OSTEOTOMIES ABOUT THE KNEE

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OSTEOTOMIES ABOUT THE KNEE

• Rod Martin M.D. FRCS(C)

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Outline

• Introduction
• Distal Femoral Osteotomy
• Proximal Osteotomies of the Tibia
• Closing wedge osteotomy
• Coventry
• Slocum
• HTO with jig plate
• Barrel-vault osteotomy
• Opening wedge osteotomy

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OSTEOTOMIES ABOUT THE KNEE

• Patients with malalignment and unicompartment
  disease
• Varus(4X) valgus(5X) OA
• 2020 OA will have largest increase of new cases
  of any disease
• Unicompartment OA 30-60 age group
• High demand / middle aged athlete

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Varus Distal Femoral Osteotomy

• Indications
• Valgus deformity gt 12 to 15 degrees
• Plane of the knee deviates from the horizontal
  gt10 degrees

• 25-22

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Distal Femoral Osteotomy

• Reported success 71 - 86
• Poor results with RA
• Satisfactory results with TKR 94
• (13 of 18 had complications)
• Difficulty restoring desired 5-10 degrees valgus

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Coventry Distal Femoral Osteotomy

• Coventry
• Medial or midline incision
• Rectus/medialis interval
• Insert blade at templated angle
• Osteotomy of femur
• Close wedge/secure plate

• 25-23

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Proximal Osteotomies of the Tibia

• Treatment of unicompartmental OA
• 80 satisfactory results _at_ 5 years
• Varus deformity medial OA
• Valgus deformity lateral OA
• Osteotomy unloads the overloaded

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Proximal Osteotomies of the Tibia

• Coventry (1965)
• Medial closing wedge for valgus deformity
• Lateral closing wedge for varus deformity
• Advantages
• Near the deformity
• Cancellous bone heals quickly
• Fragments held firmly by 1-2 staples
• Permits evaluation of the knee through the same
  incision

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Proximal Osteotomies of the Tibia

• Coventry (1979)
• 80 at 5 years 60 at 10 years (213 knees)
• Recurrence of deformity recurrence of pain
• Minimum overcorrection 8 degrees valgus
• gt30 ideal body weight high failure

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Proximal Osteotomies of the Tibia

• Indications
• Pain and disability
• Unicompartment OA
• Ability to use crutches post-op
• Good vascular status

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Proximal Osteotomies of the Tibia

• Contraindications
• Narrowing of lateral compartment
• Lateral tibial subluxation of gt 1 cm
• Medial compartment bone loss gt 2-3 mm
• Flexion contracture gt 15 degrees
• Knee flection lt 90 degrees
• Correction of gt 10-15 degrees
• Inflammatory arthropathies

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Proximal Osteotomies of the Tibia

• Coventry correction formula
• (1) Normal valgus (5-8 degrees)
• (2) amount of varus deformity
• (3) overcorrection factor of 3 to 5
  degrees
• total correction required
• (approx. 1 mm / degree)

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Proximal Osteotomies of the Tibia

• 25-10

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Proximal Osteotomies of the Tibia (Coventry)
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Proximal Osteotomies of the Tibia (Coventry)
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Proximal Osteotomies of the Tibia (Slocum)
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Proximal Osteotomies of the Tibia (jig and plate)
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Proximal Osteotomies of the Tibia
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Proximal Osteotomies of the Tibia

• Maquet (barrel-vault) osteotomy
• Inherently stable
• extensive degrees of correction possible
• Technically difficult
• Intraarticular fracture
• Scarring about the patellofemoral mechanism

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Proximal Osteotomies of the Tibia (Barrel-vault)
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Proximal Osteotomies of the Tibia

• Medial opening wedge osteotomy
• Does not shorten the extremity
• Correct medial laxity
• Surgery directed to the diseased compartment
• Corrects up to 15

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Proximal Osteotomy of the Tibia (opening wedge)
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conclusions

• Delays/avoids arthroplasty
• Refute claims osteotomies compromise arthroplasty
• Second wave of osteotomies coming

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43 year female with increasing knee pain
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M.B. 43 year female increasingknee pain
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Opening wedge HTO
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(No Transcript)
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• 6mos post op
• Resumed all adls
• knee feels 75 better

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Thank you