Clark Sean C, Pan Xuankang, Saris Daniel B F, Taunton Michael J, Krych Aaron J, Hevesi Mario
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopedic Surgery, University Medical Center, Utrecht University, Utrecht, The Netherlands.
Bone Jt Open. 2024 Nov 11;5(11):1013-1019. doi: 10.1302/2633-1462.511.BJO-2024-0152.R1.
Distal femoral osteotomies (DFOs) are commonly used for the correction of valgus deformities and lateral compartment osteoarthritis. However, the impact of a DFO on subsequent total knee arthroplasty (TKA) function remains a subject of debate. Therefore, the purpose of this study was to determine the effect of a unilateral DFO on subsequent TKA function in patients with bilateral TKAs, using the contralateral knee as a self-matched control group.
The inclusion criteria consisted of patients who underwent simultaneous or staged bilateral TKA after prior unilateral DFO between 1972 and 2023. The type of osteotomy performed, osteotomy hardware fixation, implanted TKA components, and revision rates were recorded. Postoperative outcomes including the Forgotten Joint Score-12 (FJS-12), Tegner Activity Scale score, and subjective knee preference were also obtained at final follow-up.
A total of 21 patients underwent bilateral TKA following unilateral DFO and were followed for a mean of 31.5 years (SD 11.1; 20.2 to 74.2) after DFO. The mean time from DFO to TKA conversion was 13.1 years (SD 9.7) with 13 (61.9%) of DFO knees converting to TKA more than ten years after DFO. There was no difference in arthroplasty implant systems employed in both the DFO-TKA and TKA-only knees (p > 0.999). At final follow-up, the mean FJS-12 of the DFO-TKA knee was 62.7 (SD 36.6), while for the TKA-only knee it was 65.6 (SD 34.7) (p = 0.328). In all, 80% of patients had no subjective knee preference or preferred their DFO-TKA knee. Three DFO-TKA knees and two TKA-only knees underwent subsequent revision following index arthroplasty at a mean of 12.8 years (SD 6.9) and 8.5 years (SD 3.8), respectively (p > 0.999).
In this self-matched study, DFOs did not affect subsequent TKA function as clinical outcomes, subjective knee preference, and revision rates were similar in both the DFO-TKA and TKA-only knees at mean 32-year follow-up.
股骨远端截骨术（DFO）常用于矫正外翻畸形和外侧间室骨关节炎。然而，DFO对后续全膝关节置换术（TKA）功能的影响仍是一个有争议的话题。因此，本研究的目的是通过将对侧膝关节作为自身配对对照组，确定单侧DFO对双侧TKA患者后续TKA功能的影响。
纳入标准为1972年至2023年间在先前单侧DFO后接受同期或分期双侧TKA的患者。记录所进行的截骨术类型、截骨硬件固定、植入的TKA组件和翻修率。在最终随访时还获得了术后结果，包括遗忘关节评分-12（FJS-12）、Tegner活动量表评分和主观膝关节偏好。
共有21例患者在单侧DFO后接受了双侧TKA，并在DFO后平均随访31.5年（标准差11.1；20.2至74.2年）。从DFO到TKA转换的平均时间为13.1年（标准差9.7），其中13例（61.9%）DFO膝关节在DFO后十年以上转换为TKA。DFO-TKA膝关节和仅行TKA膝关节所采用的关节置换植入系统没有差异（p>0.999）。在最终随访时，DFO-TKA膝关节的平均FJS-12为62.7（标准差36.6），而仅行TKA膝关节的平均FJS-12为65.6（标准差34.7）（p=0.328）。总体而言，80%的患者没有主观膝关节偏好或更喜欢他们的DFO-TKA膝关节。3例DFO-TKA膝关节和2例仅行TKA膝关节在初次关节置换术后分别平均12.8年（标准差6.9）和8.5年（标准差3.8）进行了后续翻修（p>0.999）。
在这项自身配对研究中，在平均32年的随访中，DFO-TKA膝关节和仅行TKA膝关节的临床结果、主观膝关节偏好和翻修率相似，DFO并未影响后续TKA功能。
