Surgical treatment of arthritic valgus knee: femoral supracondylar osteotomy or knee replacement?

Twenty-two of the 24 patients operated on with femoral supracondylar osteotomy for arthritic valgus knee between 1978 and 1987 were evaluated, comparing the results with those obtained in a similar group of 10 patients with the same disorder treated with knee replacement during the same period. From a functional viewpoint and according to the Hospital for Special Surgery rating scale, the results of the osteotomy were not significantly different from the extremely positive outcome of the knee replacement. However, as far as pain is concerned, only 50% of the osteotomy patients were completely asymptomatic after the operation. In the 50% of the osteotomy patients with post-operative under or over correction of the mechanical axis of the knee, the results were unsatisfactory. Finally, there was only one case of delayed union. In the light of these results, in contrast to what has been said by other authors, femoral osteotomy may be considered a valid alternative to knee replacement in the treatment of arthritic valgus knee in active subjects, less than 65 years old, with a valgus angulation of no more than 15 degrees and Ahlback stage 2 beta arthritis of the lateral compartment. It is, however, a technique which requires extreme precision both in planning and performing the operation.