Lateral femoral sliding osteotomy in total knee arthroplasty with valgus deformity greater than twenty degrees

Abstract

Purpose

Lateral femoral sliding osteotomy has been reported as an effective technique for total knee arthroplasty (TKA) with significant valgus deformity. This study aims to investigate its utility in TKA with valgus deformity greater than 20°, for which few studies have examined.

Methods

Consecutive TKA patients with valgus deformity treated with the sliding osteotomy at our institution were retrospectively studied. Constraint implants were not used. Radiological and clinical parameters at follow-ups were compared with those pre-operatively. Radiological parameters included the hip-knee-ankle angle (HKA), the anatomical lateral distal femoral angle (aLDFA), the anatomical lateral plateau ankle angle (aLPTA), and the angle between the femoral mechanical axis and transepicondylar line (femoral transepicondylar angle, FTEA) which was used to reflect concurrent extra-articular valgus and corresponding local alignment. Clinical outcome measures included the Knee Society Score and Functional Score.

Results

Twenty-five patients operated on between July 2011 and February 2017 were enrolled. The average follow-up time was 3.3 (1.5~7.9) years. The pre-operative HKA of 202.7 ± 2.3° (equivalent to valgus of 22.7 ± 2.3°) was reduced to 180.4 ± 2.3° at final follow-ups (P < 0.001). The aLFDA, aLPTA, and FTEA were all significantly improved, with the last one increased from 84.2 ± 1.8° to 89.6 ± 1.6° (t = − 11.35, P < 0.001). All clinical scores were significantly improved without major complications.

Conclusions

Lateral femoral sliding osteotomy can be effective and safe for TKA with severe valgus deformity greater than 20°.

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References

  1. 1.

    Lange J, Haas SB (2017) Correcting severe valgus deformity taking out the knock. Bone Joint J 99:60–64. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0340.R1

    Article  PubMed  Google Scholar 

  2. 2.

    Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am 87:271–284. https://doi.org/10.2106/JBJS.E.00308

    Article  PubMed  Google Scholar 

  3. 3.

    Touzopoulos P, Drosos GI, Ververidis A, Kazakos K (2015) Constrained implants in total knee replacement. Surg Technol Int 26:307–316

    PubMed  Google Scholar 

  4. 4.

    Mullaji AB, Shetty GM (2010) Lateral epicondylar osteotomy using computer navigation in total knee arthroplasty for rigid valgus deformities. J Arthroplast 25:166–169. https://doi.org/10.1016/j.arth.2009.06.013

    Article  Google Scholar 

  5. 5.

    Brilhault J, Lautman S, Favard L, Burdin P (2002) Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. J Bone Joint Surg (Br) 84:1131–1137. https://doi.org/10.1016/j.otsr.2010.06.008

    CAS  Article  Google Scholar 

  6. 6.

    Strauch M, von Eisenhart Rothe R, Graichen H (2013) A new navigation-based technique for lateral distalizing condylar osteotomy in patients undergoing total knee arthroplasty with fixed valgus deformity. Knee Surgery, Sport Traumatol Arthrosc 21:2263–2270. https://doi.org/10.1007/s00167-012-2112-5

    Article  Google Scholar 

  7. 7.

    Maderbacher G, Baier C, Benditz A, Wagner F, Greimel F, Grifka J, Keshmiri A (2017) Presence of rotational errors in long leg radiographs after total knee arthroplasty and impact on measured lower limb and component alignment. Int Orthop 41:1553–1560. https://doi.org/10.1007/s00264-017-3408-3

    Article  PubMed  Google Scholar 

  8. 8.

    Brinkman J-M, Lobenhoffer P, Agneskirchner JD, Staubli AE, Wymenga AB, van Heerwaarden RJ (2008) Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies. J Bone Joint Surg (Br) 90:1548–1557. https://doi.org/10.1302/0301-620X.90B12.21198

    Article  Google Scholar 

  9. 9.

    Meneghini RM, Ritter MA, Pierson JL, Meding JB, Berend ME, Faris PM (2006) The effect of the Insall-Salvati ratio on outcome after total knee arthroplasty. J Arthroplast 21:116–120. https://doi.org/10.1016/j.arth.2006.04.014

    Article  Google Scholar 

  10. 10.

