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Surgeons recommend double level osteotomies for severe genu varum deformity
Other than loss of correction in 1 patient, double-level osteotomies resulted in no complications at follow-up.
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Although rarely performed, double-level osteotomies to correct 42 cases of severe genu varum deformity in 38 patients were associated with no complications.
The main goal of this procedure is to avoid an oblique joint line.
An investigator on the team studying the mid-term outcomes, however, reported one medial side recurrence of the deformity, but said it was associated with premature full weight bearing in an obese patient.
Dominique Saragaglia
The team, from the Department of Orthopaedics and Sport Traumatology, CHU de Grenoble-Hôpital Sud, in Échirolles, France, used preoperative navigation and preoperative long-leg radiographs to determine the amount of correction that the osteotomies — one on the femur and one on the tibia — needed to provide, Dominique Saragaglia, MD, PhD, who is chief of the department, said when he presented the results at a meeting.
Shown is the genu varum deformity in a 52 year old man.
A computer-assisted double level osteotomy was performed in this case.
Images: Saragaglia D
Greater accuracy with navigation
This long-leg radiograph shows a 181° hip-knee-ankle angle at 1 year follow-up. The patient’s Knee Osteoarthritis Outcome Score had improved to 100 points.
By adding navigation to a surgery he did for years without computer assistance, Saragaglia contends the procedure became considerably easier to perform. He and colleagues navigated the osteotomy procedures with the OrthoPilot Navigation System (Aesculap Implant Systems; Tuttlingen, Germany).
“Navigation can improve the accuracy of the correction compared with non-computer assisted osteotomy,” he said.
The intended hip-knee-ankle angle of these procedures was 182° ± 2° and the planned tibial mechanical axis was 90° ± 2°, as noted in the abstract.
Satisfied patients
“Following double-level osteotomy, the satisfaction of the patient is very high. Despite the difficulty of the procedure, complications are very rare. We recommend double-level osteotomy for severe genu varum deformity,” Saragaglia said.
The mean follow-up time at which all patients (42 knees) in the study were assessed was 46 months.
Based on the abstract, two patients felt they had a poor result but the others were either satisfied or very satisfied with their outcomes. Thirty-six patients were either satisfied or very satisfied with their osteotomies.
In terms of postoperative function, the mean Lysholm-Tegner score was 83.3 points and the mean Knee Osteoarthritis Outcome Score was 95.1 points.
Excluding 1 patient who had a loss of correction, “The goals were reached in 39 cases at 92.7%, and 36 cases had a tibial mechanical axis at 90º ± 2º and we had only one case of 93º. The mean hip knee angle was 181º,” Saragaglia said.
When he presented these findings, the session moderators congratulated Saragaglia and his colleagues on the low complication rate they had. – by Susan M. Rapp
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Disclosure: Saragaglia has no relevant financial disclosures.