Kniegelenknahe Doppelosteotomie bei Genu varum

Axis correction in the frontal plane by osteotomy is a proven treatment for varus gonarthritis. In addition to correction of the mechanical axis the joint line must also be considered. In cases of extensive deformities this necessitates a double osteotomy of the femur and tibia.

The aim was to examine the feasibility and effect of a unilateral valgus correction by double osteotomy of the femur and tibia in cases of extensive varus deformity.

Evaluation of a case collective of 33 patients (37 knees) with extensive varus deformity who underwent double level osteotomy. Fixation was carried out using angle stable plates. Postoperatively, the patients were assigned to 20 kg partial weight-bearing using 2 crutches for 6 weeks followed by full weight-bearing. The mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA) were measured. The clinical outcome was evaluated using Lequesne, Lysholm, Oxford and the International Knee Documentation Committee (IKDC) scores at the time of follow-up.

A total of 24 patients (28 knee joints) were available for the follow-up examination at a mean of 18 months postoperatively. The preoperative mTFA was −11  ± 3° and increased to 0 ± 2° at final follow-up. The difference between the planned mTFA and the final result at follow-up was −2  ± 3° (p < 0.0006). At final follow-up the MPTA and mLDFA were 89.2  ± 2° and 87  ± 2°, respectively. The Lysholm, Oxford, Lequesne and IKDC scores were 88  ± 13, 44  ± 3, 2  ± 2 and 77  ± 12, respectively.

This study showed that double level osteotomy for patients with severe varus malalignment and medial compartment osteoarthritis can achieve normalization of the alignment and the joint line and leads to good clinical results.