Luceri Francesco, Tamini Jacopo, Ferrua Paolo, Ricci Damiano, Batailler Cécile, Lustig Sébastien, Servien Elvire, Randelli Pietro Simone, Peretti Giuseppe Maria
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy - FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004 Lyon, France.
Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy.
SICOT J. 2020;6:35. doi: 10.1051/sicotj/2020033. Epub 2020 Sep 1.
Distal Femoral Osteotomy (DFO) is a common procedure for correcting lower limb valgus deformity and lateral compartment overload. Low 20-year survivorship rate was reported with a consequent need for total knee arthroplasty (TKA). This study aims to review literature and to analyse the influence of a previous distal femoral osteotomy on outcomes of patients undergoing TKA.
A systematic literature review was performed in PubMed/Medline and Embase in May 2020. Papers were selected based on the following criteria: patient with a previous distal femoral osteotomy; total knee replacement; Pre- and Postoperative outcomes; surgical outcomes: clinical scores, range of motion, radiographic evaluation and revisions for any cause; case series, retrospective studies, observational studies, open-label studies, randomized clinical trials; systematic reviews and meta-analyses were included to extract primitive studies.
306 articles were found, of which five papers were considered eligible for this review. In every study included, postoperative clinical outcomes (Knee Society Score or Hospital for Special Surgery score) statistically improved from the preoperative. Complications were not uncommon; implant survivorship at the available follow-up seems to be similar to primary TKA, although being too short to draw any conclusions.
Limited and highly heterogeneous evidence is currently available on the influence of DFO on outcomes after TKA. Knee replacement improves clinical middle-term outcomes in patients with previous distal femoral osteotomy. In this complex surgery, the use of technical tips and tricks could help surgeons to obtain an accurate knee balancing and better long-term results.
股骨远端截骨术（DFO）是矫正下肢外翻畸形和外侧间室负荷过重的常见手术。据报道，该手术20年生存率较低，因此需要进行全膝关节置换术（TKA）。本研究旨在回顾文献，并分析既往股骨远端截骨术对接受TKA患者预后的影响。
2020年5月在PubMed/Medline和Embase上进行了系统的文献综述。根据以下标准选择论文：有既往股骨远端截骨术的患者；全膝关节置换术；术前和术后结果；手术结果：临床评分、活动范围、影像学评估以及任何原因导致的翻修；病例系列、回顾性研究、观察性研究、开放标签研究、随机临床试验；纳入系统评价和荟萃分析以提取原始研究。
共检索到306篇文章，其中5篇被认为符合本综述的要求。在纳入的每项研究中，术后临床结果（膝关节协会评分或特种外科医院评分）在统计学上均较术前有所改善。并发症并不少见；在现有的随访中，植入物生存率似乎与初次TKA相似，尽管随访时间过短，无法得出任何结论。
目前关于DFO对TKA术后预后影响的证据有限且高度异质性。膝关节置换术可改善既往有股骨远端截骨术患者的中期临床结果。在这种复杂的手术中，运用技术技巧有助于外科医生实现准确的膝关节平衡并获得更好的长期效果。
