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International Orthopaedics

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Open Access 01-10-2019 | Original Paper

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting

Authors: Alexander Kolb, Verena Isak, Gerhard M. Hobusch, Catharina Chiari, Reinhard Windhager

Published in: International Orthopaedics | Issue 10/2019

Abstract

Background

The lateral opening wedge distal femoral osteotomy (LOWDFO) to reconstruct knee alignment in patients with genu valgum originating in the distal femur has gained importance within the last years.

Purpose

To analyze clinical and radiographic outcome of patients treated with LOWDFO with respect to bone healing without grafting and patient age.

Material and methods

Twenty-two consecutive patients with genu valgum corrected with 23 LOWDFOs using a Tomofix-locking plate were retrospectively analyzed (mean age 23.7 years). Clinical evaluation was based on pre- and post-operative KOOS scores. A pre- and post-operative radiographic assessment, including MAD, mLDFA, LLD, bone healing, and patella parameters, was performed. Differences between subgroups (age, bone grafting) were analyzed.

Results

The restoration of MAD and mLDFA resulted in significantly improved post-operative KOOS₅ scores in younger and older patients (p = 0.001). Bone healing without bone grafting was reliable in all patients. The leg length was significantly increased post-operatively (p = 0.001). The Blackburne-Peel ratio was significantly reduced to more normal values post-operatively (p < 0.001).

Conclusion

LOWDFO without bone grafting is a reliable procedure representing a promising treatment option particularly in young patients with genu valgum. Besides correction of the MAD, a significant leg length increase and additional patella stability can be expected.

Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia. Clin Orthop Relat Res 65–71

Franco V, Cipolla M, Gerullo G et al (2004) Open wedge osteotomy of the distal femur in the valgus knee. Orthopade 33:185–192. https://doi.org/10.1007/s00132-003-0597-9 CrossRef

W-Dahl A, Lidgren L, Sundberg M, Robertsson O (2015) Introducing prospective national registration of knee osteotomies. A report from the first year in Sweden. Int Orthop 39:1283–1288. https://doi.org/10.1007/s00264-014-2621-6 CrossRefPubMed

Jacobi M, Wahl P, Bouaicha S et al (2011) Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. Arch Orthop Trauma Surg 131:725–728. https://doi.org/10.1007/s00402-010-1193-1 CrossRefPubMed

Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD (2015) Lateral opening-wedge distal femoral osteotomy: pain relief, functional improvement, and survivorship at 5 years. Clin Orthop Relat Res 473:2009–2015. https://doi.org/10.1007/s11999-014-4106-8 CrossRefPubMed

Saithna A, Kundra R, Getgood A, Spalding T (2014) Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. Knee 21:172–175. https://doi.org/10.1016/j.knee.2013.08.014 CrossRefPubMed

Elattar O, Swarup I, Lam A et al (2017) Open wedge distal femoral osteotomy: accuracy of correction and patient outcomes. HSS J 13:128–135. https://doi.org/10.1007/s11420-016-9516-6 CrossRefPubMed

Roos EM, Roos HP, Lohmander LS et al (1998) Knee injury and osteoarthritis outcome score (KOOS)—development of a self-administered outcome measure. J Orthop Sport Phys Ther 28:88–96. https://doi.org/10.2519/jospt.1998.28.2.88 CrossRef

Hare KB, Lohmander LS, Christensen R, Roos EM (2013) Arthroscopic partial meniscectomy in middle-aged patients with mild or no knee osteoarthritis: a protocol for a double-blind, randomized sham-controlled multi-centre trial. BMC Musculoskelet Disord 14:1. https://doi.org/10.1186/1471-2474-14-71 CrossRef

10.

Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP (2011) Validity of four pain intensity rating scales. Pain 152:2399–2404. https://doi.org/10.1016/j.pain.2011.07.005 CrossRefPubMed

11.

Fabricant PD, Camara JM, Rozbruch SR (2013) Femoral deformity planning: intentional placement of the apex of deformity. Orthopedics 36:e533–e537. https://doi.org/10.3928/01477447-20130426-11 CrossRefPubMed

12.

