Distal femoral varus osteotomy outcome: Is associated femoropatellar osteoarthritis consequential?

Zarrouk, Abdelaziz; Bouzidi, Ramzi; Karray, B.; Kammoun, S.; Mourali, Slim; Kooli, Mondher

doi:10.1016/j.otsr.2010.04.009

Cited by 61 publications

(62 citation statements)

References 17 publications

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“…The Kellgren-Lawrence (K-L) classification was utilized to stratify patients in 2 studies (mean, 1.76 5 and 2.3 22 . ), and the Ahlbäck classification was used in 1 study (mean, 2.75 25 ) ( Table 2 ). The opening-wedge group was more heterogeneous regarding rehabilitation protocol.…”

Section: Resultsmentioning

confidence: 99%

Opening- and Closing-Wedge Distal Femoral Osteotomy

Chahla

Mitchell

Liechti

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Lateral compartment osteoarthritis of the knee can be a challenging pathology in the younger, active population due to limited treatment options and high patient expectations. Distal femoral osteotomy (DFO) has been reported to be a potential treatment option.Purpose:To perform a systematic review on the survival, outcomes, and complications of DFO for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Registry of Controlled Trials, PubMed, and MEDLINE from 1980 to present. Inclusion criteria were as follows: outcomes of opening- and closing-wedge DFOs performed for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee, English language, minimum 2-year follow-up, and human studies. Data abstracted from the selected studies included type of osteotomy (opening vs closing), survival rate, patient-reported and radiographic outcomes, and complications.Results:Fourteen studies met the inclusion criteria and were considered for the review. A total of 9 closing-wedge and 5 opening-wedge DFO studies were included. All were retrospective studies and reported good to excellent patient-reported outcomes after DFO. Survival decreased with increasing time from surgery, with 1 study reporting a 100% survival rate at 6.5 years, compared with 21.5% at 20 years in another study. A low rate of complications was reported throughout the review.Conclusion:Highly heterogeneous literature exists for both opening- and closing-wedge DFOs for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment. A mean survival rate of 80% at 10-year follow-up was reported, supporting that this procedure can be a viable treatment option to delay or reduce the need for joint arthroplasty. A low complication rate was observed, with symptomatic hardware being the most prevalent postoperative complication.

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Section: Resultsmentioning

confidence: 99%

Opening- and Closing-Wedge Distal Femoral Osteotomy

Chahla

Mitchell

Liechti

et al. 2016

Orthopaedic Journal of Sports Medicine

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“…However, its indication remains controversial when associated patellofemoral osteoarthrosis is present. Zarrouk et al [153] conducted a retrospective study of 22 knees and concluded that the association of patellofemoral osteoarthritis does not affect the functional results. No studies exist examining the effect of varus and femoral derotation osteotomies on realignment and patellofemoral osteoarthrosis.…”

Section: Other Bony Proceduresmentioning

confidence: 99%

The Operative Management of Patella Malalignment

Iliadis¹,

Jaiswal²,

Khan³

et al. 2012

TOORTHJ

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Management of patellofemoral joint pathology is challenging as a result of the unique and complex organization of static forces and dynamic factors contributing to its functional capacity. Anterior knee pain is a common musculoskeletal complaint seen daily in the practices of primary care physicians, rheumatologists, and orthopedic surgeons. The key to successful treatment lies not only in the correct diagnosis of a chondral defect, but more importantly, in the accurate identification of associated pathomechanical factors. Appreciating the pathoanatomic basis of the disease and addressing imbalances and anatomical abnormalities should guide treatment.Despite the complexity of the interplay of various components it is essential to attempt to describe patellar malalignement as a clinical entity in order to proceed with appropriate surgical management and successful outcomes. The goals of patellofemoral re- alignment surgery should be to create both a stable environment for optimal extensor mechanism performance and an appropriate load transmission for optimal cartilage wear and joint loading. In the context of this article we will review the operative management of patellofemoral malalignment; the indications for surgery, the different techniques available and the evidence regarding their effectiveness.A large number of procedures have been employed and they have all undergone various modifications over the course of the years. The majority of publications are retrospective series in poorly defined population groups. There are significant methodological inconsistencies and as a result there is lack of strong evidence base for the majority of these procedures.

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“…Good survival rate at 5-year follow-up are reported in literature also for opening-wedge DFO, ranging from 74% to 100% (11,15,22,34,44,45 All the osteotomies in the first group healed within nine months while there were four cases of non-union in the second group. They concluded that this difference was not statistically significant but seems that it could be significant if more patients were enrolled in the study (47 In patients with failed DFOs, performing a total knee arthroplasty (TKA) is an highly demanding procedure with an increased risk of poor results (7).…”

Section: Resultsmentioning

confidence: 81%

“…A varus opening wedge DFO may reduce the Q angle unloading the patellofemoral lateral compartment (3). Zarrouk et al, in their analysis of 26 DFOs, demonstrated that patients with patellofemoral osteoarthritis had comparable results to the others patients at the final follow-up (15). Although some authors consider symptomatic patellofemoral arthritis an absolute (13) or relative contraindication to DFO (12,16), considering the theoretical mechanical advantages and Zarrouk's results, moderate patellofemoral arthritis may not be considered an absolute contraindication to DFO (15,17).…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Femoral osteotomies for the valgus knee

Olivero¹,

Rosso²,

Dettoni³

et al. 2017

Ann. Joint

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Coronal limb malalignment is an important contributing factor to articular cartilage damage and to the development of knee osteoarthritis. Osteotomies around the knee are effective and well-recognized treatments for unloading the affected compartment. Valgus malalignment is less common than varus malalignment. Consequently, distal Femoral Osteotomies to correct the valgus knee are less commonly performed compared to high tibial osteotomy (HTO) for the varus knee. There are few papers describing the outcomes of distal femoral osteotomy (DFO) to treat valgus knee alignment and knee arthritis. In literature, there is still an open debate about the correct indication and contraindication, the best surgical technique (opening versus closing wedge), the amount of correction to achieve and the use of bone grafts to enhance osteotomies healing. However, with the correct indications, Distal Femoral Osteotomies showed good outcomes in the treatment of valgus knee. The aim of this manuscript is to review the literature about DFO in the valgus knee, summarizing the indications and contraindications, the available surgical techniques, outcomes, complications and failure rates.

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Distal femoral varus osteotomy outcome: Is associated femoropatellar osteoarthritis consequential?

Abstract: Level IV. Retrospective study.

Cited by 61 publications

References 17 publications

Opening- and Closing-Wedge Distal Femoral Osteotomy

Opening- and Closing-Wedge Distal Femoral Osteotomy

The Operative Management of Patella Malalignment

Femoral osteotomies for the valgus knee

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