Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 11 , ISSUE 3 ( November, 2016 ) > List of Articles

Original Article

Distal femoral valgus osteotomy: bone healing time in single plane and biplanar technique

J. A. D. van der Woude, S. Spruijt, B. T. J. van Ginneken, R. J. van Heerwaarden

Keywords : Distal femoral osteotomy, Valgus producing, Closed-wedge, Limb alignment, Biplanar, Uniplanar

Citation Information : van der Woude JA, Spruijt S, van Ginneken BT, van Heerwaarden RJ. Distal femoral valgus osteotomy: bone healing time in single plane and biplanar technique. 2016; 11 (3):177-186.

DOI: 10.1007/s11751-016-0266-2

License: CC BY-NC-SA 4.0

Published Online: 30-11-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Varus deformity can be localized in the tibia, in the femur or in both. If varus deformity is localized within the femur, it is mandatory to correct it in the femur. This report presents the technique and results of a consecutive case series of lateral uniplanar and biplanar closed-wedge valgus osteotomy of the distal femur for the treatment of varus deformity of the knee. Retrospectively, fifteen patients (sixteen knees) were identified. Indications for surgery varied from unloading an osteoarthritic medial compartment to reduction to symmetrical varus leg alignment. Pre- and post-operative X-rays, including a full leg radiograph, were assessed as well as bone healing time at follow-up intervals. Clinical outcome was assessed using different questionnaires. There were nine male and six female patients with a median age at surgery of 45 (±14) years. The mLDFA changed from 95.9° (±2.7°) preoperatively to 89.3° (±2.9°) post-operatively. Preoperative planning and the use of angle stable implants resulted in accurate corrections according to preoperative aims in all but one patient. At follow-up (mean, 40 months), the mean VAS score was 2.5 (±2.4) and the WOMAC score averaged 80 (±20). The mean bone healing time of biplanar osteotomies (4 ± 3 months) was shorter than in the uniplanar osteotomies (6 ± 3 months). Distal lateral closed-wedge valgus osteotomy of the femur for the treatment of femoral varus deformities resulted in clinical improvement and accurate corrections in patients with different aims for correction. A biplanar osteotomy technique shortens bone healing time.


