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All issues Volume 6 (2020) SICOT-J, 6 (2020) 35 Full HTML

Table 1

Comparison of eligible studies.

Author Study design Sample size DFO Osteotomy correction Surgical approach Outcomes Follow-up
Cameron et al. [10] Retrospective observational 8 patients (F: 5; M: 3); mean age; 54.8 y.o. (40; 66); BMI: N/R

  • 7 Medial CWDFO – Subvastus approach

  • 1 Lateral OWDFO + tibial osteotomy

  • Average interval between DFO and TKA: 4 years

 Mean: 12°

  • 7 Medial parapatellar approach

  • 1 Lateral subvastus approach – Tricon knee

  • HSS in 5 excellent, in 3 good

  • Post-TKA ROM: > 100°; Mean HKA: valgus 7° (5°;9°)

  • Complication: 1 revision after 6 years (polyhetilene wear), 1 MUA for stiffness, 1 reflex sympathetic dystrophy

 4 years (range 2–9)
Chalmers et al. [11] Retrospective observational

  • 29 patients (F: 17; M: 12), 31 knees;

  • mean age: 51 y.o. (22; 76);

  • BMI:

  • 32

  • 17 Lateral and 14 Medial DFO; 25 varus- and 6 valgus-producing

  • Average interval between DFO and TKA: 10 years (2; 20)

 N/R N/R – 24 PS implants; 4 Varus-Valgus constrained; 3 CR implants

  • PreOp KSS: 50 (32 to 68)

  • PostOp KSS: 93 (76; 100)

  • Post-TKA Flexion: 117°; 88% ten-year implant survivorship.

  • Complications: 3 knee stiffness; 1 patella fracture, 1 aseptic loosening, 2 instabilities, radiolucency in 3 TKAs

 10 years (range 2–16)
Gaillard et al. [9] Retrospective case-control

  • 14 patients (F: 2; M: 12);

  • median age: 66.6 y.o (43-89);

  • BMI: 27.2

  • 14 Lateral OWDFO – Lateral approach

  • Average interval between DFO and TKA: 18.8 years (6; 63)

 Surgical goal: residual varus 0-3° Medial (11) or Lateral (3) parapatellar approach – 14 PS implants

  • PreOp KSS knee: 46.3

  • PreOp KSS function: 59.3

  • PostOp KSS knee: 91.7

  • PostOp KSS function: 70.6

  • Post-TKA Flexion: 116°

  • mFTA 177°

  • Complications:

  • -IntraOp: lateral laxity (2), medial laxity (2), patella tendon injuries (4), need for screw support for the tibial component (2)

  • -PostOp: 1 skin necrosis

 Median: 41.8 months (range 12–102)
Kosashvili et al. [8] Retrospective observational

  • 21 patients (F: 17; M: 4), 22 knees;

  • mean age: 56 y.o. (42; 71);

  • BMI: N/R

  • N/R

  • − Subvastus approach

  • + Fresh chondral allograft transfer (7 knees)

  • Average interval between DFO and TKA: 13 years (3; 23)

 Varus-producing

  • N/R – Stemmed components in 5 knees (2 femoral and 3 tibial components)

  • NexGen posterior-stabilized implant (Zimmer Inc, Warsaw, Ind)

  • PreOp KSS: 49 (10;75)

  • PostOp KSS: 91 (67; 100)

  • Post-TKA (unrevised only) ROM: 114° (90°;130°)

  • PostOp Install-Salvati Ratio: 1.00 (0.68;1.42)

  • Complications: 4 patella baja, 2/7 with previous fresh osteochondral allograft revised for component loosening: 1 polyethylene wear (8 years) + instability + osteolysis around tibial and femoral component, 1 aseptic loosening of tibial component (at 12 years), radiolucency in all the TKAs

 5 years (range 2–14)
Nelson et al. [12] Retrospective observational

  • 9 patients (F: 7; M: 2), 11 knees;

  • mean age: 44 y.o. (15; 70);

  • BMI: N/R

  • 4 medial, 5 lateral, 2 N/R

  • Average interval between DFO and TKA: 14 years (2; 32)

  • Varus-producing

  • - 6 varus, 2 neutral, 1 valgus knees

  • 9 medial, 2 lateral arthrotomy

  • - 1 Insall-Burstein (Zimmer), 2 Insall-Burstein II prostheses (Zimmer), and 2 PFC PS (DePuy); 5 CCK; 1 rotating-hinge prosthesis (FINN; Biomet)

  • PreOp KSS: 35 (13; 58)

  • PostOp KSS: 84 (71; 93)

  • Post-TKA ROM: 105.9° (90°; 125°)

  • Radiographic alignment: 3.6° PreOp valgus (7° varus; 18° valgus);

  • 3.3° of PostOp valgus (1°; 6° valgus)

  • Complications: 1 intraoperative femur fracture, 1 patellar clunk (4 years); 1 death not related to surgery, radiolucency in all the TKAs

 5.1 years (range 2.5-18)

F female, M male, y.o. years old, N/R not reported, DFO Distal Femur Osteotomy, CWDFO Closing Wedge Distal Femur Osteotomy, OWDFO Opening Wedge Distal Femur Osteotomy, TKA Total Knee Arthroplasty, HSS Hospital for Special Surgery rating, ROM Range Of Motion, KSS Knee Society Score, MUA Manipulation Under Anaesthesia.

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