Orthopedic surgeons should focus on four key prognostic factors related to femoral osteotomies to improve their patients’ outcomes with the procedure, according to a presenter at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress, here.
“Femoral osteotomy remains a valid treatment for lateral osteoarthritis. Improved patient selection, planning, fixation and osteotomy techniques will lead — but we have to prove that — to better results,” Ronald J. van Heerwaarden, MD, said during his presentation.
According to van Heerwaarden, of Woerden, The Netherlands, a radiograph is a good method to confirm the proper patient is selected, someone with true lateral compartment osteoarthritis and deformity that is present just in the femur.
“It is all about planning,” he said.
Measurements should be down to the millimeter so that both the planning and the osteotomy are done accurately.
Van Heerwaarden encouraged his colleagues who perform lateral femoral osteotomies to read the “new” results in the literature and to learn how to use a biplane technique.
“I think you should try to go over to biplane techniques,” he said, and then he showed some examples of how they can lead to a successful result and good alignment.
Osteotomy fixation is another prognostic factor he discussed, but “you can talk for hours about fixation,” van Heerwaarden said.
Although he was trained using the AO angle blade plate, he said today he finds it challenging to carry out the lateral femoral osteotomy with that implant. “It is easier with angle stable plates, which I use often. There are many other solutions. If you tailor the fixation strength of your construct to postop rehab, you can use any plate.”