Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee

doi:10.1007/s00167-013-2828-x

. 2015 May;23(5):1317-1323.

doi: 10.1007/s00167-013-2828-x. Epub 2014 Jan 14.

Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee

Michael Drexler^{1

2}, Allan Gross³, Tim Dwyer^{3

4}, Oleg Safir³, David Backstein³, Hasaan Chaudhry⁵, Anna Goulding⁵, Yona Kosashvili³

Affiliations

¹ , 640 Roselwan Avenue Unit 717, Toronto, ON, M5N 1K9, Canada. mt.drexler@gmail.com.
² Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada. mt.drexler@gmail.com.
³ Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
⁴ Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B1, Canada.
⁵ University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.

PMID: 24420606
DOI: 10.1007/s00167-013-2828-x

Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee

Michael Drexler et al. Knee Surg Sports Traumatol Arthrosc. 2015 May.

. 2015 May;23(5):1317-1323.

doi: 10.1007/s00167-013-2828-x. Epub 2014 Jan 14.

Authors

Michael Drexler^{1

2}, Allan Gross³, Tim Dwyer^{3

4}, Oleg Safir³, David Backstein³, Hasaan Chaudhry⁵, Anna Goulding⁵, Yona Kosashvili³

Affiliations

¹ , 640 Roselwan Avenue Unit 717, Toronto, ON, M5N 1K9, Canada. mt.drexler@gmail.com.
² Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada. mt.drexler@gmail.com.
³ Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
⁴ Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B1, Canada.
⁵ University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.

PMID: 24420606
DOI: 10.1007/s00167-013-2828-x

Abstract

Purpose: This study was conducted to examine the long-term survivorship and functional outcome of distal femoral varus osteotomy with fresh osteochondral allograft following failed lateral tibial plateau fracture surgery. We hypothesized that this procedure would be associated with a low rate of conversion to total knee arthroplasty (TKA) at medium to long-term follow-up.

Methods: A consecutive series of 27 of distal femoral varus osteotomy combined with fresh osteochondral allograft following (27 patients) conducted between January 1981 and January 2005 for failed lateral tibial plateau fracture was retrospectively reviewed. Outcome measures included the Knee Society Knee Score (KSKS) and Knee Society Function Score (KSFS) and conversion rates to TKA.

Results: The study group consisted of 15 females (55.6 %) and 12 males (44.4 %), with a median age of 41.2 years (range 17-62 years). The median follow-up was 13.3 years (range 2-31 years). The knee function scores improved significantly at 2 years post-surgery (p < 0.01) from a median of 54.6 points preoperatively to 83.8 points (KSKS) and median of 50.6 points to 71.1 points (KSFS) at 2 years post-distal femoral varus osteotomy with fresh osteochondral allograft following surgery. At most recent follow-up, 4/27 patients had required conversion to TKA, and one patient had fractured the FOCA, requiring revision of the allograft. The survivorship for distal femoral varus osteotomy with fresh osteochondral allograft following was 88.9 ± 4.6 % at 10 years, 71.4 ± 18.1 % at 15 years, and 23.8 ± 11.1 % at 20 years.

Conclusion: The use of distal femoral varus osteotomy combined with fresh osteochondral allograft following in patients with failed lateral tibial plateau fracture results in the majority of patients having good or excellent clinical outcomes and significantly delays the need for TKA in most patients.

Level of evidence: Case series, Level IV.

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References

1. Asif S, Choon DS (2005) Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong) 13:280–284
1. Backstein D, Morag G, Hanna S, Safir O, Gross A (2007) Long-term follow-up of distal femoral varus osteotomy of the knee. J Arthroplasty 22:2–6 - DOI - PubMed
1. Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87:640–645 - DOI - PubMed
1. Edgerton BC, Mariani EM, Morrey BF (1993) Distal femoral varus osteotomy for painful genu valgum. A five-to-11-year follow-up study. Clin Orthop Relat Res 288:263–269 - PubMed
1. Gardiner A, Richmond JC (2013) Periarticular osteotomies for degenerative joint disease of the knee. Sports Med Arthrosc 21:38–46 - DOI - PubMed

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[1] Asif S, Choon DS (2005) Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong) 13:280–284

[2] Asif S, Choon DS (2005) Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong) 13:280–284

[3] Backstein D, Morag G, Hanna S, Safir O, Gross A (2007) Long-term follow-up of distal femoral varus osteotomy of the knee. J Arthroplasty 22:2–6 - DOI - PubMed

[4] Backstein D, Morag G, Hanna S, Safir O, Gross A (2007) Long-term follow-up of distal femoral varus osteotomy of the knee. J Arthroplasty 22:2–6 - DOI - PubMed

[5] Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87:640–645 - DOI - PubMed

[6] Bartlett W, Skinner JA, Gooding CR, Carrington RW, Flanagan AM, Briggs TW, Bentley G (2005) Autologous chondrocyte implantation versus matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: a prospective, randomised study. J Bone Joint Surg Br 87:640–645 - DOI - PubMed

[7] Edgerton BC, Mariani EM, Morrey BF (1993) Distal femoral varus osteotomy for painful genu valgum. A five-to-11-year follow-up study. Clin Orthop Relat Res 288:263–269 - PubMed

[8] Edgerton BC, Mariani EM, Morrey BF (1993) Distal femoral varus osteotomy for painful genu valgum. A five-to-11-year follow-up study. Clin Orthop Relat Res 288:263–269 - PubMed

[9] Gardiner A, Richmond JC (2013) Periarticular osteotomies for degenerative joint disease of the knee. Sports Med Arthrosc 21:38–46 - DOI - PubMed

[10] Gardiner A, Richmond JC (2013) Periarticular osteotomies for degenerative joint disease of the knee. Sports Med Arthrosc 21:38–46 - DOI - PubMed

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Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee

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Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee

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