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Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis

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

Abstract

Purpose

To evaluate the time-dependent functional outcome of patients with lateral knee osteoarthritis with increased valgus treated with lateral opening-wedge osteotomy to shift the load from the lateral to the medial compartment of the knee.

Methods

Twenty-four consecutive patients with lateral knee osteoarthritis were treated with distal femoral opening-wedge varus osteotomy stabilized with the Puddu plate and bone transplantation. The mean age of the patients was 48 years (CI 40.3–55.7, range 31–62). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at 3 and 6 months, 1, 2, 5 and 10 years post-operatively. The knee osteoarthritis was graded according to the Kellgren–Lawrence radiological scoring system. The mean follow-up time was 7.9 years (CI 6.8–9.0, range 4.0–10.2).

Results

The mean angular correction measured on pre- and post-operative radiographs was 9.6° (CI 7.7°–11.5°, range 4°–20°). All osteotomies healed. KOOS increased significantly during the first year by 28–122 % beyond the preoperative values for all the five subscores. This improvement remained at 10-year follow-up for those with surviving osteotomy. Six knees were converted to total knee arthroplasty (TKA) mean 6.4 years (CI 3.3–9.6, range 4.0–11.8) post-operatively. The osteotomy survival rate at 5 years was 88 % and at 10 years 74 %. The preoperative osteoarthritic grade did not increase significantly during the follow-up period, but was significantly correlated (r = −0.49), P = 0.019 to the KOOS subscore symptoms at the 2-year follow-up.

Conclusion

Distal femoral opening-wedge osteotomy for lateral knee osteoarthritis resulted in good functional recovery after 1 year and favourable midterm results. It may be a good treatment option for middle-aged patients with valgus knees and lateral osteoarthritis in order to prevent or postpone TKA.

Level of evidence

IV.

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References

  1. Ahlbäck S (1968) Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn 7(Suppl 277):7–72

    Google Scholar 

  2. Backstein D, Morag G, Hanna S, Safir O, Gross A (2007) Long-term follow-up of distal femoral varus osteotomy of the knee. J Arthroplasty 22:2–6

    Article  PubMed  Google Scholar 

  3. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85(Suppl 2):58–69

    PubMed  Google Scholar 

  4. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD (2015) Lateral opening-wedge distal femoral osteotomy: pain relief, functional improvement, and survivorship at 5 years. Clin Orthop Relat Res 473:2009–2015

    Article  PubMed  Google Scholar 

  5. Collins B, Getgood A, Alomar AZ, Giffin JR, Willits K, Fowler PJ, Birmingham TB, Litchfield RB (2013) A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc 21:152–160

    Article  PubMed  Google Scholar 

  6. Coventry MB (1973) Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Am 55:23–48

    CAS  Google Scholar 

  7. Das D, Sijbesma T, Hoekstra H (2008) Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. Open Access Surgery 1:25–29

    Article  Google Scholar 

  8. de Carvalho LH, Temponi EF, Soares LFM, Gonçalves MBJ, Costa LP (2014) Physical activity after distal femur osteotomy for the treatment of lateral compartment knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 22:1607–1611

    PubMed  Google Scholar 

  9. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J (2013) Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. Knee Surg Sports Traumatol Arthrosc 21:249–254

    Article  CAS  PubMed  Google Scholar 

  10. Dugdale TW, Noyes FR, Styer D (1992) Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res 274:248–264

    PubMed  Google Scholar 

  11. Edgerton BC, Mariani EM, Morrey BF (1993) Distal femoral varus osteotomy for painful genu valgum. A five-to-11-year follow-up study. Clin Orthop Relat Res 288:263–269

    PubMed  Google Scholar 

  12. Finkelstein JA, Gross AE, Davis A (1996) Varus osteotomy of the distal part of the femur. A survivorship analysis. J Bone Joint Surg Am 78:1348–1352

    CAS  PubMed  Google Scholar 

  13. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin N Am 10:585–608

    CAS  Google Scholar 

  14. Gardiner A, Sevilla GR, Steiner ME, Richmond JC (2010) Osteotomies about the knee for tibiofemoral malalignment in the athletic patient. Am J Sports Med 38:1038–1047

    Article  PubMed  Google Scholar 

  15. Haviv B, Bronak S, Thein R, Thein R (2013) The results of corrective osteotomy for valgus arthritic knees. Knee Surg Sports Traumat Arrthrosc 21:49–56

