Distal femoral valgus osteotomy: bone healing time in single plane and biplanar technique

Abstract

Varus deformity can be localized in the tibia, in the femur or in both. If varus deformity is localized within the femur, it is mandatory to correct it in the femur. This report presents the technique and results of a consecutive case series of lateral uniplanar and biplanar closed-wedge valgus osteotomy of the distal femur for the treatment of varus deformity of the knee. Retrospectively, fifteen patients (sixteen knees) were identified. Indications for surgery varied from unloading an osteoarthritic medial compartment to reduction to symmetrical varus leg alignment. Pre- and post-operative X-rays, including a full leg radiograph, were assessed as well as bone healing time at follow-up intervals. Clinical outcome was assessed using different questionnaires. There were nine male and six female patients with a median age at surgery of 45 (±14) years. The mLDFA changed from 95.9° (±2.7°) preoperatively to 89.3° (±2.9°) post-operatively. Preoperative planning and the use of angle stable implants resulted in accurate corrections according to preoperative aims in all but one patient. At follow-up (mean, 40 months), the mean VAS score was 2.5 (±2.4) and the WOMAC score averaged 80 (±20). The mean bone healing time of biplanar osteotomies (4 ± 3 months) was shorter than in the uniplanar osteotomies (6 ± 3 months). Distal lateral closed-wedge valgus osteotomy of the femur for the treatment of femoral varus deformities resulted in clinical improvement and accurate corrections in patients with different aims for correction. A biplanar osteotomy technique shortens bone healing time.

Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome

“…Referring to those reports, the clinical results of our oHTO patients are within the upper range. Only the study by van der Woude et al investigated the postoperative clinical outcome after a cDFO so far and reported a Lysholm score of 73 points and a pain level of 3 (VAS) [6]. In comparison, the patients in our cDFO group showed a 17-point higher Lysholm score and a 2-point lower postoperative pain level.…”

“…In our study, 64% (7 of 11) of the patients were within the ±3°limit of deviation with regards to preoperative planning. This is explained by the technically demanding closed wedge osteotomy, since the surgeon must rely on the accuracy of the bone resection, and intraoperative readjustment is only possible to a limited extent [6,12]. Lateral inaccuracy of DFO could be produced by the same reason and due to the tension of the gastrocnemius muscle on the distal femur.…”

“…In varus deformities, osteotomies were usually performed in the tibia, with valgus deformities predominantly treated with femoral procedures. However, it has become common practice to perform a deformity analysis using a long standing radiograph (LSR) to determine the origin of deformity prior to surgery [4,5], since varus deformities can be localized either in the tibia or in the femur [6][7][8].…”

“…At the distal femur, a closed wedge procedure is recommended due to the frequent instability in femoral open wedge osteotomies [12]. There exist only 2 studies reporting on lateral distal closing wedge femoral osteotomies, covering a total of only 19 cases [6,8].…”

Additional distal femoral osteotomy for insufficient correction after high tibial osteotomy

“…According to the preoperative deformity analysis mentioned above, 8° of LCWDFO was performed. The surgical procedure for LCWDFO was based on the report by van der Woude et al 15. After making a 15 cm straight skin incision on the lateral aspect of the thigh, the iliotibial band was split.…”