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15.01.2022 | KNEE

No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy

verfasst von: Andreas Flury, Armando Hoch, Sandro Hodel, Florian B. Imhoff, Sandro F. Fucentese, Patrick O. Zingg

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 2/2023

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Abstract

Purpose

The purpose of this study was to investigate if one level of corrective femoral osteotomy (subtrochanteric or supracondylar) bears an increased risk of unintentional implications on frontal and sagittal plane alignment in a simulated clinical setting.

Methods

Out of 100 cadaveric femora, 23 three-dimensional (3-D) surface models with femoral antetorsion (femAT) deformities (> 22° or < 2°) were investigated, and femAT normalized to 12° with single plane rotational osteotomies, perpendicular to the mechanical axis of the femur. Change of the frontal and sagittal plane alignment was expressed by the mechanical lateral distal femoral angle (mLDFA) and the posterior distal femoral angle (PDFA), respectively. The influence of morphologic factors of the femur [centrum–collum–diaphyseal (CCD) angle and antecurvatum radius (ACR)] were assessed. Furthermore, position changes of the lesser (LT) and greater trochanters (GT) in the frontal and sagittal plane compared to the hip centre were investigated.

Results

Mean femoral derotation of the high-antetorsion group (n = 6) was 12.3° (range 10–17°). In the frontal plane, mLDFA changed a mean of 0.1° (− 0.06 to 0.3°) (n.s.) and − 0.3° (− 0.5 to − 0.1) (p = 0.03) after subtrochanteric and supracondylar osteotomy, respectively. In the sagittal plane, PDFA changed a mean of 1° (0.7 to 1.1) (p = 0.03) and 0.3° (0.1 to 0.7) (p = 0.03), respectively. The low-antetorsion group (n = 17) was rotated by a mean of 13.8° (10°–23°). mLDFA changed a mean of − 0.2° (− 0.5° to 0.2°) (p < 0.006) and 0.2° (0–0.5°) (p < 0.001) after subtrochanteric and supracondylar osteotomy, respectively. PDFA changed a mean of 1° (− 2.3 to 1.3) (p < 0.01) and 0.5° (− 1.9 to 0.3) (p < 0.01), respectively. The amount of femAT correction was associated with increased postoperative deviation of the mechanical leg axis (p < 0.01). Using multiple regression analysis, no other morphological factors were found to influence mLDFA or PDFA. Internal rotational osteotomies decreased the ischial-lesser trochanteric space by < 5 mm in both the frontal and sagittal plane (p < 0.001).

Conclusions

In case of femAT correction of ≤ 20°, neither subtrochanteric nor supracondylar femoral derotational or rotational osteotomies have a clinically relevant impact on frontal or sagittal leg alignment. A relevant deviation in the sagittal (but not frontal plane) might occur in case of a > 25° subtrochanteric femAT correction.

Level of evidence

IV.
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Metadaten
Titel
No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy
verfasst von
Andreas Flury
Armando Hoch
Sandro Hodel
Florian B. Imhoff
Sandro F. Fucentese
Patrick O. Zingg
Publikationsdatum
15.01.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 2/2023
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-021-06843-x

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