Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting

Alexander Kolb,Gerhard M. Hobusch,Catharina Chiari,Verena Isak,Reinhard Windhager

doi:10.1007/s00264-018-4216-0

Alexander Kolb, Gerhard M. Hobusch + Show 3 more

Open Access

https://doi.org/10.1007/s00264-018-4216-0

Copy DOI

Journal: International orthopaedics	Publication Date: Nov 13, 2018
Citations: 13	License type: open-access

Affiliation: Medical University of Vienna

Abstract

BackgroundThe lateral opening wedge distal femoral osteotomy (LOWDFO) to reconstruct knee alignment in patients with genu valgum originating in the distal femur has gained importance within the last years.PurposeTo analyze clinical and radiographic outcome of patients treated with LOWDFO with respect to bone healing without grafting and patient age.Material and methodsTwenty-two consecutive patients with genu valgum corrected with 23 LOWDFOs using a Tomofix-locking plate were retrospectively analyzed (mean age 23.7 years). Clinical evaluation was based on pre- and post-operative KOOS scores. A pre- and post-operative radiographic assessment, including MAD, mLDFA, LLD, bone healing, and patella parameters, was performed. Differences between subgroups (age, bone grafting) were analyzed.ResultsThe restoration of MAD and mLDFA resulted in significantly improved post-operative KOOS5 scores in younger and older patients (p = 0.001). Bone healing without bone grafting was reliable in all patients. The leg length was significantly increased post-operatively (p = 0.001). The Blackburne-Peel ratio was significantly reduced to more normal values post-operatively (p < 0.001).ConclusionLOWDFO without bone grafting is a reliable procedure representing a promising treatment option particularly in young patients with genu valgum. Besides correction of the MAD, a significant leg length increase and additional patella stability can be expected.

Highlights

Osteotomies around the knee are an accepted option for the treatment of varus and valgus malalignment of the lower extremity
Reports on specific implants used for the lateral opening wedge distal femoral osteotomy like the Tomofix plate (Synthes GmbH, Oberdorf, Switzerland) are rare, relied on different techniques of bone grafting, and have reported controversial results [4,5,6,7]
This study aimed to (1) analyze the results of the lateral opening wedge distal femoral osteotomy without bone grafting, (2) to assess differences between pre- and postoperative knee function and mechanical alignment including effects on leg length and patellar parameters, (3) to assess the influence of patient age, and (4) to assess complications related to bone healing, local pain, and surgical site infection

Summary

Introduction

Osteotomies around the knee are an accepted option for the treatment of varus and valgus malalignment of the lower extremity. Reports on specific implants used for the lateral opening wedge distal femoral osteotomy like the Tomofix plate (Synthes GmbH, Oberdorf, Switzerland) are rare, relied on different techniques of bone grafting, and have reported controversial results [4,5,6,7]. This study aimed to (1) analyze the results of the lateral opening wedge distal femoral osteotomy without bone grafting, (2) to assess differences between pre- and postoperative knee function and mechanical alignment including effects on leg length and patellar parameters, (3) to assess the influence of patient age, and (4) to assess complications related to bone healing, local pain, and surgical site infection. The lateral opening wedge distal femoral osteotomy (LOWDFO) to reconstruct knee alignment in patients with genu valgum originating in the distal femur has gained importance within the last years.

Objectives

Methods

Results

Conclusion