

In diesem Artikel werden Patientenselektionierung, Planung, Operationstechniken, Fixationsstabilität und Knochenheilung bei suprakondylären Femurosteotomien diskutiert. Bei den bisherigen DFO-Techniken wurden mehrheitlich schwierig und kompliziert einzubringende Implantate verwendet, was das Verfahren aufwändiger gestaltete. Häufiges Implantatversagen älterer Osteotomieplatten führte zu Komplikationsraten von bis zu 16% berichtet.

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Compliance with ethical guidelines

Acknowledgements

J.-M. Brinkman would like to thank the Marti-Koening Eckhardt foundation for their support of his scientific work.

Conflict of interest

J.-M. Brinkman, D. Freiling, P.l. Lobenhoffer, A.E. Staubli and R.J. van Heerwaarden state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Orthopaedics, Limb Deformity Reconstruction Unit, Sint Maartenskliniek Woerden, Polanerbaan 2, 3447GN, Woerden, The Netherlands

    J.-M Brinkman & R.J. van Heerwaarden

  2. Sportsclinic Germany, Uhlemeyerstraße 16, 30175, Hannover, Germany

    D. Freiling & P. Lobenhoffer

  3. Department of Orthopaedic Surgery, Privatklinik Sonnmatt, Hemschlenstrasse, 6000, Lucerne, Switzerland

    A.E. Staubli

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  1. J.-M Brinkman
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  2. D. Freiling
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  3. P. Lobenhoffer
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  4. A.E. Staubli
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  5. R.J. van Heerwaarden
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Corresponding author

Correspondence to R.J. van Heerwaarden.

Additional information

The German version of this article can be found at doi: 10.1007/s00132-014-3036-1

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Brinkman, JM., Freiling, D., Lobenhoffer, P. et al. Supracondylar femur osteotomies around the knee. Orthopäde 43 (Suppl 1), 1–10 (2014). https://doi.org/10.1007/s00132-014-3007-6

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