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The effects of femoral external derotational osteotomy on frontal plane alignment

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Femoral osteotomies are the preferred treatment in significant torsional deformity of the femur. The influence of torsional osteotomies on frontal plane alignment is poorly understood. Therefore, the aim of the present study was to evaluate the effects of external derotational osteotomies on proximal, mid-shaft and distal levels onto frontal plane alignment.

Methods

The effect of rotation around the anatomical axis of the femur on frontal plane alignment was determined with a 3D computer model, created from CT data of a right human cadaver femur. Virtual torsional osteotomies of 10°, 20° and 30° were performed at proximal, mid-shaft and distal levels under five antecurvatum angles of the femur. The change of the frontal plane alignment was expressed by the mechanical lateral femoral angle.

Results

Proximal derotational osteotomies resulted in an increased mechanical lateral distal femoral angle (mLDFA) of 0.8°–2.6° for 10°, of 1.6°–5.1° for 20° and of 2.3–7.9° for 30° derotational osteotomy, indicating an increased varus angulation. Supracondylar derotational osteotomy resulted in a decreased mLDFA of −0.1° to −1.7° for 10°, of −0.2 to −3.7° for 20° and of −0.7 to −6.9° for 30° derotational osteotomy, indicating an increased valgus angulation. The effect increased with the amount of torsional correction and virtually increased antecurvatum angles. Mid-shaft torsional osteotomies had the smallest effect on frontal plane alignment.

Conclusion

This three-dimensional computer model study demonstrates the relationship between femoral torsional osteotomies and frontal plane alignment. Proximal external derotational osteotomies tend to result in an increased varus angulation, whilst distal external derotational osteotomies tend to result in an increased valgus angulation. As a clinical consequence, torsional osteotomies have an increased risk of unintentional implications on frontal plane alignment.

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Authors and Affiliations

  1. Orthopaedic Specialty Clinic, Clinics Kempten-Oberallgäu, MVZ Oberstdorf, Trettachstrasse 16, 87561, Oberstdorf, Germany

    M. Nelitz

  2. Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Ulm, Germany

    T. Wehner, M. Steiner & L. Dürselen

  3. Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany

    S. Lippacher

Authors
  1. M. Nelitz
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  2. T. Wehner
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  3. M. Steiner
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  4. L. Dürselen
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  5. S. Lippacher
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Correspondence to M. Nelitz.

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Nelitz, M., Wehner, T., Steiner, M. et al. The effects of femoral external derotational osteotomy on frontal plane alignment. Knee Surg Sports Traumatol Arthrosc 22, 2740–2746 (2014). https://doi.org/10.1007/s00167-013-2618-5

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  • DOI: https://doi.org/10.1007/s00167-013-2618-5

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