Medial closing wedge distal femoral osteotomy in 'Rescue Realignment' post primary total knee arthroplasty: A mini-case-series of three cases.

Abstract

Medial closing wedge distal femoral osteotomy (MCWDFO) is an effective procedure mainly indicated for correction of the valgus malaligned native knee. Nevertheless, valgus malalignment has been reported following total knee arthroplasty (TKA). Therefore, employing a realignment osteotomy for a symptomatic valgus malaligned TKA could be a potential rescue from an unnecessary revision surgery with high morbidity and mortality and uncertain outcome. The following report describes 3 consecutive cases presented with symptomatic valgus malalignment following primary TKA. The 3 cases were treated with MCWDFO to improve the overall limb alignment and biomechanics. Preoperative and postoperative alignment indices were recorded from long leg standing radiographs (LSRs). Patient reported outcome measures, assessed by simple knee value (SKV) scores, visual analogue scale (VAS) for pain and patient satisfaction were reported preoperatively and postoperatively at the latest follow up. Postoperatively, the overall limb alignment has been corrected as represented by the mechanical tibiofemoral angle and Mikulicz line. No intraoperative or postoperative complications were reported. At the final follow up (8 years for two cases and 2 years for one case), significant improvements in patient reported outcome measures, as assessed by the simple knee value and VAS pain scores and 100% satisfaction, were observed. Medial closing wedge distal femoral osteotomy can be employed in rescue realignment of valgus malalignment post primary TKA with resultant significant improvement in patient reported outcome measures, and 100% satisfaction with no complications in a small series.