Additional distal femoral osteotomy for insufficient correction after high tibial osteotomy

Abstract

A 70-year-old man who was treated with a closed-wedge high tibial osteotomy (HTO) had recurrent right medial knee pain 12 years after the initial osteotomy. We planned a recorrection osteotomy because the patient led an active lifestyle, had well-preserved range of motion and the lateral compartment was still intact. According to preoperative deformity analysis, which indicated a tibia in slight valgus and a femur in moderate varus, recorrection of the distal femur was chosen. Seven degrees of biplanar distal femoral osteotomy (DFO) was performed using a contralateral version of the TomoFix Medial Distal Femur. At 1 year follow-up, the femorotibial angle had improved from 178° to 170°, and the Japanese Orthopaedic Association score had improved from 75 to 95 points. Additional DFO could be a viable alternative for total knee arthroplasty or recorrection HTO when the centre of the deformity is located at the distal femur.

Around-knee osteotomy conversion for failed high tibial osteotomy: Re-correction high tibial osteotomy and additional distal femoral osteotomy may enable return to sporting activities

“…Thus, there are no adhesions at the femoral osteotomy site and no unmanageable postoperative sclerotic bones. 13 …”

“…Herein, we explored some non-prosthetic joint-preserving solutions for failed HTO and hypothesised that conversion to around-knee osteotomies (AKO-conversion), such as re-correction HTO 10 , 11 , 12 or additional distal femoral osteotomy (DFO), 13 after failed HTO enables RTS as well as primary osteotomies. Thus, the objectives of this study were: 1) to introduce potential non-prosthetic joint-preserving solutions for failed HTO and 2) to investigate the RTS after these solutions.…”