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No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

A Correction to this article was published on 11 February 2022

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Abstract

Purpose

The purpose of this study was to investigate if one level of corrective femoral osteotomy (subtrochanteric or supracondylar) bears an increased risk of unintentional implications on frontal and sagittal plane alignment in a simulated clinical setting.

Methods

Out of 100 cadaveric femora, 23 three-dimensional (3-D) surface models with femoral antetorsion (femAT) deformities (> 22° or < 2°) were investigated, and femAT normalized to 12° with single plane rotational osteotomies, perpendicular to the mechanical axis of the femur. Change of the frontal and sagittal plane alignment was expressed by the mechanical lateral distal femoral angle (mLDFA) and the posterior distal femoral angle (PDFA), respectively. The influence of morphologic factors of the femur [centrum–collum–diaphyseal (CCD) angle and antecurvatum radius (ACR)] were assessed. Furthermore, position changes of the lesser (LT) and greater trochanters (GT) in the frontal and sagittal plane compared to the hip centre were investigated.

Results

Mean femoral derotation of the high-antetorsion group (n = 6) was 12.3° (range 10–17°). In the frontal plane, mLDFA changed a mean of 0.1° (− 0.06 to 0.3°) (n.s.) and − 0.3° (− 0.5 to − 0.1) (p = 0.03) after subtrochanteric and supracondylar osteotomy, respectively. In the sagittal plane, PDFA changed a mean of 1° (0.7 to 1.1) (p = 0.03) and 0.3° (0.1 to 0.7) (p = 0.03), respectively. The low-antetorsion group (n = 17) was rotated by a mean of 13.8° (10°–23°). mLDFA changed a mean of − 0.2° (− 0.5° to 0.2°) (p < 0.006) and 0.2° (0–0.5°) (p < 0.001) after subtrochanteric and supracondylar osteotomy, respectively. PDFA changed a mean of 1° (− 2.3 to 1.3) (p < 0.01) and 0.5° (− 1.9 to 0.3) (p < 0.01), respectively. The amount of femAT correction was associated with increased postoperative deviation of the mechanical leg axis (p < 0.01). Using multiple regression analysis, no other morphological factors were found to influence mLDFA or PDFA. Internal rotational osteotomies decreased the ischial-lesser trochanteric space by < 5 mm in both the frontal and sagittal plane (p < 0.001).

Conclusions

In case of femAT correction of ≤ 20°, neither subtrochanteric nor supracondylar femoral derotational or rotational osteotomies have a clinically relevant impact on frontal or sagittal leg alignment. A relevant deviation in the sagittal (but not frontal plane) might occur in case of a > 25° subtrochanteric femAT correction.

Level of evidence

IV.

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Funding

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. This work is part of the LEDECO project supported by the SNF Swiss National Science Foundation (Grant Number: 320030_182352).

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Authors and Affiliations

  1. Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Andreas Flury, Armando Hoch, Sandro Hodel, Florian B. Imhoff, Sandro F. Fucentese & Patrick O. Zingg

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  1. Andreas Flury
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  2. Armando Hoch
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  3. Sandro Hodel
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  4. Florian B. Imhoff
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  5. Sandro F. Fucentese
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Contributions

FA, HS, IF, and HA researched literature and conceived the study. FA, HA, ZP, and IF were involved in protocol development. Radiological assessment was performed by FA and HS. FA, ZP, and FS were involved in data analysis. FA wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

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Correspondence to Andreas Flury.

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The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval for this study was obtained from Zurich Cantonal Ethics Commission: 2017-01616. The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and in accordance with the HIPAA.

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Flury, A., Hoch, A., Hodel, S. et al. No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy. Knee Surg Sports Traumatol Arthrosc 31, 414–423 (2023). https://doi.org/10.1007/s00167-021-06843-x

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