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Distale Femurosteotomie in lateraler Open-wedge-Technik

Distal femoral osteotomy using a lateral opening wedge technique

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Verlagerung der Traglinie des Beins nach zentral durch Öffnen einer metaphysären Osteotomie am lateralen distalen Femur.

Indikationen

Femoral basierte Valgusfehlstellung und symptomatische unikompartimentelle laterale Gonarthrose, laterale Hyperkompression, Knorpeltherapie im lateralen Kompartiment, Meniskusersatz im lateralen Kompartiment, mediale Instabilität durch lateralen Schub („Valgus-Thrust“), Rekonstruktion des medialen Kollateralbandapparats, Patellainstabilität und/oder Maltracking.

Kontraindikationen

Fortgeschrittene Knorpelschädigung (> Grad 2) oder Z. n. subtotaler Meniskektomie des medialen Kompartiments, Alter > 65 Jahre (relativ), Nikotinabusus, Body-Mass-Index > 30, Flexionskontraktur > 25°, Korrekturen mit Osteotomiespalt > 10 mm bei angeborener Deformität, entzündliche oder infektiöse Gelenkerkrankungen, fortgeschrittene Osteoporose.

Operationstechnik

Lateraler Zugang zum distalen Femur; biplanare Osteotomie (frontale + axiale Osteotomie); graduelles Aufspreizen der Osteotomie; Fixation mittels winkelstabiler Plattenosteosynthese.

Weiterbehandlung

Keine Einschränkungen des Bewegungsumfangs, Teilbelastung mit 20 kg für 2 Wochen, anschließend beschwerdeadaptierte Aufbelastung.

Ergebnisse

Bei Patienten mit unikompartimenteller lateraler Gonarthrose kann nach varisierender distaler Femurosteotomie von einer durchschnittlichen Zunahme um 20–30 Punkte in funktionellen Scores und einer mittleren Überlebensrate von 80 % nach 10 Jahren ausgegangen werden. Die durchschnittliche Komplikationsrate liegt bei 9 %.

Abstract

Objective

To shift the weight-bearing axis of the lower limb medially by opening a lateral-based metaphyseal osteotomy at the distal femur.

Indications

Femoral-based valgus malalignment and symptomatic lateral unicompartimental osteoarthritis, lateral hyperpression syndrome, cartilage therapy of the lateral compartment, lateral meniscal replacement/transplantation, medial instability with valgus thrust, reconstruction of the medial collateral ligament, patellar instability and/or maltracking.

Contraindications

Advanced cartilage damage (>grade 2) or subtotal meniscal loss of the medial compartment, age >65 years (relative), nicotine abuse, body mass index >30, flexion contracture >25°, corrections with a wedge base >10 mm in case of congenital deformities, inflammatory or septic arthritis, severe osteoporosis.

Surgical technique

Lateral approach to the distal femur; biplanar osteotomy (frontal + axial osteotomy), gradual opening of the osteotomy, osteotomy fixation with a locking plate.

Postoperative management

Free range of motion. Partial weight bearing with 20 kg for 2 weeks, followed by progressive weight bearing thereafter.

Results

Mean improvement of knee scores from 20–30 points and mean 10-year survival rate of 80% in patients with lateral unicompartimental osteoarthritis. Mean complication rate of 9%.

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland

    M. J. Feucht

  2. Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, München, Deutschland

    J. Mehl, P. Forkel & A. B. Imhoff

  3. OrthoPlus München, München, Deutschland

    S. Hinterwimmer

Authors
  1. M. J. Feucht
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  2. J. Mehl
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  3. P. Forkel
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  4. A. B. Imhoff
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  5. S. Hinterwimmer
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Corresponding author

Correspondence to M. J. Feucht.

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Interessenkonflikt

A.B. Imhoff und S. Hinterwimmer haben eine Beratertätigkeit bei der Firma Arthrex. M.J. Feucht, J. Mehl und P. Forkel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

A.B. Imhoff, München

Zeichner

J. Kühn, Mannheim

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Feucht, M.J., Mehl, J., Forkel, P. et al. Distale Femurosteotomie in lateraler Open-wedge-Technik. Oper Orthop Traumatol 29, 320–329 (2017). https://doi.org/10.1007/s00064-017-0503-y

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  • DOI: https://doi.org/10.1007/s00064-017-0503-y

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