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Opening-wedge osteotomies of the distal femur: minor advantages for a biplanar compared to a uniplanar technique

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Valgus malalignment of the distal femur may be treated with corrective osteotomy. The purpose of this study was to compare the primary stability of a lateral opening-wedge osteotomy (LOWO) using a uniplanar compared to a biplanar technique. A study was carried out to test both surgeries, with both an intact medial cortex and with a deliberate attached cut of the medial cortex simulating a fracture. The primary hypothesis was that the biplanar technique provides higher axial and torsional stiffness. It was further hypothesized that the mechanical superiority of the biplanar technique would not be affected in the case of breakage of the far medial cortex.

Methods

A LOWO was performed in ten synthetic femora (#3406 left large Femur, 4th Generation, Sawbones, Malmö, Sweden) using a lateral angle stable locking plate (NCB© Distal Femur Plate, Zimmer Biomet, Warsaw, USA). A uniplanar osteotomy was performed in five femora, and a biplanar osteotomy was performed in five femora. The femora were tested for axial and torsional loads using a servo-hydraulic testing machine (Instron 8874, Instron Structural Testing GmbH, High Wycombe, UK).

Results

Axial stiffness decreased significantly (p = 0.001) in both groups (20% in the uniplanar group and 28 % in the biplanar group) by cutting the medial cortex. The type of osteotomy had no significant effect. A slightly lower but not statistically significant axial stiffness was seen in the biplanar group both for intact and broken medial cortices. Internal torsional stiffness dropped by more than 30% for the uniplanar group and almost 24% for the biplanar group when the cortex was cut (p < 0.001). No significant change concerning internal torsional stiffness was found between the two groups. External torsional stiffness decreased by 32% for the uniplanar group and 4% for the biplanar group after the cortical cut (p = 0.029). No significant change concerning external torsional stiffness was found between the groups, but the biplanar group showed a tendency towards higher values of external torsional stiffness.

Conclusions

The axial and torsional stiffness of the implant-bone construct were not significantly affected by the type of osteotomy performed. Biplanar osteotomy tended to increase external torsional stiffness. In cases of fracture of the medial cortex, biplanar osteotomy significantly reduced the external rotation at the osteotomy and showed a significantly increased external torsional stiffness.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria

    Martin Pietsch & Markus Hochegger

  2. Institute of Biomechanics, Trauma Center Murnau, Prof.-Kuentscher-Straße 8, 82418, Murnau, Germany

    Martin Winkler & Sabrina Sandriesser

  3. Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria

    Thomas Freude

  4. Institute of Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria

    Peter Augat

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  1. Martin Pietsch
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Correspondence to Martin Pietsch.

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In Europe mechanical tests on plastic materials are not subject to ethical approval by any review board. Thus, IRB approval is not available and not required for this project.

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Pietsch, M., Hochegger, M., Winkler, M. et al. Opening-wedge osteotomies of the distal femur: minor advantages for a biplanar compared to a uniplanar technique. Knee Surg Sports Traumatol Arthrosc 27, 2375–2384 (2019). https://doi.org/10.1007/s00167-018-5332-5

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  • DOI: https://doi.org/10.1007/s00167-018-5332-5

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