Osteotomy for Correction of Genu Valgum After TKR
Yatin Kirane, MBBS, D.Ortho, MS, PhD S. Robert Rozbruch, MD
Limb Lengthening and Complex Reconstruction Service Hospital for Special Surgery, New York, NY
Disclaimer I have nothing else to disclose
Introduction: Residual deformities after TKR are common – Russo et al, Knee 2008; Sorrells et al, Knee 2007
Malalignment leads to inferior outcomes and decreased prosthesis survivorship
- Jeffery et al, JBJS 1991; Bargren et al, CORR 1983; Ritter et al, CORR 1994; Fang et al, J Arthoplasty
2009; Sikorski JM. JBJS 2008; Lotke P and Ecker M JBJS 1977; Vince KG et al, JBJS 1989; Sharkey et al,
CORR 2002
Correction of significant deformity after TKR
◦ Revision TKR – Sharkey et al, CORR 2002; Gothensen et al, J Bone Joint 2013
◦ Extra-articular osteotomy
Two Cases of Juxta-articular
Distal Femoral Osteotomy
After TKR
Case 1: Preop 77M
Rt TKR 7 years ago
Difficulty walking
15° genu valgum MAD 57mm lateral LDFA 84°
Rt ankle PTOA and varus
Preop clinical photographs
Planning
DFO is planned in the supracondylar region regardless of the CORA
Single level osteotomy
Intentional overcorrection of the mechanical axis
No need for translation
– Fabricant et al, Orthopaedics 2013
Planning – Fabricant et al, Orthopaedics 2013
DMA = Distal mechanical axis
Point X = desired femoral head location
PMA = Proximal mechanical axis 6° off anatomical axis
Point O = desired osteotomy level
Correction angle = XO - PMA
Osteotomy wedge size (Z)
X
6°
Z
Surgical Technique
Osteotomy completed Plate fixation completed Bone grafts inserted
Case 1: Postop
R knee: preop and postop radiographs
R ankle: preop and postop radiographs Preop and postop long leg radiographs
Measurement PreOP PostOP
LDFA 84º 89º
MAD 57 mm lateral 0 mm
Case 1: Correction Measurements
Case 2: Preop 82F
Bil TKR 18 yrs ago
Difficulty walking with bil foot drop
Bil genu valgum Rt 9°, Lt 5°
Rt MAD 27mm lateral LDFA 86
Lt ankle OA
Preop clinical photographs
Case 2: Postop
Preop and postop long leg radiographs
Preop and postop clinical photographs
Measurement PreOP PostOP
LDFA 86º
90º
MAD 27 mm lateral 0 mm
Case 2: Correction Measurements
Conclusions & Discussion
With accurate planning & execution, a DFO –
is a safe procedure after TKR
can successfully correct residual knee valgus deformity after TKR
is a good alternative to revision TKR in the presence of well-fixed, well-balanced TKR prostheses
