Review Article

Total knee arthroplasty after distal femoral osteotomy: a systematic review and current concepts

¹ IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
² FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004 Lyon, France
³ Humanitas Clinical and Research Center – IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy
⁴ Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
⁵ FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004 Lyon, France
⁶ LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, Lyon, France
⁷ LIBM, EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
⁸ U.O.C. 1 a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
⁹ Laboratorio di Biomeccanica Applicata, Dipartimento di Scienze Biomediche per la Salute, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
¹⁰ Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

^* Corresponding author: f.luceri88@gmail.com

Received: 6 May 2020
Accepted: 12 August 2020

Abstract

Introduction: Distal Femoral Osteotomy (DFO) is a common procedure for correcting lower limb valgus deformity and lateral compartment overload. Low 20-year survivorship rate was reported with a consequent need for total knee arthroplasty (TKA). This study aims to review literature and to analyse the influence of a previous distal femoral osteotomy on outcomes of patients undergoing TKA. Methods: A systematic literature review was performed in PubMed/Medline and Embase in May 2020. Papers were selected based on the following criteria: patient with a previous distal femoral osteotomy; total knee replacement; Pre- and Postoperative outcomes; surgical outcomes: clinical scores, range of motion, radiographic evaluation and revisions for any cause; case series, retrospective studies, observational studies, open-label studies, randomized clinical trials; systematic reviews and meta-analyses were included to extract primitive studies. Results: 306 articles were found, of which five papers were considered eligible for this review. In every study included, postoperative clinical outcomes (Knee Society Score or Hospital for Special Surgery score) statistically improved from the preoperative. Complications were not uncommon; implant survivorship at the available follow-up seems to be similar to primary TKA, although being too short to draw any conclusions. Conclusions: Limited and highly heterogeneous evidence is currently available on the influence of DFO on outcomes after TKA. Knee replacement improves clinical middle-term outcomes in patients with previous distal femoral osteotomy. In this complex surgery, the use of technical tips and tricks could help surgeons to obtain an accurate knee balancing and better long-term results.