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. 2019 Oct;43(10):2315-2322.
doi: 10.1007/s00264-018-4216-0. Epub 2018 Nov 13.

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting

Alexander Kolb  1 , Verena Isak  2 , Gerhard M Hobusch  2 , Catharina Chiari  2 , Reinhard Windhager  2
Affiliations

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting

Alexander Kolb et al. Int Orthop. 2019 Oct.

Abstract

Background: The lateral opening wedge distal femoral osteotomy (LOWDFO) to reconstruct knee alignment in patients with genu valgum originating in the distal femur has gained importance within the last years.

Purpose: To analyze clinical and radiographic outcome of patients treated with LOWDFO with respect to bone healing without grafting and patient age.

Material and methods: Twenty-two consecutive patients with genu valgum corrected with 23 LOWDFOs using a Tomofix-locking plate were retrospectively analyzed (mean age 23.7 years). Clinical evaluation was based on pre- and post-operative KOOS scores. A pre- and post-operative radiographic assessment, including MAD, mLDFA, LLD, bone healing, and patella parameters, was performed. Differences between subgroups (age, bone grafting) were analyzed.

Results: The restoration of MAD and mLDFA resulted in significantly improved post-operative KOOS5 scores in younger and older patients (p = 0.001). Bone healing without bone grafting was reliable in all patients. The leg length was significantly increased post-operatively (p = 0.001). The Blackburne-Peel ratio was significantly reduced to more normal values post-operatively (p < 0.001).

Conclusion: LOWDFO without bone grafting is a reliable procedure representing a promising treatment option particularly in young patients with genu valgum. Besides correction of the MAD, a significant leg length increase and additional patella stability can be expected.

Keywords: Femoral osteotomie; Genu valgum; Open wedge.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Comparison of pre- and post-operative long leg standing radiographs: mechanical axis of the leg (green line), tibial plateau width (white line with mark at the midpoint), MAD (blue line), and LLD (red line) radiographs
Fig. 2
Fig. 2
Assessment of bone healing according to Staubli and Schröter [12, 13]. a Direct postoperatively, after 6 weeks (b), 3 month (c), after 6 month (d), and 1 year post-operatively (e). The width of the opened wedge showing bone healing (distance a) and width of the osteotomy from lateral to medial (distance b) were measured. The percentage of the osteotomy gap showing bone healing was calculated (distance a/distance b * 100)
Fig. 3
Fig. 3
Measurement of the patellar height on lateral radiographs pre-operatively (a) and post-operatively (b); measurement of the perpendicular height of the lower end of the articular surface of the patella from the tibial plateau line (a) and length of the articular surface of the patella (b). The Blackburne-Peel ratio is defined as a/b [15]
See this image and copyright information in PMC

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