OSTEOTOMIES ABOUT

THE KNEE

Rod Martin M.D. FRCS(C)

Outline
 Introduction
 Distal Femoral Osteotomy
 Proximal Osteotomies of the Tibia
– Closing wedge osteotomy
 Coventry
 Slocum
 HTO with jig & plate

– Barrel-vault osteotomy
– Opening wedge osteotomy
OSTEOTOMIES ABOUT
THE KNEE
 Patients with malalignment and
unicompartment disease
 Varus(4X) & valgus(5X) OA
 2020 OA will have largest increase of
new cases of any disease
 Unicompartment OA 30-60 age group
 High demand / middle aged athlete
Varus Distal Femoral
Osteotomy
 Indications  25-22
– Valgus deformity >
12 to 15 degrees
– Plane of the knee
deviates from the
horizontal >10
degrees
Distal Femoral Osteotomy

 Reported success 71% - 86%

 Poor results with RA
 Satisfactory results with TKR 94%
– (13 of 18 had complications)
– Difficulty restoring desired 5-10 degrees
valgus
Coventry Distal Femoral
Osteotomy
 Coventry  25-23
– Medial or midline
incision
– Rectus/medialis
interval
– Insert blade at
templated angle
– Osteotomy of femur
– Close wedge/secure
plate
Proximal Osteotomies of
the Tibia
 Treatment of unicompartmental OA
 80% satisfactory results @ 5 years
 Varus deformity = medial OA
 Valgus deformity = lateral OA
 Osteotomy “unloads” the “overloaded”
Proximal Osteotomies of
the Tibia
 Coventry (1965)
– Medial closing wedge for valgus deformity
– Lateral closing wedge for varus deformity
– Advantages
 Near the deformity
 Cancellous bone heals quickly
 Fragments held firmly by 1-2 staples
 Permits evaluation of the knee through the same
incision
Proximal Osteotomies of
the Tibia
 Coventry (1979)
– 80% at 5 years & 60% at 10 years (213
knees)
– Recurrence of deformity = recurrence of
pain
– Minimum “overcorrection” 8 degrees
valgus
– >30% ideal body weight = high failure
Proximal Osteotomies of
the Tibia
 Indications
– Pain and disability
– Unicompartment OA
– Ability to use crutches post-op
– Good vascular status
Proximal Osteotomies of
the Tibia
 Contraindications
– Narrowing of lateral compartment
– Lateral tibial subluxation of > 1 cm
– Medial compartment bone loss > 2-3 mm
– Flexion contracture > 15 degrees
– Knee flection < 90 degrees
– Correction of > 10-15 degrees
– Inflammatory arthropathies
Proximal Osteotomies of the
Tibia
 Coventry correction formula

– (1) Normal valgus (5-8 degrees)

– (2) + amount of varus deformity
– (3) + “overcorrection factor” of 3 to 5
degrees
= total correction required
(approx. 1 mm / degree)
Proximal Osteotomies of the
Tibia
 25-10
Proximal Osteotomies of
the Tibia (Coventry)
Proximal Osteotomies of
the Tibia (Coventry)
Proximal Osteotomies of
the Tibia (Slocum)
Proximal Osteotomies of
the Tibia (jig and plate)
Proximal Osteotomies of the
Tibia
Proximal Osteotomies of the
Tibia
 Maquet (barrel-vault) osteotomy
– Inherently stable
– “extensive” degrees of correction possible
– Technically difficult
– Intraarticular fracture
– Scarring about the patellofemoral
mechanism
Proximal Osteotomies of
the Tibia (Barrel-vault)
Proximal Osteotomies of the
Tibia
 Medial opening
wedge osteotomy
– Does not “shorten”
the extremity
– Correct medial laxity
– Surgery directed to
the diseased
compartment
– Corrects up to 15˚
Proximal Osteotomy of the
Tibia (opening wedge)
conclusions

 Delays/avoids arthroplasty
 Refute claims osteotomies compromise
arthroplasty
 Second “wave” of osteotomies coming
43 year female with
increasing knee pain
M.B. 43 year female
increasing
knee pain
Opening wedge HTO
 6mos post op
 Resumed all adl’s
 “knee feels 75%
better”
Thank you