PDF Share
  1. Brouwer GM, van Tol AW, Bergink AP et al (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56(4):1204-1211
  2. Agneskirchner JD, Hurschler C, Wrann CD et al (2007) The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. Arthroscopy 23(8):852-861
  3. Hofmann S, Lobenhoffer P, Staubli A, Van Heerwaarden R (2009) Osteotomies of the knee joint in patients with monocompartmental arthritis. Orthopade 38(8):755-769
  4. Paley D (2003) Normal lower limb alignment and joint orientation. In: Paley D, Herzenberg JE (eds) Principles of deformity correction, 2nd edn. Springer, New York, pp 1-18
  5. Babis GC, An K, Chao EYS et al (2002) Double level osteotomy of the knee: a method to retain joint line obliquity. J Bone Joint Surg Am 84:1380-1388
  6. Brinkman JM, Freiling D, Lobenhoffer P, Staubli AE, van Heerwaarden RJ (2014) Supracondylar femur osteotomies around the knee. Patient selection, planning, operative techniques, stability of fixation and bone healing. Orthopade 43(11):988-999
  7. Van Heerwaarden R, Wymenga A, Freiling D, Lobenhoffer P (2007) Distal medial closed wedge varus femur osteotomy stabilized with TomoFix plate fixator. Oper Tech Orthop 17(1):12-21
  8. Van Heerwaarden RJ, Wymenga AB, Freiling D, Staubli AE (2008) Supracondylar varization osteotomy of the femur with plate fixation. In: Lobenhoffer P, van Heerwaarden RJ, Staubli AE, Jakob RP (eds) Osteotomies around the knee. Georg Thieme Verlag, Stuttgart, pp 147-166
  9. Freiling D, van Heerwaarden R, Staubli A et al (2010) Medial closed-wedge osteotomy of the distal femur for the treatment of unicompartmental lateral osteoarthritis of the knee. Oper Orthop Traumatol 22:317-334
  10. Paley D (2003) Radiographic assessment of lower limb deformities. In: Paley D, Herzenberg JE (eds) Principles of deformity correction, 2nd edn. Springer, New York, pp 31-60
  11. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthritis. Ann Rheum Dis 16:494-502
  12. De Groot IB, Favejee MM, Reijman M et al (2008) The Dutch version of the knee injury and osteoarthritis outcome score: a validation study. Health Qual Life Outcomes 16(6):1-11
  13. Bellamy N (1995) Outcome measurement in osteoarthritis clinical trials. J Rhematol Suppl 43:49-51
  14. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150-154
  15. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43-49
  16. Van Heerwaarden R, Spruijt S (2014) Die suprakondyläre varisierende und valgisierende Femurosteotomie mit Plattenfixateur. In: Lobenhoffer P, van Heerwaarden R, Agneskirchner JD (eds) Kniegelenknahe Osteotomien. Indikation—Planung—Operationstechniken mit Plattenfixateuren. Georg Thieme Verlag Stuttgart, New York, pp 180-198
  17. Müller ME (1977) Suprakondyläre Osteotomien. In: Müller ME, Allgöwer M, Schneider R, Willenegger H (eds) Manual der osteosynthese, 2nd edn. Springer, Berlin, pp 376-377
  18. Schatzker J (2005) Postoperative care—supracondylar fractures of the femur. In: Schatzker J, Tile M (eds) The rationale of operative fracture care, 3rd edn. Springer, Berlin, p 437
  19. Van Hemert WLW, Willems K, Anderson PG, van Heerwarden RJ, Wymenga AB (2004) Tricalcium phosphate granules or rigid wedge preforms in open wedge high tibial osteotomy: a radiologic study with a new evaluation system. Knee 11(6):451-456
  20. Paley D, Herzenberg JE, Tetsworth K et al (1994) A deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25(3):425-465
  21. Saragaglia D, Mercier N, Colle PE (2010) Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop 34(2):185-190
  22. Terauchi M, Shirakura K, Katayama M et al (2002) Varus inclination of the distal femur and high tibial osteotomy. J Bone Joint Surg Br 84(2):223-226
  23. Van Raaij TM, Takacs I, Reijman M, Verhaar JA (2009) Varus inclination of the proximal tibia or the distal femur does not influence high tibial osteotomy outcome. Knee Surg Sports Traumatol Arthrosc 17(4):390-395
  24. Saithna A, Kundra R, Modi CS et al (2012) Distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. A systematic review of the literature. Open Orthop J 6:313-319
  25. Virolainen P, Aro HT (2004) High tibial osteotomy for the treatment of osteoarthritis of the knee: a review of the literature and a meta-analysis of follow-up studies. Arch Orthop Trauma Surg 124(4):258-261
  26. Vena G, D'amio S, Amendola A (2013) Complications of osteotomies about the knee. Sports Med Arthrosc 21(2):113-120
  27. Efe T, Ahmed G, Heyse TJ et al (2011) Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord 12:46
  28. Jacobi M, Wahl P, Bouaicha S et al (2011) Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. Arch Orthop Trauma Surg 131(6):725-728
  29. Van Heerwaarden R, Najfeld M, Brinkman M et al (2013) Wedge volume and osteotomy surface depend on surgical technique for distal femoral osteotomy. Knee Surg Sports Tramatol Arthrosc 21(1):206-212
  30. Bagherifard A, Jabalameli M, Ali Hadi H et al (2015) The results of biplanar distal femoral osteotomy; a case series study. Arch Bone Jt Surg 3(1):35-38
  31. Vasconcellos DA, Giffin JR, Amendola A (2009) Avoiding and managing complications in osteotomies of the knee. In: Meislin RJ, Halbrecht J (eds) Complications in knee and shoulder surgery: management and treatment options for the sports medicine orthopedist. Springer, London, pp 115-132
  32. Van Raaij TM, Brouwer RW, de Vlieger R et al (2008) Opposite cortical fracture in high tibial osteotomy: lateral closing compared to the medial opening-wedge technique. Acta Orthop 79(4):508-514
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.