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PubMed1990

[The role of osteotomy in the therapy of the arthritic genu varum].

The good results achieved with osteotomy in the treatment of arthritic varus knee lead the authors to pinpoint some frequently controversial aspects that are important for the attainment of an excellent outcome. The study consisted of 46 patients, each subjected to valgus osteotomy. The site of the tibial osteotomy should be above the insertion point of the patellar tendon in order to better guarantee stability and healing. For mechanical reasons, high metaphyseal peroneal osteotomy is preferred over other methods such as diaphyseal osteotomy, excision of the peroneal head, and proximal tibioperoneal syndesmotomy. Both osteotomies can be done through a single anterolateral incision, without risking injury to the lateral popliteal sciatic nerve. The preferred method of osteotomy is to cut a noncuneiform linear rima with the osteotome and perform the angular correction at the joint of the metaphyseal spongy bone. The osteotomy is then stabilized with staples and a cast for a period of 40 days. Overcorrection past the physiological valgus deformity is necessary in order to move the weight-bearing axis onto the lateral hemirima; the degree of surgical correction should be calculated on the basis of orthostatic radiographs. Good clinical results are always accompanied by the following radiographic developments: opening of the medial articular hemirima, improvement of the subchondral bone sclerosis, and reappearance of the outlines of both the spongy bone and the subchondral bone lamina; all these are signs of good bone adjustment made possible by the reinstatement of mechanical equilibrium in the knee.

Arthritis↗
PubMed1987

[Outcome of the femoropatellar joint in osteoarthritic genu varum after tibial wedge osteotomy for angulation. 10 to 13 year regression].

The progressive radiological changes in the patello-femoral joint after upper tibial osteotomy performed for arthrosis of the knee were studied more than 10 years after the surgical procedure. The changes were found to be minimal. In cases where the patello femoral joint space was normal before the osteotomy, it was still so 10 years later. In half of the cases where the patello-femoral joint space was abnormal before the osteotomy, it had deteriorated 10 years later, the lesions being more severe on the medial facet of the patella. This change occurred in 11 cases. It was not affected by the extent of the valgus osteotomy, changes in the tibio femoral joint space or the technique of the osteotomy. The functional results could only be correlated with the changes in the tibio femoral joint space and not with those in the patello-femoral joint space. However, excellent results as regards the tibio femoral joint space could still be associated with pain in the patello-femoral joint when it was arthrotic before the osteotomy. Nevertheless, the authors conclude that an associated transposition of the tibial tubercle in association with upper tibial osteotomy is not worthwhile, since no failure in their series could be attributed to impairment of the patello-femoral joint.

Follow-Up Studies↗
PubMed1986

[Outcome at more than 10 years of 93 tibial osteotomies for internal arthritis in genu varum (or the predominant influence of the frontal angular correction)].

Ninety three high tibial valgus osteotomies have been performed by the authors for degenerative arthritis and reviewed more than 10 years later. The mean age of the 66 patients was 70 years. The results were somewhat disappointing. Seventeen knees had to be operated on before the tenth post-operative year and only 42 knees were painless at the time of review. Radiological improvement in the medial tibio-femoral joint was rarely seen. Fortunately, deterioration in the lateral tibio femoral joint was exceptional and joint laxity was rarely troublesome. The authors conclude that the amount of correction at the time of the osteotomy is of extreme importance. The results were satisfactory only in cases where valgus ranging between 3 and 6 degrees had been obtained. When an osteotomy produced a greater amount of valgus, deterioration of the lateral tibio-femoral joint was seen. When the osteotomy produced less than 3 degrees of valgus, recurrence of the varus deformity developed. In these cases, functional deterioration was noted after seven years. Thus, the osteotomy appeared to have slowed down the natural evolution of the disease. The results of valgus osteotomy were satisfactory in most of the cases, but they were excellent only in cases in which a valgus ranging from 3 to 6 degrees had been produced. The importance of a precise radiological measurement is stressed, the accuracy of measurement being doubtful in cases with associated flexion deformity or joint laxity. The precision of the surgical procedure is also very important.

Aged↗