Osteotomy for Correction of Genu Valgum After TKR

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
– Fabricant et al, Orthopaedics 2013

DFO is planned in the
supracondylar region
regardless of the CORA

Single level osteotomy

Intentional overcorrection
of the mechanical axis

No need for translation
Planning
– Fabricant et al, Orthopaedics 2013
X

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 =

Osteotomy wedge size (Z)
6°

XO - PMA
Z

Surgical Technique
Osteotomy completed
Plate fixation completed
Bone grafts inserted
Case 1: Postop
R knee: preop and postop radiographs
Preop and postop long leg radiographs
R ankle: preop and postop radiographs
Case 1: Correction Measurements
Measurement
PreOP
PostOP
LDFA
84º
89º
MAD
57 mm lateral
0 mm
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 clinical photographs
Preop and postop long leg radiographs
Case 2: Correction Measurements
Measurement
PreOP
PostOP
LDFA
86º
90º
MAD
27 mm lateral
0 mm
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