Medial Closing-Wedge Distal Femoral Varus Osteotomy via Lateral Approach: The Modified Technique for Treating Valgus Osteoarthritic Knee as Case Series

Chaturong  Pornrattanamaneewong; Pakpoom  Ruangsomboon; Rapeepat  Narkbunnam; Keerati  Chareancholvanich

doi:10.33192/Smj.2022.88

Authors

Chaturong Pornrattanamaneewong Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Pakpoom Ruangsomboon Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Rapeepat Narkbunnam Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
Keerati Chareancholvanich Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University

DOI:

https://doi.org/10.33192/Smj.2022.88

Keywords:

Distal femoral varus osteotomy, medial closing wedge, survivorship, osteoarthritis, knee

Abstract

Objective: The medial closing-wedge distal femoral varus osteotomy (MCW-DFVO) was an excellent operation for painful valgus lateral unicompartmental osteoarthritic (OA) knee, especially in the young patient. Originally, it requires a medial approach that has more precarious. On top of that, releasing of the iliotibial band that is the deforming force needs added incision. Therefore, this study aims to describe the modified surgical technique of MCW-DFVO that uses a lateral approach and lateral plating to treat the valgus OA knee. Additionally, we also reveal the outcomes of our technique as the case series.

Materials and Methods: Ten patients (12 knees) who underwent MCW-DFVO via a lateral approach were retrospectively reviewed. The inclusion criteria were age 18-60 years, isolated lateral compartmental OA knee (Kellgren-Lawrence grade 3-4), no significant patellofemoral pain, and range of motion (ROM) > 90 degrees. We excluded the inflammatory joint disease, unstable knee (femorotibial joint subluxation > 1 cm), and prior surgical procedure. Demographic data, pre- and postoperative ROM, radiographic outcomes, complications, and survivorship were recorded.

Results: The mean age, body mass index, and preoperative ROM were 55.3 ± 4.0 years, 25.4 ± 3.7 kg/m2 and 113.3 ± 11.5 degrees, respectively. The preoperative mechanical femorotibial angle was 162.3 ± 4.8 degrees, and the final post-operative alignment was 182.3 ± 2.6 degrees. Overall mean operative time of this technique was 92.5 ± 26.7 minutes. During the mean follow-up period of 8.3 ± 3.1 years, all osteotomy were united and the final postoperative ROM was decreased to 108.8 ± 11.7 degrees. One knee required plate removal due to hardware irritation, and another knee required subsequent total knee arthroplasty at 1 and 8.5 years after MCW-DFVO, respectively. The survivorship of this technique was 91.7% at the mean survival time of 13.8 years (95% confidence interval, 11.9 – 15.7 years).

Conclusion: This study proposed the modified surgical technique of MCW-DFVO via a lateral approach. This technique provided the excellent correction angle, union rate and survivorship.

References

Matsuda S, Miura H, Nagamine R, Mawatari T, Tokunaga M, Nabeyama R, et al. Anatomical analysis of the femoral condyle in normal and osteoarthritic knees. J Orthop Res Off Publ Orthop Res Soc. 2004;22(1):104-9.

Shoji H, Insall J. High tibial osteotomy for osteoarthritis of the knee with valgus deformity. J Bone Joint Surg Am. 1973;55(5):963-73.

Coventry MB. Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee. J Bone Joint Surg Am. 1987;69(1):32-8.

Tírico LEP, Demange MK, Bonadio MB, Helito CP, Gobbi RG, Pécora JR. Medial Closing-Wedge Distal Femoral Osteotomy: Fixation With Proximal Tibial Locking Plate. Arthrosc Tech. 2015;4(6):e687-95.

Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E. Which osteotomy for a valgus knee? Int Orthop. 2010;34(2):239-47.

McDermott AG, Finklestein JA, Farine I, Boynton EL, MacIntosh DL, Gross A. Distal femoral varus osteotomy for valgus deformity of the knee. J Bone Joint Surg Am. 1988;70(1):110-6.

Favorito PJ, Mihalko WM, Krackow KA. Total knee arthroplasty in the valgus knee. J Am Acad Orthop Surg. 2002;10(1):16-24.

Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop. 1992;(274):248-64.

Stähelin T, Hardegger F, Ward JC. Supracondylar osteotomy of the femur with use of compression. Osteosynthesis with a malleable implant. J Bone Joint Surg Am. 2000;82(5):712-22.

Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM. The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am. 1988;70(10):1479-83.

Krettek C, Miclau T, Grün O, Schandelmaier P, Tscherne H. Intraoperative control of axes, rotation and length in femoral and tibial fractures. Technical note. Injury. 1998;29 Suppl 3:C29-39.

Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. A survivorship analysis. J Bone Joint Surg Am. 1996;78(9):1348-52.

Wang J-W, Hsu C-C. Distal femoral varus osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am. 2005;87(1):127-33.

Backstein D, Morag G, Hanna S, Safir O, Gross A. Long-term follow-up of distal femoral varus osteotomy of the knee. J Arthroplasty. 2007;22(4 Suppl 1):2-6.

Omidi-Kashani F, Hasankhani IG, Mazlumi M, Ebrahimzadeh MH. Varus distal femoral osteotomy in young adults with valgus knee. J Orthop Surg. 2009;4:15.

Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Int Orthop. 2010;34(2):249-54.

Das DH, Sijbesma T, Hoekstra H, W. van Leeuwen. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. Open Access Surg. 2008;1:25-9.

Zarrouk A, Bouzidi R, Karray B, Kammoun S, Mourali S, Kooli M. Distal femoral varus osteotomy outcome: Is associated femoropatellar osteoarthritis consequential? Orthop Traumatol Surg Res OTSR. 2010;96(6):632-6.

Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. Arch Orthop Trauma Surg. 2011;131(6):725-8.

Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. J Orthop Sci Off J Jpn Orthop Assoc. 2012;17(6):745-9.

Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2013;21(1):249-54.

Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. The Knee. 2014;21(1):172-5.

Saithna A, Kundra R, Modi CS, Getgood A, Spalding T. Distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. A systematic review of the literature. Open Orthop J. 2012;6:313-9.

Edgerton BC, Mariani EM, Morrey BF. Distal femoral varus osteotomy for painful genu valgum. A five-to-11-year followup study. Clin Orthop. 1993;(288):263-9.