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

Petros Ismailidis; Corinna Schmid; Julika Werner; Corina Nüesch; Annegret Mündermann; Geert Pagenstert; Christian Egloff

doi:10.1007/s00402-023-04923-w

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

Arch Orthop Trauma Surg. 2023 Oct;143(10):6147-6157. doi: 10.1007/s00402-023-04923-w. Epub 2023 Jun 6.

Authors

Petros Ismailidis^#^{1

2}, Corinna Schmid^#³, Julika Werner³, Corina Nüesch^{3

4

5

6}, Annegret Mündermann^{3

4

5

6}, Geert Pagenstert^{4

7}, Christian Egloff^{3

4}

Affiliations

¹ Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. petrosismailidis@gmail.com.
² Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland. petrosismailidis@gmail.com.
³ Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
⁴ Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
⁵ Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
⁶ Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
⁷ Knee Institute Basel, Clarahof, Clinic of Orthopaedic Surgery, Clarahofweg 19a, 4058, Basel, Switzerland.

^# Contributed equally.

Abstract

Introduction: The 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.

Methods: Over 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.

Results: The 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/m². 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)°, mechanical lateral distal femoral angle (mLDFA) was 83.7 (79.9-88.2)°, and mechanical proximal tibial angle (MPTA) was 89.0 (86.6-94.5)°. Postoperatively, HKA was -1.3 (-9.0-1.2)° and mLDFA was 90.8 (87.3-97.3)°. 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.

Conclusion: DFO 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. Level of evidence Level IV, Case Series. Trial registration number NCT04382118, clinicaltrials.gov, May 11, 2020.

Keywords: DFO; Distal femoral osteotomy; Knee osteoarthritis; Valgus knee.

Publication types

Clinical Study

MeSH terms

Activities of Daily Living*
Adolescent
Adult
Cohort Studies
Femur / surgery
Humans
Knee Joint / surgery
Middle Aged
Osteoarthritis, Knee* / etiology
Osteoarthritis, Knee* / surgery
Osteotomy / adverse effects
Retrospective Studies
Tibia / surgery
Young Adult

Associated data

ClinicalTrials.gov/NCT04382118