دانلود رایگان مقاله تکنیک گوه باز جانبی برای دیستال فمور استئوتومی

Abstract

Coronal limb malalignment is a significant contributor to asymmetric joint wear, gait abnormalities, and the development and progression of degenerative joint disease. Osteotomies about the knee were developed to realign the mechanical axis of the limb to unload the affected compartment. Valgus malalignment is less common than varus malalignment, but can contribute to a variety of clinical conditions, including lateral compartment cartilage defects and arthritis, lateral patellofemoral instability, and medial collateral ligament laxity. In this article, we describe our preferred operative technique for a lateral opening wedge varus-producing distal femoral osteotomy to correct mild to moderate valgus malalignment. The authors report the following potential conflict of interest or source of funding: M.J.S. receives support from Arthrex and Stryker and is on the editorial or governing board for the American Journal of Sports Medicine. A.J.K. receives support from Arthrex, Arthritis Foundation, and Histogenics.

Discussion

There is consistency in the literature regarding patient outcomes and longevity utilizing modern osteotomy techniques and implants. Most authors agree this procedure is indicated for the young patient with isolated lateral compartment arthritis and valgus deformity. Kosashvili demonstrated that modified Knee Society scores significantly improved in 33 DFOs with minimum 10-year follow-up. One-half of these patients required conversion to total knee arthroplasty at 15 years following surgery.5 Backstein et al. reviewed a series of 40 DFOs with a mean follow-up of 10 years, demonstrating a 10-year survivorship of 82%, with a significant decline to 45% at 15 years.6 Sixty percent reported good to excellent results at most recent follow-up, with 15% reporting fair to poor; the majority of the latter group went on to total knee arthroplasty. In their systematic review in 2012, Saithna et al. reported similar results, with a cumulative survival ranging between 64% and 82% at 10 years, and 45% at 15 years, with conversion to arthroplasty serving as the end point.7 Drexler et al. showed encouraging results for DFOs in combination with osteochondral allograft transfer. Survivorship was reported as 89% at 10 years, 71% at 15 years, and 24% at 20 years.8