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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2010 October;61(5):381-92
Corrections of axial deviations of the lower extremities in children and adults
Moreschini O., Palmesi A., Pelle S., Mazzotta G.
Clinica Ortopedica Policlinico Umberto I,, Roma, Italia
Aim. One of the physical characteristics of the human skeleton showing remarkable individual variability is knee conformation. Allowing for variation of normal, an angle of 0° to 5° between the femoral and the tibial axis is considered acceptable, although no normotype exists. In persons prone to gonarthrosis, significant axial deviation of the knee, particularly varus deviation, can lead to degenerative joint changes in adulthood. In this retrospective study, clinical and radiographic outcomes were evaluated in 25 patients undergoing staple epiphysiodesis or opening wedge osteotomy (varusizing or valgusizing) and Puddu plate fixation for axial deviation of the knee (genu varum or valgum). A further aim of the study was to underline the importance of adequate and prompt treatment with appropriate timing of intervention with a view to obviate the need for later knee arthroplasty (unicompartmental prosthesis).
Methods. The series was composed of 25 patients operated for axial deviation of the knee: 16 (10 males and 6 females; mean age, 40 years, range, 14-58 years) underwent osteotomy; 9 (6 males and 3 females; mean age, 12.5 years, range, 11-14) underwent staple epiphysiodesis. All patients underwent preoperative clinical and radiographic assessment. In the latter group, the staples were inserted into the femur or tibia to correct valgus or varus deviation, respectively. Follow-up examinations showed a significant improvement in mechanical axis deviation of the lower extremity. The patients in the former group were operated either for deformities that had caused unicompartmental gonarthrosis or for fractures. Prior to osteotomy, arthroscopy was performed to treat joint damage (meniscal debridement, condroabrasion and/or subcondral perforation, partial synovectomy) followed by open surgery. The mean duration of follow-up was 5 years. Clinical, functional and radiographic outcomes were assessed.
Results. A significant improvement in pain symptoms and knee joint function was noted in all patients. No complications (neurologic, vascular, fractures) occurred. All osteotomies consolidated and the degree of correction remained, with slight variations, unchanged. No postoperative complications developed. In properly selected patients, tibial and femoral addition osteotomy with the Puddu plate, as well as staple epiphysiodesis, were found to be optimal techniques for femorotibial axis correction in the treatment and prevention (epiphysiodesis) of unicompartmental gonarthrosis.
Conclusion. The reliability, reproducibility and simplicity of the technique, together with the maintenance of mid- and long-term outcomes, argue for epiphysiodesis as a useful alternative to conservative correction should such methods fail. Puddu’s osteotomy was found to be a valuable alternative to uni- or tricompartmental knee arthroplasty, conventional external subtraction osteotomy (Coventry), and hemicallotasis.