Distal femoral osteotomy for the valgus knee: indications, complications, clinical and radiological outcome

被引:17
作者
Ismailidis, Petros [1 ,2 ]
Schmid, Corinna [1 ]
Werner, Julika [1 ]
Nuesch, Corina [1 ,2 ,3 ,5 ]
Mundermann, Annegret [1 ,2 ,3 ,5 ]
Pagenstert, Geert [2 ,4 ]
Egloff, Christian [1 ,2 ]
机构
[1] Univ Hosp Basel, Dept Orthopaed & Traumatol, Spitalstr 21, CH-4031 Basel, Switzerland
[2] Univ Basel, Dept Clin Res, Schanzenstr 55, CH-4056 Basel, Switzerland
[3] Univ Hosp Basel, Dept Spine Surg, Spitalstr 21, CH-4031 Basel, Switzerland
[4] Knee Inst Basel, Clarahof Clin Orthopaed Surg, Clarahofweg 19a, CH-4058 Basel, Switzerland
[5] Univ Basel, Dept Biomed Engn, Basel, Switzerland
关键词
Distal femoral osteotomy; DFO; Valgus knee; Knee osteoarthritis; MEDIAL CLOSING-WEDGE; OSTEOARTHRITIS; PROGRESSION; ALIGNMENT; VARUS; RISK; MALALIGNMENT; FRACTURE;
D O I
10.1007/s00402-023-04923-w
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
IntroductionThe aim of this study was to describe the indications and technical aspects of medial closing and lateral opening distal femoral osteotomy (MCDFO and LODFO) for patients with a valgus knee and to report clinical and radiological outcomes and complications.MethodsOver 6 years, 28 DFOs (22 MCDFO, 6 LODFO) were performed in 22 Patients. In this cohort study, we retrospectively analyzed clinical and radiological outcome measures as well as complications.ResultsThe median (range) age was 47 (17-63) years, height 1.68 (1.56-1.98) m, body mass 80 (49-105) kg, and body mass index (BMI) 27.4 (18.6-37.0) kg/m(2). The clinical follow-up was 21 (7-81) months, the need for total or unicompartmental knee arthroplasty (TKA/UKA) and hardware removal was followed up for 59 (7-108) months postoperatively. Preoperatively, hip-knee-ankle angle (HKA, negative values denote varus) was 7.0 (2.0-13.0)degrees, mechanical lateral distal femoral angle (mLDFA) was 83.7 (79.9-88.2)degrees, and mechanical proximal tibial angle (MPTA) was 89.0 (86.6-94.5)degrees. Postoperatively, HKA was -1.3 (-9.0-1.2)degrees and mLDFA was 90.8 (87.3-97.3)degrees. The incidence of minor and major complications was 25% and 14%, the incidence of delayed and nonunion was 18% and 4%, respectively. At the last follow-up, 18% of the patients had pain at rest, 25% during activities of daily living, and 39% during physical activity, and 71% were satisfied with the outcome. 7% of the cases received a TKA/UKA, 71% received a hardware removal.ConclusionDFO is a reasonable treatment for lateral osteoarthritis in younger patients to avoid disease progression and the need for an UKA/TKA. However, there is a long rehabilitation time, a considerable risk for complications, and a high need for hardware removal. While many patients experienced symptoms at the long-term follow-up, most were satisfied with the outcome. Appropriate patient information is essential.
引用
收藏
页码:6147 / 6157
页数:11
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