[Proximal tibial valgus osteotomy with callus distraction]

Area of Science:

• Orthopedic surgery
• Biomechanical engineering
• Regenerative medicine

Background:

• Genu varum and medial compartment knee osteoarthritis significantly impact patient mobility and quality of life.
• Current treatments for medial compartment knee issues include total knee arthroplasty and high tibial osteotomy, each with limitations.
• Proximal osteotomy with callus distraction offers a potential method for gradual correction and unloading.

Purpose of the Study:

• To evaluate the efficacy and outcomes of using proximal osteotomy and callus distraction for correcting symptomatic genu varum.
• To assess the potential for unloading the medial knee compartment in patients with various medial compartment pathologies.

Main Methods:

• A prospective study involving 24 patients undergoing proximal tibial osteotomy and external fixator-assisted callus distraction.
• Surgical technique involved osteotomy with lateral cortex preservation and gradual distraction (1 mm/day) initiated postoperatively.
• Radiographic assessment and clinical follow-up were performed to monitor correction and outcomes.

Main Results:

• A median correction of 6 degrees in the femorotibial angle was achieved, improving alignment from 179 to 185 degrees.
• Twenty out of 21 followed patients would accept the procedure again, indicating patient satisfaction.
• Complications were noted in 15 corrections, with eight requiring surgical revision, highlighting potential risks.

Conclusions:

• Proximal tibial osteotomy with callus distraction is a viable technique for correcting genu varum and unloading the medial knee compartment.
• The procedure demonstrated positive patient-reported outcomes and achieved significant angular correction.
• Careful patient selection and management are crucial due to the complication rate and need for potential revisions.