Thurs., 10/18/07 Reconstruction, Paper #20, 5:22 pm OTA-2007
Osteotomy for Femoral or Tibial Shaft Malunion in Patients with End-Stage Osteoarthritis of the Knee
Arvindera Ghag, BSc (n); Piotr A. Blachut, MD (a-Synthes, Stryker);
Henry Broekhuyse, MD (a-Synthes, Stryker); Robert N. Meek, MD (a-Synthes, Stryker);
Pierre Guy, MD (a-Synthes, Stryker); Peter J. O’Brien, MD (a-Synthes, Stryker);
University of British Columbia, Vancouver, British Columbia, Canada
Purpose: Femoral and tibial shaft malunions can not only predispose to osteoarthritis of the knee but also pose a problem for knee reconstruction since malposition of total knee prostheses is a known cause of early failure. Limb realignment may prove to be beneficial prior to proceeding with arthroplasty. The purpose of this study was to evaluate the outcome and effect of shaft osteotomy prior to total knee arthroplasty (TKA).
Methods: A search of the trauma database at a Level I trauma center between 1987 and 2006 was conducted. 22 osteotomies were performed on 21 patients with femoral or tibial shaft malunion at the request of an orthopaedic reconstruction specialist. The average patient age at time of osteotomy was 55 years and follow-up duration was 25 months. Time intervals between surgical procedures and Knee Society knee and function scores were calculated. Patients were surveyed regarding pain relief and functional improvement.
Results: 15 femoral osteotomies were stabilized by intramedullary fixation in 10 patients, plate fixation in 3, and dynamic condylar screw fixation in 2. Seven tibial osteotomies were stabilized by plate fixation in three patients, intramedullary fixation in three, and Ilizarov external fixation in one. Osteotomy improved the mean Knee Society knee scores from 49.7 to 78.1 and function scores from 36.3 to 58.4. Four osteotomies were complicated by nonunion and required further intervention.
Nine patients went on to TKA. The mean interval between osteotomy and TKA was 74 months. Hardware was removed at a mean of 59 months prior to TKA. TKA improved the mean Knee Society knee scores from 61.2 to 83.3 and function scores from 36.4 to 67.8. On survey, these patients indicated that osteotomy improved pain and function for a mean of 50 months prior to TKA. One TKA was revised after 11 months due to valgus malalignment and was complicated by a wound infection. There were no other infections or wound complications.
Conclusion/Significance: Femoral and tibial shaft osteotomy effectively delays TKA, relieves pain, and improves function in patients who present with malunion and end-stage knee arthritis. The complication rate and clinical results of TKA following shaft osteotomy appear to be similar to primary TKA.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.