Abstract
PurposeThe aim of this work was to retrospectively analyze the clinical, subjective, and radiological results of medial closing-wedge distal femur osteotomy (MCW-DFO) for the treatment of osteoarthritis (OA) in valgus knee at medium- to long-term follow-up.Materials and methodsA total of 57 patients (62 knees) treated with MCW-DFO between 1984 and 2018 were included in the study. Patient age at the time of the surgery ranged between 28 and 61 years (average: 48 years). All patients with a minimum follow-up of 4 years were contacted to request for them to undergo clinical, subjective, and radiological evaluation. Preoperative hip–knee–ankle (HKA) angle (i.e., preoperative valgus malalignment) was 8.6° ± 2°. Patients were evaluated using the following scales: the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Knee Society Score (KSS), the International Knee Documentation Committee (IKDC), the Visual Analog Scale (VAS), and the Numeric Rating Scale 11 (NRS-11).ResultsMean follow-up was 11.6 ± 4.9 years, and a total of 17 patients (20 knees) were available for the last examination. At maximum follow-up, 4 patients underwent conversion to a total knee replacement (20%); their survival rate was 100% at 10 years and 66.7% at 15 years, as estimated using the Kaplan–Meier curve. The subjective Knee Society Score improved on average from 37.7 ± 10 to 63.9 ± 15.4. The objective Knee Society Score improved on average from 42.2 ± 11.7 to 75 ± 22.5. The pain detected through the VAS and NRS-11 scales improved from 56.7 ± 12.9 to 42 ± 17.1 and from 5.8 ± 1.1 to 4.4 ± 1.7, respectively. Thirteen patients (70%) required hardware removal at an average time of 19 ± 4 months due to a local nuisance.ConclusionsMCW-DFO can improve symptoms in patients with osteoarthritis in a valgus knee at medium- to long-term follow-up, reducing the progression of osteoarthritis in properly selected patients.
Highlights
Osteoarthritis of the knee is a frequent condition [1], with a higher occurrence in subjects affected by axis deviation of the lower limbs
medial closing-wedge distal femur osteotomy (MCW-distal femoral osteotomy (DFO)) has some advantages: (i) a single osteotomy cut is required; (ii) it ensures a more precise measurement of the wedge thickness, especially for wedges with considerable dimensions [8, 9]; (iii) this technique might be more familiar to the surgeon, who may use the surgical access to carry out associated procedures as well
The MCW-DFO technique was chosen by the surgeon for the cohort of patients considered in the present work, as it was considered more appropriate to correct the actual site of deformity in these patients, meaning that an etiological treatment was needed instead of just a compensatory treatment
Summary
Osteoarthritis of the knee is a frequent condition [1], with a higher occurrence in subjects affected by axis deviation of the lower limbs. In patients affected by Uboldi et al J Orthop Traumatol (2021) 22:35 femoral rather than tibial osteotomy to correct valgus knee. The X-ray-monitored angular correction and functional results are equivalent for the two techniques in the medium to long term [11], as is the conversion rate to knee prosthesis [12]. For these reasons, neither technique can be considered better than the other, but a thorough assessment of patient characteristics needs to be done. The aim of the present study was to retrospectively evaluate subjective radiological and clinical outcomes of medial closure supracondylar femoral osteotomies for arthritic valgus knee treatment at longterm follow-up
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