The influence of osteotomies around the knee on the adjacent hip joint

Objectives: There is no doubt that osteotomies around the knee are emerging as a treatment modality for degenerative knee disease.

The influence of these osteotomies on adjacent and especially the hip is poorly understood and has not been well considered by clinicians during treatment planning.

It was the aim of this study to evaluate the influence of high tibial osteotomy and distal femur osteotomy on the adjacent hip joint.

Methods: Seventy eight patients undergoing osteotomies around the knee (high tibial osteotomy (HTO) or distal femur osteotomy (DFO)) were included in this study. Pre- and postoperative orthoradiograms in standing position were performed. The mechanical alignment of the treated limb alongside the joint line orientation, the mechanical medial proximal tibial angle (mMPTA) and mechanical lateral distal femur angle (mLDFA), femoro-ischial distance and femur adduction angle in standing position were measured pre-and postoperatively. Multivariate linear regression was performed.

Results and Conclusion: The results showed that valgisation osteotomy around the knee results in an increase in femoral adduction and reduction of femoral offset in standing position (p < 0.001). This effect is more pronounced with reverse obliquity of the joint line (p < 0.001). Varisation osteotomy around the knee resulted in an increase in femoral offset in standing position.

It is important to consider the entire limb alignment when planning an osteotomy around the knee. Overcorrection may result in extra-articular femoro-ischial Impingment in the hip joint due to loss of offset.

Overcorrection resulting in oblique joint lines should be avoided since they exacerbate this effects and double level osteotomies should be favoured in select cased to maintain physiological reference values of bony limb alignment.

Stichwörter: high tibial osteotomy; hip impingment; femoroacetabular impingement, distal femur osteotomy; osteotomy

Publication History

Article published online:
15 October 2020