Changes in Distribution of Lower Limb Alignment After Total Hip Arthroplasty for Crowe IV Developmental Dysplasia of the Hip

Sun, Jingyang; Guo, Lingfei; Ni, Ming; Shen, Junmin; Du, Yinqiao; Zhang, Bohan; Zhang, Guoqiang; Zhou, Yonggang

doi:10.2147/tcrm.s302298

Cited by 1 publication

(2 citation statements)

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“…2). 14,15 The aTFA, aLDFA, MPTA, and plate-condyle angles were measured postoperatively and then at 6 months, 1 year, and annually after the DFEO. When a subsequent operation was performed for knee deformities, radiographic data were recorded before the operation.…”

Section: Measurementsmentioning

confidence: 99%

“…Measurements of the skeletal morphology around the knee included the anatomic tibiofemoral angle (aT-FA), anatomic lateral distal femoral angle (aLDFA), medial proximal tibia angle (MPTA), and plate-condyle angle. 14,15 The aTFA was defined by the axes of the femoral and tibia shafts (normal range, 170 to 175 degrees). Genu valgum was defined as an aTFA of <170 degrees, and the genu varum was defined as an aTFA of > 175 degrees.…”

Section: Measurementsmentioning

confidence: 99%

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Genu Valgum After Distal Femur Extension Osteotomy in Children With Cerebral Palsy

Liou

Lee

Kao

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Distal femur extension osteotomy (DFEO) is a common treatment for knee flexion contracture and crouch gait in patients with cerebral palsy (CP), but skeletally immature patients tend to develop genu valgum deformities after DFEO. This study aimed to report the tendency of valgus changes after DFEO and determine the risk factors for subsequent surgery for excessive genu valgum. Methods: This retrospective case-control study included 25 children with CP who underwent DFEO in 44 limbs for knee flexion contractures ≥ 15 degrees at a mean age of 11.0 years. Radiologic measurements included the anatomic lateral distal femoral angle (aLDFA), anatomic tibiofemoral angle (aTFA), medial proximal tibia angle, and plate-condyle angle, postoperatively and at the latest follow-up. Age, sex, preoperative knee flexion contracture angle, Gross Motor Function Classification System level, and radiographic measurements were compared between children with and without subsequent guided growth for genu valgum. Results: A significant valgus change was observed at the distal femur in the first postoperative year (aLDFA from 83.6 to 80.1 degrees, P < 0.001; aTFA from 176.1 to 172.5 degrees, P < 0.01; plate-condylar angle from 5.3 to 9.5 degrees, P < 0.001). Valgus changes occurred in 36 of the 44 limbs (82%) by an average of −4.6 degrees in the aLDFA, and subsequent guided growth was performed in 5 patients (20%). Guided growth for genu valgum was associated with a greater postoperative valgus angle (aLD-FA: 78.0 vs. 84.9 degrees, P < 0.01) but not with age, Gross Motor Function Classification System level, or preoperative flexion contracture. Conclusions: Distal metaphyseal osteotomies and distally placed angled plates near the physis are associated with valgus changes following growth. We recommend making a slight varus alignment during DFEO to compensate for subsequent valgus changes.

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Section: Measurementsmentioning

confidence: 99%

Section: Measurementsmentioning

confidence: 99%