Scientific Article   |    
Total Knee Arthroplasty After Varus Osteotomy of the Distal Part of the Femur
Charles L. Nelson, MD; Khaled J. Saleh, MD, MSc, FRCSC; Rida A. Kassim, MD; Russell Windsor, MD; Steven Haas, MD; Richard Laskin, MD; Thomas Sculco, MD
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Investigation performed at the Hospital for Special Surgery, New York, NY, the University of Pennsylvania, Philadelphia, Pennsylvania, and the University of Minnesota, Minneapolis, Minnesota

Charles L. Nelson, MD
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4271

Khaled J. Saleh, MD, MSc, FRCSC
Rida A. Kassim, MD
Department of Orthopaedics and Clinical Outcome Research Center, Health Services Research and Policy School of Public Health, University of Minnesota, 420 Delaware Street S.E., Box 492, Minneapolis, MN 55455

Russell Windsor, MD
Steven Haas, MD
Richard Laskin, MD
Thomas Sculco, MD
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Orthopaedic Research and Education Foundation and the American Geriatric Society. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Pharmacia, Stryker-Howmedica-Osteonics, DePuy, Zimmer, Smith and Nephew) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2003 Jun 01;85(6):1062-1065
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Background: There is little information in the literature regarding the outcome of total knee arthroplasty following distal femoral varus osteotomy. The purpose of the present study was to evaluate the intermediate-term results of total knee arthroplasty following distal femoral varus osteotomy.

Methods: The study group consisted of nine consecutive patients (eleven knees) who had had a total knee arthroplasty following varus osteotomy of the distal part of the femur. The average age of the patients was forty-four years (range, fifteen to seventy years) at the time of the arthroplasty. The results were evaluated with use of the Knee Society score preoperatively and after a mean duration of follow-up of 5.1 years. Radiographs made preoperatively and at the time of follow-up were evaluated for alignment in the coronal plane.

Results: The mean Knee Society knee score was 35 points before the arthroplasty and 84 points after the arthroplasty. The mean Knee Society function score was 49 points before the arthroplasty and 68 points after the arthroplasty. The mean interval between the femoral osteotomy and the total knee replacement was fourteen years (range, two to thirty-two years). A constrained prosthesis was required in five of the eleven knees. Two knees had an excellent result, five had a good result, and four had a fair result. The mean arc of motion improved from 81.8° to 105.9°. The mean radiographic alignment was 3.6° of valgus (range, 7° of varus to 18° of valgus) before the arthroplasty and 3.3° of valgus (range, 1° of valgus to 6° of valgus) at the time of the latest follow-up. There were no infections or wound complications.

Conclusion: Total knee arthroplasty following distal femoral varus osteotomy decreases pain and improves knee function, but the procedure is technically demanding and is associated with inferior results when compared with those of primary arthroplasty performed in a patient without a prior femoral osteotomy. In the present series, the use of an intramedullary femoral alignment guide increased the tendency to place the femoral component in relative varus angulation (that is, in <5° of valgus). We recommend checking the alignment of the femoral component with an extramedullary guide in knees that have had a previous distal femoral varus osteotomy.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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