Simultaneous Peri-Articular Femoral Osteotomy and Total Knee Arthroplasty for Treatment of Osteoarthritis Associated With A Severe Valgus Deformity of >45°

Introduction & Case: A 76 year old woman presented with a painful, valgus right knee measuring 49°. She had a simultaneous peri-articular femoral osteotomy and total knee arthroplasty. Pre and post operative WOMAC and VAS scores were obtained. Results: At 6 weeks, the patient was fully weight bearing without any aids; radiographs demonstrated bony union with good alignment. At one year, the patient was pain free, with a ROM of 0° to 110° without a quadriceps lag. There was a marked improvement in the WOMAC and VAS scores. Conclusion: We believe that this operative technique in severely valgus knees allows for excellent correction of malalignment and aids soft tissue balance with good patient outcome. Case Report Volume 1 Issue 2 2014 Fahad Attar* Department of Orthopaedics, Lincoln County Hospital, UK *Corresponding author: Fahad Attar, Department of Orthopaedics, Lincoln County Hospital, Lincoln, LN2 5QY, UK, Tel: +44-0-1522573151; Fax: +44-0-1522573830; Email: [email protected] Received: May 20, 2014 | Published: July 30, 2014 Figure 1: Preoperative AP view of the knee. Simultaneous Peri-Articular Femoral Osteotomy and Total Knee Arthroplasty for Treatment of Osteoarthritis Associated With A Severe Valgus Deformity of >45° Citation: Attar F (2014) Simultaneous Peri-Articular Femoral Osteotomy and Total Knee Arthroplasty for Treatment of Osteoarthritis Associated With A Severe Valgus Deformity of >45°. MOJ Orthop Rheumatol 1(2): 00007. DOI: 10.15406/mojor.2014.01.00007 Copyright:  2014 Attar 2/4 was stabilized with bone clamps throughout the remainder of the procedure. The distal femur cut was made using an extra-medullary alignment guide; the femoral canal was then progressively reamed to allow the use of a femoral stem and the AP cuts were made in a standard 3° of external rotation. This left a large defect in the lateral femoral condyle, which was curetted and bone grafted. Attention was then turned to the tibia, the medullary canal was progressively reamed for the diaphyseal fitting tibial stem, and an intra-medullary guide used to cut the medial plateau. The lateral tibial plateau was freshened with the saw, and this defect addressed with the use of a tibial augment. A trial was performed; PCL and popliteus were released in order to obtain a balanced resection. The implants were cemented in place. The patella tracked laterally at the end of the procedure, despite patella resurfacing. In order to address this quadricepsplasty and vastus medialis oblique (VMO) advancement was performed, allowing compensation for the change in alignment from extreme valgus to neutral alignment; the patella tracked well following this. The range of motion at the end of the operation was 0° to 120°. Post operatively, full ROM and full weight bearing was permitted from post-operative day two. By six week follow up the patient was fully weight bearing without any aids; radiographs demonstrated bony union at the osteotomy site with good alignment (Figure 4-6). At one year review, the patient was pain free, with a ROM of 0° to 110° without a quadriceps lag, and with clinically acceptable alignment (Figure 7). Pre and postoperative knee scores are listed in Table 1.