    Yoshioka Y, Siu D, Cooke TD (1987) The anatomy and functional axes of the femur. J Bone Joint Surg Am 69-A:873–880

    Article  Google Scholar 

  11. 11.

    Stiehl JB, Abbott BD (1995) Morphology of the transepicondylar axis and its application in primary and revision total knee arthroplasty. J Arthroplast 10:785–789

    CAS  Article  Google Scholar 

  12. 12.

    Jacofsky D, D’Alessio J, Patel A, Kester M. (2012) The relationship of joint line and flexion/extension axes of the knee to the mechanical axis in the coronal planes. Orthopaedic Proceedings. https://doi.org/10.1302/1358-992x.94bsupp_xl.ista2011-036. Accessed 1 January 2019

  13. 13.

    Conjeski JM, Scuderi GR (2017) Lateral femoral epicondylar osteotomy for correction of fixed valgus deformity in total knee arthroplasty: a technical note. J Arthroplast 33:386–390. https://doi.org/10.1016/j.arth.2017.09.018

    Article  Google Scholar 

  14. 14.

    Loures FB, Correia W, Reis JH, Pires e Albuquerque RS, de Paula MA, de Souza EB, Maia PV, Barretto JM (2018) Outcomes after knee arthroplasty in extra-articular deformity. Int Orthop. https://doi.org/10.1007/s00264-018-4147-9

    Article  Google Scholar 

  15. 15.

    Tan H, Wang Y, Long T, Nie B, Mao Z, Yue B (2018) How to accurately determine the distal femoral valgus cut angle in the valgus knee arthroplasty. Int Orthop 42:537–542. https://doi.org/10.1007/s00264-018-3778-1

    Article  PubMed  Google Scholar 

  16. 16.

    Shi J, Lv W, Wang Y, Ma B, Cui W, Liu Z, Han K (2018) Three dimensional patient-specific printed cutting guides for closing-wedge distal femoral osteotomy. Int Orthop. https://doi.org/10.1007/s00264-018-4043-3

    Article  Google Scholar 

  17. 17.

    Collins B, Getgood A, Alomar AZ, Giffin JR, Willits K, Fowler PJ, Brimingham TB, Litchfield RB (2013) A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surgery, Sport Traumatol Arthrosc 21:152–160. https://doi.org/10.1007/s00167-012-2070-y

    Article  Google Scholar 

  18. 18.

    Keblish PA (1991) The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res 271:52–62

    Google Scholar 

  19. 19.

    Tonelli Filho JR, Passarelli MC, Brito JA, Campos GC, Zorzi AR, Miranda JB (2016) Keblish’s lateral surgical approach enhances patellar tilt in valgus knee arthroplasty. Rev Bras Ortop 51:680–686. https://doi.org/10.1016/j.rboe.2016.10.010

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Saku SA, Madanat R, Mäkinen TJ (2018) Reasons and risk factors for ninety day re-admission following primary total knee arthroplasty in a high-volume centre. Int Orthop 42:95–99. https://doi.org/10.1007/s00264-017-3676-y

    Article  PubMed  Google Scholar 

  21. 21.

    Lazennec JY, Chometon Q, Folinais D, Robbins CB, Pour AE (2017) Are advanced three-dimensional imaging studies always needed to measure the coronal knee alignment of the lower extremity? Int Orthop 41:917–924. https://doi.org/10.1007/s00264-016-3340-y

    Article  PubMed  Google Scholar 

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Correspondence to Hua Tian.

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This retrospective study was approved by the hospital ethics committee of the corresponding author’s hospital.

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The authors declare that they have no conflict of interest.

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Li, F., Liu, N., Li, Z. et al. Lateral femoral sliding osteotomy in total knee arthroplasty with valgus deformity greater than twenty degrees. International Orthopaedics (SICOT) 43, 2511–2517 (2019). https://doi.org/10.1007/s00264-019-04295-0

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Keywords

  • Lateral femoral sliding osteotomy
  • Total knee arthroplasty
  • Valgus deformity