Distal femoral osteotomy for the valgus knee: indications, complications, clinical and radiological outcome
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...
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| Veröffentlicht in: | Archives of orthopaedic and trauma surgery 2023-10, Vol.143 (10), p.6147-6157 |
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| creator | Ismailidis, Petros Schmid, Corinna Werner, Julika Nüesch, Corina Mündermann, Annegret Pagenstert, Geert Egloff, Christian |
| description | 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/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)°, 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. |
| doi_str_mv | 10.1007/s00402-023-04923-w |
| format | Article |
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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/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)°, 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.</description><identifier>ISSN: 1434-3916</identifier><identifier>ISSN: 0936-8051</identifier><identifier>EISSN: 1434-3916</identifier><identifier>DOI: 10.1007/s00402-023-04923-w</identifier><identifier>PMID: 37278744</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Activities of daily living ; Ankle ; Archives & records ; Arthritis ; Body mass index ; Cohort analysis ; Joint replacement surgery ; Knee ; Magnetic resonance imaging ; Medicine ; Medicine & Public Health ; NCT ; NCT04382118 ; Orthopaedic Surgery ; Orthopedics ; Osteoarthritis ; Patients</subject><ispartof>Archives of orthopaedic and trauma surgery, 2023-10, Vol.143 (10), p.6147-6157</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-48cc1e0dd332755922f6705178d4f2e3d11b60e5526a32df84aae05fb07a92283</citedby><cites>FETCH-LOGICAL-c475t-48cc1e0dd332755922f6705178d4f2e3d11b60e5526a32df84aae05fb07a92283</cites><orcidid>0000-0003-1551-7902</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00402-023-04923-w$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00402-023-04923-w$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37278744$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ismailidis, Petros</creatorcontrib><creatorcontrib>Schmid, Corinna</creatorcontrib><creatorcontrib>Werner, Julika</creatorcontrib><creatorcontrib>Nüesch, Corina</creatorcontrib><creatorcontrib>Mündermann, Annegret</creatorcontrib><creatorcontrib>Pagenstert, Geert</creatorcontrib><creatorcontrib>Egloff, Christian</creatorcontrib><title>Distal femoral osteotomy for the valgus knee: indications, complications, clinical and radiological outcome</title><title>Archives of orthopaedic and trauma surgery</title><addtitle>Arch Orthop Trauma Surg</addtitle><addtitle>Arch Orthop Trauma Surg</addtitle><description>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/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)°, 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.</description><subject>Activities of daily living</subject><subject>Ankle</subject><subject>Archives & records</subject><subject>Arthritis</subject><subject>Body mass index</subject><subject>Cohort analysis</subject><subject>Joint replacement surgery</subject><subject>Knee</subject><subject>Magnetic resonance imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>NCT</subject><subject>NCT04382118</subject><subject>Orthopaedic Surgery</subject><subject>Orthopedics</subject><subject>Osteoarthritis</subject><subject>Patients</subject><issn>1434-3916</issn><issn>0936-8051</issn><issn>1434-3916</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1vFSEUhonR2Nr6B1wYEjcuHHv4mGGum8bUtpo0caNrwh3O3NIycAWmTf-9tLcfVxdlweHAcw68vIS8Y_CZAaiDDCCBN8BFA3JR5-sXZJdJIRuxYN3LrfUOeZPzBQDj_QJekx2huOqVlLvk8pvLxXg64hRTjTEXjCVON3SMiZZzpFfGr-ZMLwPiF-qCdYMpLob8iQ5xWvut1LtQM09NsDQZ66KPq7uNOJfK4j55NRqf8e193CO_T45_HX1vzn6e_jj6etYMUrWlkf0wMARrheCqbRecj52ClqneypGjsIwtO8C25Z0R3I69NAahHZegTIV7sUcON33X83JCO2AoVZpeJzeZdKOjcfrfk-DO9SpeaVa_kbUCaoeP9x1S_DNjLnpyeUDvTcA4Z817LkDWcYt--A-9iHMKVV-lOt5VAcAqxTfUkGLOCcfH1zDQt2bqjZm6mqnvzNTXtej9to7Hkgf3KiA2QK5HYYXp6e5n2v4FAF6sQQ</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Ismailidis, Petros</creator><creator>Schmid, Corinna</creator><creator>Werner, Julika</creator><creator>Nüesch, Corina</creator><creator>Mündermann, Annegret</creator><creator>Pagenstert, Geert</creator><creator>Egloff, Christian</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1551-7902</orcidid></search><sort><creationdate>20231001</creationdate><title>Distal femoral osteotomy for the valgus knee: indications, complications, clinical and radiological outcome</title><author>Ismailidis, Petros ; Schmid, Corinna ; Werner, Julika ; Nüesch, Corina ; Mündermann, Annegret ; Pagenstert, Geert ; Egloff, Christian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-48cc1e0dd332755922f6705178d4f2e3d11b60e5526a32df84aae05fb07a92283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Activities of daily living</topic><topic>Ankle</topic><topic>Archives & records</topic><topic>Arthritis</topic><topic>Body mass index</topic><topic>Cohort analysis</topic><topic>Joint replacement surgery</topic><topic>Knee</topic><topic>Magnetic resonance imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>NCT</topic><topic>NCT04382118</topic><topic>Orthopaedic Surgery</topic><topic>Orthopedics</topic><topic>Osteoarthritis</topic><topic>Patients</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ismailidis, Petros</creatorcontrib><creatorcontrib>Schmid, Corinna</creatorcontrib><creatorcontrib>Werner, Julika</creatorcontrib><creatorcontrib>Nüesch, Corina</creatorcontrib><creatorcontrib>Mündermann, Annegret</creatorcontrib><creatorcontrib>Pagenstert, Geert</creatorcontrib><creatorcontrib>Egloff, Christian</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of orthopaedic and trauma surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ismailidis, Petros</au><au>Schmid, Corinna</au><au>Werner, Julika</au><au>Nüesch, Corina</au><au>Mündermann, Annegret</au><au>Pagenstert, Geert</au><au>Egloff, Christian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distal femoral osteotomy for the valgus knee: indications, complications, clinical and radiological outcome</atitle><jtitle>Archives of orthopaedic and trauma surgery</jtitle><stitle>Arch Orthop Trauma Surg</stitle><addtitle>Arch Orthop Trauma Surg</addtitle><date>2023-10-01</date><risdate>2023</risdate><volume>143</volume><issue>10</issue><spage>6147</spage><epage>6157</epage><pages>6147-6157</pages><issn>1434-3916</issn><issn>0936-8051</issn><eissn>1434-3916</eissn><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/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)°, 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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37278744</pmid><doi>10.1007/s00402-023-04923-w</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-1551-7902</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Springer Nature - Complete Springer Journals |
| subjects | Activities of daily living Ankle Archives & records Arthritis Body mass index Cohort analysis Joint replacement surgery Knee Magnetic resonance imaging Medicine Medicine & Public Health NCT NCT04382118 Orthopaedic Surgery Orthopedics Osteoarthritis Patients |
| title | Distal femoral osteotomy for the valgus knee: indications, complications, clinical and radiological outcome |
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