Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee

Saithna, Adnan; Kundra, Rik; Getgood, Alan; Spalding, Tim

doi:10.1016/j.knee.2013.08.014

Cited by 78 publications

(86 citation statements)

References 21 publications

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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%

“…There are still some open debates in literature about the amount of correction to achieve, the use of bone grafts and post-operative protocol. Some authors consider contraindicated varus overcorrection (14,22) while others authors reported good clinical outcomes overcorrecting the mechanical axis (24).…”

Section: Discussionmentioning

confidence: 99%

“…Some authors considered contraindicated overcorrection in DFO (14,22). Dugdale et al defined that the goal of DFO is mechanical axis at 48-50% of the tibial plateau (21).…”

Section: Preoperative Settingmentioning

confidence: 99%

“…Forkel et al observed that 5% of the patients had revision surgery for delayed union or nonunion of the osteotomy (24). Most of the authors reported higher non-union rate in opening-wedge than in closing wedge DFOs (22,24,30).…”

Section: Complicationsmentioning

confidence: 99%

“…Hardware intolerance in opening-wedge DFO is a frequent complication: Saithna et al reported that 76% of 21 patients underwent further surgery and the most common of which was plate removal (22). Ekeland et al reported that less than half of Puddu Plate in their study had to be removed for tissue irritation (30).…”

Section: Complicationsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

“…Some authors considered contraindicated overcorrection in DFO (14,22). Dugdale et al defined that the goal of DFO is mechanical axis at 48-50% of the tibial plateau (21).…”

Section: Preoperative Settingmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

Femoral osteotomies for the valgus knee

Olivero¹,

Rosso²,

Dettoni³

et al. 2017

Ann. Joint

View full text Add to dashboard Cite

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Deformity in valgus knee malalignment is not only in the femur but also in tibia or both, based on demographic and morphological analysis before and after knee osteotomies

An,

Jacquet,

Loddo

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aims to identify the demographic and morphological features of valgus knee deformity with unilateral osteoarthritic knee in the coronal plane. A secondary aim was to identify the distinct phenotypes of valgus knees in Hirschmann's phenotype and the coronal plane alignment of the knee (CPAK) classifications before and after a knee osteotomy (KO).MethodsA total of 107 patients (57 female and 50 male) with a mean age of 42.4 ± 17.2 years, who underwent varisation osteotomy for symptomatic unilateral knee osteoarthritis (OA) and constitutional valgus deformity, were enrolled in the study, and the mean follow‐up period was 29.1 ± 7.3 months. The included cases comprised 60 cases of distal femoral osteotomy, 10 cases of double‐level osteotomy and 33 cases of high tibial osteotomy. All patients underwent preoperative and postoperative clinical, functional and radiological evaluations, analysed by analysis of variance tests.ResultsAn analysis of the location of the valgus deformities demonstrated that 56 cases (52.3%) were femoral based, 18 cases (16.8%) were both femoral and tibial based and 33 cases (30.9%) were tibial based. Twelve preosteotomy cases (11.2%) and 38 postosteotomy cases (35.5%) matched the most common eight Hirschmann's phenotypes, phenotyping the coronal lower limb alignment based on the native alignment in young patients without OA. Four (3.7%) preosteotomy cases and 89 postosteotomy cases (83.1%) matched the most common three CPAK phenotypes (Ⅰ, Ⅱ, Ⅴ) based on constitutional alignment and joint line obliquity in healthy and osteoarthritic knees.ConclusionIn valgus knee malalignment, the location of the deformity is not only solely femoral‐based but also solely tibial‐based or combined femoral and tibial‐based. An individualised osteotomy approach would be recommended to achieve careful preoperative planning that considers the location of the deformity and the resultant joint line. Hirschmann's and CPAK classification would not be relevant when KO is considered.Level of EvidenceLevel Ⅳ, retrospective case–control study.

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