    Article  Google Scholar 

  16. Heir S, Nerhus TK, Røtterud JH, Løken S, Ekeland A, Engebretsen L, Årøen A (2010) Focal cartilage defects in the knee impair quality of life as much as severe osteoarthritis: a comparison of knee injury and osteoarthritis outcome score in 4 patient categories scheduled for knee surgery. Am J Sports Med 38:231–237

    Article  PubMed  Google Scholar 

  17. Ilahi OA, Stein JD, Ho DM, Bocell JR, Lindsey RW (2008) Arthroscopic findings in knees undergoing proximal tibial osteotomy. J Knee Surg 21:63–67

    Article  PubMed  Google Scholar 

  18. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E (2011) Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. Arch Orthop Trauma Surg 131:725–728

    Article  PubMed  Google Scholar 

  19. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D (2010) Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Int Orthop 34:249–254

    Article  PubMed  PubMed Central  Google Scholar 

  21. Maquet P (1985) The treatment of choice in osteoarthritis of the knee. Clin Orthop Relat Res 192:108–112

    PubMed  Google Scholar 

  22. Mathews J, Cobb AG, Richardson S, Bentley G (1998) Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Orthopedics 21:437–440

    CAS  PubMed  Google Scholar 

  23. Morales LA, Navalon LA, Ribot PZ, Valle JA (2000) Treatment of osteoarthritis of the knee with valgus deformity by means of varus osteotomy. Acta Orthop Belg 66:272–278

    Google Scholar 

  24. Paradowski PT, Bergman S, Sundén-Lundius A, Lohmander LS, Roos EM (2006) Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord 7:38

    Article  PubMed  PubMed Central  Google Scholar 

  25. Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E (2007) Osteotomies: the surgical treatment of the valgus knee. Sports Med Arthrosc Rev 15:15–22

    Article  Google Scholar 

  26. Puddu G, Cipolla M, Cerullo G, Franco V, Giannì E (2010) Which osteotomy for a valgus knee? Int Orthop 34:239–247

    Article  PubMed  PubMed Central  Google Scholar 

  27. Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Quality Life Outcomes 1:64

    Article  Google Scholar 

  28. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    Article  CAS  PubMed  Google Scholar 

  29. Saithna A, Kundra R, Getgood A, Spalding T (2014) Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. Knee 21:172–175

    Article  CAS  PubMed  Google Scholar 

  30. Saithna A, Kundra R, Modi CS, Getgood A, Spalding T (2012) Distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. A systematic review of the literature. Open Orthop J 6:313–319

    Article  PubMed  PubMed Central  Google Scholar 

  31. Schiphof D, Boers M, Bierma-Zeinstra SM (2008) Differences in descriptions of Kellgren and Lawrence grades of knee osteoarthritis. Ann Rheum Dis 67:1034–1036

    Article  CAS  PubMed  Google Scholar 

  32. Tanner SM, Dainty KN, Marx RG, Kirkley A (2007) Knee-specific quality-of-life instruments: Which ones measure symptoms and disabilities most important to patients? Am J Sports Med 35:1450–1458

    Article  PubMed  Google Scholar 

  33. Thein R, Bronak S, Thein R, Haviv B (2012) Distal femoral osteotomy for valgus arthritic knees. J Orthop Sci 17:745–749

    Article  CAS  PubMed  Google Scholar 

  34. Wang J-W, Hsu C-C (2005) Distal femoral varus osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am 87:127–133

    Article  PubMed  Google Scholar 

  35. Zarrouk A, Bouzidi R, Karray B, Kammoun S, Mourali S, Kooli M (2010) Distal femoral varus osteotomy outcome: Is associated femoropatellar osteoarthritis consequential? Orthop Traumatol Surg Res 96:632–636

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank Nina Gunnes MSc PhD, Division of Epidemiology, Norwegian Institute of Public Health for valuable statistical advices and Elisabeth Thornes PT Ph.D. student, Martina Hansens Hospital and University of Oslo for help with statistical analyses.

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Authors and Affiliations

  1. Orthopaedic Department, Martina Hansens Hospital, Box 823, 1306, Sandvika, Norway

    Arne Ekeland, Tor Kjetil Nerhus & Stig Heir

  2. Orthopaedic Department, Lovisenberg Diaconal Hospital, Lovisenberggata 17, 0456, Oslo, Norway

    Sigbjørn Dimmen

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  1. Arne Ekeland
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  2. Tor Kjetil Nerhus
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  4. Stig Heir
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Correspondence to Arne Ekeland.

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Ekeland, A., Nerhus, T.K., Dimmen, S. et al. Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24, 1702–1709 (2016). https://doi.org/10.1007/s00167-016-3988-2

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