Experiences in Total Knee Arthtroplasty After Distal Femoral Varus Osteotomy (Health) (Report‪)‬

1. INTRODUCTION Osteotomies around the knee for the purpose of unloading the affected compartment and correction of the underlying deformity are a well recognised treatment alternative for symptomatic osteoarthritis of the knee in active patients [1]. Varus deformity with medial compartment arthritis is more common than valgus deformity with lateral compartment involvement [1,2]. Several studies reported good outcomes lasting more than a decade for patients with varus deformity treated by high valgus tibial osteotomy in appropriately selected patients. For a valgus deformity of more than 12[degrees] or in situations where the plane of the joint is deviated from the horizontal by more than 10[degrees], a distal femoral varus osteotomy (DFVO) should be preferred [1]. A recent study indicated good mid-term success rates of DFVO even in the presence of moderate patellofemoral arthritis at a mean follow-up of 99 months [3]. Edgerton et al. [4] reported on 23 patients (24 knees managed with DFVO) and found 71% with good or excellent results at a mean follow-up of 8.3 years. In a recent study by Kosashvili et al. [1] 33 consecutive DFVOs (31 patients) with a minimum follow-up of ten years (mean 15.1, range 10-25) were reviewed. Fifteen DFVOs were converted to total knee arthroplasty (TKA) and one DFVO was awaiting TKA. The authors came to the conclusion that DFVO is reliably in delaying the need for TKA by more than a decade as conversion to TKA in less than ten years occurred in 6.1%. Success of primary TKA with knee osteoarthritis is well established, and about 85% of patients are satisfied with the surgical outcome [5]. In the past, there have been reports of technical difficulties after failed high tibial head osteotomy that influenced outcomes of knee replacement. There is only little information available in TKA following DFVO [6-8]. The aim of our study was to show our experiences and mid-term results of TKA after a previous DFVO.