Varus deformities of the knee are frequently corrected by osteotomies, which should be performed at the level of origin. But in contrast to high tibial osteotomies (HTO), little data exists for distal femoral osteotomies (DFO). This study evaluates radiological and clinical outcomes after valgisation osteotomies in the proximal tibia and distal femur. We used an observational cohort study design and prospectively performed preoperative long standing radiographs (LSR), lateral x-rays and clinical questionnaires (SF-36, Lysholm score, VAS). Postoperative LSR and lateral x-rays were obtained on average 18 months postoperative and postoperative clinical questionnaires at final visit (mean follow up 46 months). A subgroup analysis of the different surgical techniques (oHTO vs. cDFO) was performed, with regards to radiological and clinical outcomes. Finally 28 osteotomies with medial tibial opening (oHTO) or lateral femoral closing (cDFO) wedge osteotomies in 25 consecutive patients (mean age 40 years) were identified. There were 17 tibal and 11 femoral procedures. All osteotomies were performed at the origin of deformity, which was of different etiology. The average deviation of the final HKA compared to the preoperative planning was 2.4° ± 0.4°. Overall, there was a significant improvement in all clinical scores (SF-36: 61.8 to 79.4, p < 0.001; Lysholm-score: 72.7 to 90.4, p < 0.001; VAS: 3 to 1, p < 0.001). There was no significant correlation between surgical accuracy and outcome scores. Valgisation osteotomies lead to a significant improvement in all clinical scores with the demonstrated treatment protocol. An appreciable proportion of varus deformities are of femoral origin. Since cDFO provides comparable radiological and clinical results as oHTO, this is an important treatment option for varus deformities of femoral origin.

中文翻译：

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内翻畸形的胫骨和股骨截骨术-放射学和临床结果

经常通过截骨术矫正膝盖的内翻畸形，应在起源水平上进行。但是与高胫骨截骨术（HTO）相比，股骨远端截骨术（DFO）的数据很少。这项研究评估了胫骨近端和股骨远端进行截骨术后的放射学和临床结局。我们采用了一项观察性队列研究设计，并进行了术前长期X线照片（LSR），侧面X射线检查和临床调查表（SF-36，Lysholm评分，VAS）。最终访视时平均术后18个月和术后临床问卷获得术后LSR和X线平片（平均随访46个月）。就放射学和临床结果而言，对不同的手术技术（oHTO与cDFO）进行了亚组分析。最终确定了25例连续患者（平均年龄40岁）中有内侧胫骨开口（oHTO）或股骨外侧闭合（cDFO）楔形截骨的28处截骨术。进行了17次胫骨和11次股骨手术。所有截骨术均在畸形的起源处进行，这是不同的病因。最终HKA与术前计划相比的平均偏差为2.4°±0.4°。总体而言，所有临床评分都有显着改善（SF-36：61.8至79.4，p <0.001； Lysholm评分：72.7至90.4，p <0.001； VAS：3至1，p <0.001）。手术准确性和结果评分之间无显着相关性。采用已证实的治疗方案，进行静脉曲张截骨术可显着改善所有临床评分。内翻畸形的相当一部分是股骨来源的。