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Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy
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[Osteotomies around the Knee].

Jörg Dickschas, Alex Staubli, Jörg Harrer

    Zeitschrift Fur Orthopadie Und Unfallchirurgie
    |April 16, 2019
    PubMed
    Summary
    This summary is machine-generated.

    Osteotomies are a viable alternative to knee replacement for osteoarthritis, offering comparable outcomes. Medial open wedge high tibial osteotomy (MOWHTO) is common, with good long-term survival rates.

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    Area of Science:

    • Orthopedic surgery
    • Biomechanics
    • Osteoarthritis treatment

    Background:

    • Osteotomies around the knee are gaining popularity as an alternative to total knee arthroplasty for unicompartmental osteoarthritis.
    • Medial open wedge high tibial osteotomy (MOWHTO) and closed wedge high tibial osteotomy (CWHTO) are common tibial procedures.
    • Distal femur osteotomies (DFO), primarily closed wedge, are increasingly used for femoral alignment correction.

    Purpose of the Study:

    • To review the current status and relevance of various osteotomy techniques around the knee.
    • To compare osteotomies with total knee arthroplasty regarding outcomes and adverse events.
    • To highlight the indications and technical considerations for different osteotomy types.

    Main Methods:

    • Review of literature on knee osteotomies, including MOWHTO, CWHTO, and DFO.
    • Analysis of surgical techniques, including biplanar bone cuts and double-level osteotomies for severe malalignment.
    • Comparison of complication rates, focusing on non-union and its association with smoking.
    • Evaluation of long-term survival data for high tibial osteotomies (HTOs).

    Main Results:

    • Osteotomies are effective alternatives to total knee arthroplasty, with 10-year survival rates for HTOs reported between 85-91%.
    • Adverse event rates are comparable to arthroplasty, with non-union being a specific risk for osteotomies, particularly in smokers.
    • Biplanar bone cuts are recommended for isolated frontal plane corrections, and double-level osteotomies are necessary for severe varus/valgus deformities.

    Conclusions:

    • Osteotomies around the knee, particularly MOWHTO, represent an important treatment option for unicompartmental osteoarthritis.
    • While generally safe, potential complications like non-union require careful patient selection and management.
    • There are few age restrictions for osteotomy procedures, making them broadly applicable.