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  • Title: Distal femoral varus osteotomy outcome: Is associated femoropatellar osteoarthritis consequential?
    Author: Zarrouk A, Bouzidi R, Karray B, Kammoun S, Mourali S, Kooli M.
    Journal: Orthop Traumatol Surg Res; 2010 Oct; 96(6):632-6. PubMed ID: 20829143.
    Abstract:
    INTRODUCTION: Distal femoral varus osteotomy (FVO) can be indicated for young active patients who have lateral unicompartmental osteoarthritis in a valgus knee originating in the femur. However, its indication remains controversial when associated patellofemoral osteoarthrosis is present. HYPOTHESIS: Associated patellofemoral osteoarthrosis influences the results of osteotomy in cases of lateral tibiofemoral osteoarthrosis. METHODS: Twenty patients (22 knees) underwent opening wedge FVO for lateral tibiofemoral osteoarthrosis of a valgus knee. The osteoarthrosis was lateral and unicompartmental in 11 cases, associated with patellofemoral osteoarthrosis in nine cases, and global in two cases. The osteotomy site was fixed with a 95° blade plate in all cases. At a mean follow-up of 54 months, all the patients were evaluated using the International Knee Society (IKS) score. RESULTS: Eighteen knees had good or excellent results (80%), two had fair results (9.5%), and two had poor results (9.5%). One female patient underwent total knee replacement revision at 8 years and three others are awaiting total knee replacement. The mean preoperative IKS score increased from 49.28 (range, 14-70) to 74.23 (range, 41-92) at the last follow-up. The mean preoperative functional score increased from 50.68 (range, 30-80) to 72.85 (range, 40-90) at the last follow-up (p=0.001). The 8-year survival rate was 91% (confidence interval, 69-100%). We noted improvement in patellofemoral syndrome and recentering of the patella in seven cases out of nine with severe patellofemoral osteoarthrosis. CONCLUSION: Distal femoral varus osteotomy, with lateral opening wedge and fixation can be a good alternative to treatment of lateral tibiofemoral osteoarthritis associated with a valgus knee originating in the femur. The association of patellofemoral osteoarthritis does not affect the functional results. LEVEL OF EVIDENCE: Level IV. Retrospective study.
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