Functional outcomes and survivorship of distal femoral osteotomy with cartilage restoration of the knee

Abstract

IntroductionFew studies have reported on functional outcome and survivorship of simultaneous distal femoral osteotomy (DFO) and cartilage restoration techniques, including lateral femoral condyle osteochondral allograft transplantation (OCA). ObjectivesThe purpose of this investigation is therefore to evaluate short-term outcomes, mid-term outcomes, and satisfaction in patients receiving OCA and DFO. MethodsA registry of consecutive patients undergoing DFO with concomitant OCA between 2004 and 2017 was retrospectively reviewed. Patient records meeting inclusion criteria were reviewed to collect baseline demographic data; both pre- and postoperative radiographs were reviewed. Patients were contacted to complete postoperative outcome questionnaires. Subsequent surgical history and patient satisfaction were also assessed. The postoperative outcomes obtained were compared to prospectively collected preoperative outcome scores. Outcomes were compared using paired t-testing, with statistical significance defined as P< .05. ResultsA total of 24 patients were identified, of which 17 (70.8%) completed follow-up at a mean of 7.13 years (range, 2-14.2 years) after surgery. At final follow-up, there were significant improvements in IKDC (P < .001), Lysholm (P = .001), and 4 of the KOOS subscales (ADL, P ≤ .001; Pain, P < .001; QOL, P < .001; Sport, P = .001). Two patients (10.5%) were considered treatment failures (one revision OCA and one graft debridement) at an average 1.48 years postoperatively. No patients underwent subsequent knee arthroplasty. All patients reported satisfaction with the surgery at final follow-up. ConclusionIn young, active patients with valgus deformity and lateral chondral defects of the knee, DFO with concomitant OCA can significantly improve functional scores compared to baseline at a minimum of 2 years after surgery.