Dual Femoral and Tibial Osteotomies for Large Varus and Valgus Deformities

Abstract

Aim and background: The aim of this study is to evaluate the outcomes of acute correction of large varus and valgus deformities with simultaneous distal femoral and tibial osteotomies. Acute correction of large coronal plane deformities is complex and if done incorrectly, can lead to problems like non-union, soft tissue problems, and joint line obliquity.

Materials and methods: Radiographic, clinical, and patient-reported outcomes are analysed through a retrospective series of 21 extremities in 18 consecutive patients with coexisting femoral and tibial deformities who underwent concurrent distal femoral and proximal tibial osteotomies with acute coronal plane correction and internal fixation.

Results: The mean mechanical axis deviation (MAD) correction was 56 mm for varus deformities (n = 13) and 45 mm for valgus deformities (n = 8) with an overall mean correction of the femoral tibial angle of 15° per extremity. The accuracy of correction was 92.9% compared to the goal MAD. Two patients had peri-incisional cellulitis that resolved with antibiotics. There was no incidence of non-union, deep vein thrombosis, compartment syndrome, deep infection, or peripheral nerve palsy. Patient-reported outcome scores had clinically meaningful improvements in pain, function, and mental health.

Conclusion: Acute correction of large coronal plane deformities can be accurately and safely performed with simultaneous distal femoral and proximal tibial osteotomies with internal fixation.

Clinical significance: This study highlights a safe method to accurately correct large coronal plane deformities in the lower extremity.

How to cite this article: Wallace SJ, Jaime MK, Fragomen AT, et al. Dual Femoral and Tibial Osteotomies for Large Varus and Valgus Deformities. Strategies Trauma Limb Reconstr 2024;19(3):135-140.

Keywords: Bowlegs; Corrective osteotomy; Deformity correction; Genu valgum; Genu varum; Joint preservation; Knock knees.

Fig. 1

Equation to calculate the accuracy of the correction. Error is dependent on the difference between what MAD was achieved and the goal MAD (numerator) normalised to the magnitude of the initial deformity (denominator). The goal MAD was pre-operatively determined to be neutral, overcorrected, or under corrected based on patient specific factors MAD, mechanical axis deviation

Figs 2A and B

Two case examples of coronal plane deformity. (A) A patient with genu varum deformity who underwent bilateral femoral and tibia acute correction (staged) and (B) A patient with genu valgum deformity who underwent unilateral deformity correction MAD, mechanical axis deviation; mTFA, mechanical tibio-femoral angle; mLDFA, mechanical lateral distal femoral angle; mMPTA, mechanical medial proximal tibial angle

Figs 3A and B

Hip-to-ankle standing radiographs after correction and healing of the two case examples from Figure 1. (A) Staged bilateral genu varum deformity correction with dual femoral and tibial opening wedge osteotomies and plate fixation; (B) Acute correction of a genu valgum deformity with plate fixation for a distal femoral osteotomy and tibial intramedullary nail fixation after correction. Note the tibial blocking screw used to obtain and maintain coronal plate correction MAD, mechanical axis deviation; mTFA, mechanical tibio-femoral angle; mLDFA, mechanical lateral distal femoral angle; mMPTA, mechanical medial proximal tibial angle