We introduce a torsional index for validation and quantification of torsional deformities, and can clearly show that torsional osteotomy is the treatment of choice for a torsional deformity.

Various pathologies of the hip or knee, such as patellofemoral malalignment or femoroacetabular impingement may be caused by a femoral torsional deformity. When diagnosed and analyzed, it is treated by femoral torsional osteotomy. Thirty femoral torsional osteotomies in 25 patients were included, the principal symptoms were patellar dislocation in 15 patients, anterior knee pain in 17, and femoroacetabular impingement in two. A computed‐tomography‐based measurement of the torsional angle was performed in all patients. Japanese Knee Society score, Tegner activity score, Lysholm score, and visual analog scale score were determined before surgery and at follow‐up after 41 (6–113) months. Femoral internal torsion was on average 40.9° (29° − 66°; normal 24°). Surgical treatment consisted of a femoral external torsional osteotomy of on average 13.8° (5° − 26°). Tegner activity score increased non‐significantly (p‐value 0.326) from 3.57 to 3.71. Japanese Knee Society score improved significantly from 72 to 87 (p‐value 0.004) while Lysholm score rose significantly from 66 to 84 points (p‐value 0.004). Pain relief was demonstrated by a significant decrease in the VAS score from 5.6 to 2.4 (p‐value 0.007). No further patellar dislocation was reported. Torsional deformities of the femur frequently cause symptoms in the knee or hip joint. After thorough assessment and diagnostic investigation, a femoral external torsional osteotomy provides significant pain relief as well as patellofemoral stability. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:???–???, 2015.

IV, case series.

The results of this study show that in cases of tibial maltorsion, a torsional osteotomy can lead to patellofemoral stability and pain relief, and should be considered as a treatment option. The improved clinical scores in the present investigation show the value of the procedure. Level of evidence Level IV.

Diagnostic study, Level III.

This review article provides an overview of lower limb deformity analysis. A brief history and radiographic standards are presented. Deformity analysis is considered in the frontal, sagittal, and axial planes, from simple to more complex cases. The authors recommended analysis methods based on their own experience of deformity correction, while acknowledging that there may be different ways to treat individual cases. Subsequently, methods for osteotomy planning to address the identified deformities are discussed.

This article provides an overview of symptomatic torsional deformities of the lower extremity, and operative treatment techniques are described in detail. A definition of torsion versus rotation as well as information to physical examination and the relevance of radiological evaluation is given. Based on current literature and the own personal experience of the authors in osteotomies, surgical techniques at the proximal and at the distal femur, as well as at the tibia are presented.

Purpose This study was conducted to investigate patients’ expectations on high tibial osteotomies, distal femur osteotomies, and double‐level osteotomies in different health‐related domains. It was hypothesized that expectations are high in terms of capacity to work, pain relief, and restoring knee function. Methods A total of 264 patients (age 47 years ± 11 years) were enrolled in this study from March 2015 until May 2016 in seven specialized orthopaedic surgery departments. Data were collected via the Knee injury and Osteoarthritis Outcome Score, the Hospital for Special Surgery‐Knee Surgery Expectations Survey, and a ten‐item (non‐validated) questionnaire to specifically ask about expectations of osteotomies around the knee 24–48 h prior to surgery. In addition, self‐efficacy was assessed. Parametric tests were used to test the hypothesis. Results Knee injury and Osteoarthritis Outcome Score test results showed that all patients suffered because of their knee impairments prior to surgery. All participants had high expectations in all aspects regarding the surgical outcome: on a four‐point Likert scale ranging from 1 (very important) to 4 (not important), all mean values were between 1.2 and 1.7. For patients who had a demanding physical work, the ability to keep a stressful working posture was more important than for other patients (i.e. to kneel, to squat). Furthermore, preoperative lower quality of life was associated with higher expectations concerning improving the ability to walk, to achieve improvements in activities of daily living and social well‐being. Conclusions Patients’ expectations of osteotomies around the knee are high in terms of capacity to work, pain relief, and restoring functions. The natural course of osteoarthritis and the potential need for conversion to TKA were underestimated by a substantial proportion of the study population. However, the expectation regarding survival rate is in line with the reported literature. The results of this study should assist surgeons in discussing realistic expectations when considering and counselling patients regarding osteotomies around the knee. This may help to clarify realistic expectations preoperatively and ultimately improve patients’ satisfaction. Level of evidence Therapeutic study, Level II.