Surgical correction of angular deformity of the knee in children with renal osteodystrophy

Twenty-nine children with renal osteodystrophy (RO) and angular deformities about the knee were studied, including 19 in whom 36 corrective operations were performed. Corrective osteotomy of the distal femur was performed in 20 knees, osteotomy of the proximal tibia in 11 knees, combined femoral/tibial osteotomy in three knees, and medial physeal stapling in two knees. The indication for surgery was a deformity significant enough to interfere with gait. Complications occurred in three patients and recurrence severe enough to require repeated surgery occurred in four patients. Patients who required repeated osteotomy appeared to have had poor metabolic control during the initial surgery, as measured by an increased alkaline phosphatase. Surgery for children with RO and knee deformities is quite feasible but requires careful surgical planning and preoperative metabolic stabilization. Whether to correct the femur or tibia can be determined by evaluating full-length films of the lower extremities.