Staubli AE (2008) Radiological examination of bone healing after open-wedge tibial osteotomy. Osteotomies around the knee. Stuttgart: Thieme, AO Foundation Publishing, pp 131–146

13.

Schröter S, Freude T, Kopp MM et al (2015) Smoking and unstable hinge fractures cause delayed gap filling irrespective of early weight bearing after open wedge osteotomy. Arthroscopy 31:254–265. https://doi.org/10.1016/j.arthro.2014.08.028 CrossRefPubMed

14.

Swarup I, Elattar O, Rozbruch SR (2017) Patellar instability treated with distal femoral osteotomy. Knee 24:608–614. https://doi.org/10.1016/j.knee.2017.02.004 CrossRefPubMed

15.

Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59:241–242CrossRef

16.

Dewilde TR, Dauw J, Vandenneucker H, Bellemans J (2013) Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. Knee Surg Sports Traumatol Arthrosc 21:249–254. https://doi.org/10.1007/s00167-012-2156-6 CrossRef

17.

Wylie JD, Jones DL, Hartley MK et al (2016) Distal femoral osteotomy for the valgus knee: medial closing wedge versus lateral opening wedge: a systematic review. Arthroscopy 32:2141–2147. https://doi.org/10.1016/j.arthro.2016.04.010 CrossRef

18.

Kim YC, Yang JH, Kim HJ, Tawonsawatruk T, Chang YS, Lee JS, Bhandare NN, Kim KS, Delgado GDGNK (2018) Distal femoral varus osteotomy for valgus arthritis of the knees: systematic review of open versus closed wedge osteotomy. Knee Surg Relat Res 30:3–16CrossRef

19.

Liska F, Voss A, Imhoff FB et al (2018) Nonunion and delayed union in lateral open wedge distal femoral osteotomies—a legitimate concern? Int Orthop 42:9–15. https://doi.org/10.1007/s00264-017-3504-4 CrossRefPubMed

20.

Özcan Ç, Sökücü S, Beng K et al (2016) Prospective comparative study of two methods for fixation after distal femur corrective osteotomy for valgus deformity; retrograde intramedullary nailing versus less invasive stabilization system plating. Int Orthop 40:2121–2126. https://doi.org/10.1007/s00264-016-3190-7 CrossRefPubMed

21.

McWalter EJ, Cibere J, MacIntyre NJ et al (2007) Relationship between varus-valgus alignment and patellar kinematics in individuals with knee osteoarthritis. J Bone Joint Surg Am 89(A):2723–2731. https://doi.org/10.2106/JBJS.F.01016 CrossRefPubMed

22.

Ward SR, Terk MR, Powers CM (2007) Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am 89:1749–1755. https://doi.org/10.2106/JBJS.F.00508 CrossRefPubMed

23.

Ferlic PW, Runer A, Seeber C et al (2018) Segmental torsion assessment is a reliable method for in-depth analysis of femoral alignment in computer tomography. Int Orthop 42:1227–1231. https://doi.org/10.1007/s00264-017-3598-8 CrossRefPubMed

24.

Madelaine A, Lording T, Villa V et al (2016) The effect of lateral opening wedge distal femoral osteotomy on leg length. Knee Surg Sports Traumatol Arthrosc 24:847–854. https://doi.org/10.1007/s00167-014-3387-5 CrossRefPubMed

25.

Song SY, Pang C-HH, Kim CH et al (2015) Length change behavior of virtual medial Patellofemoral ligament fibers during in vivo knee flexion. Am J Sports Med 43:1165–1171. https://doi.org/10.1177/0363546514567061 CrossRefPubMed

26.

Lee OS, Ahn S, Lee YS (2018) Comparison of the leg-length change between opening- and closing-wedge high Tibial osteotomy: a systematic review and meta-analysis. J Knee Surg. https://doi.org/10.1055/s-0038-1641176 PubMed

Title: Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting
Authors: Alexander Kolb
Verena Isak
Gerhard M. Hobusch
Catharina Chiari
Reinhard Windhager
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 10/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4216-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting

Abstract

Background

Purpose

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Purpose

Material and methods

Results

Conclusion

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