Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee.

PURPOSE: This study was conducted to examine the long-term survivorship and functional outcome of distal femoral varus osteotomy with fresh osteochondral allograft following failed lateral tibial plateau fracture surgery. We hypothesized that this procedure would be associated with a low rate of conversion to total knee arthroplasty (TKA) at medium to long-term follow-up. METHODS: A consecutive series of 27 of distal femoral varus osteotomy combined with fresh osteochondral allograft following (27 patients) conducted between January 1981 and January 2005 for failed lateral tibial plateau fracture was retrospectively reviewed. Outcome measures included the Knee Society Knee Score (KSKS) and Knee Society Function Score (KSFS) and conversion rates to TKA. RESULTS: The study group consisted of 15 females (55.6 %) and 12 males (44.4 %), with a median age of 41.2 years (range 17-62 years). The median follow-up was 13.3 years (range 2-31 years). The knee function scores improved significantly at 2 years post-surgery (p < 0.01) from a median of 54.6 points preoperatively to 83.8 points (KSKS) and median of 50.6 points to 71.1 points (KSFS) at 2 years post-distal femoral varus osteotomy with fresh osteochondral allograft following surgery. At most recent follow-up, 4/27 patients had required conversion to TKA, and one patient had fractured the FOCA, requiring revision of the allograft. The survivorship for distal femoral varus osteotomy with fresh osteochondral allograft following was 88.9 ± 4.6 % at 10 years, 71.4 ± 18.1 % at 15 years, and 23.8 ± 11.1 % at 20 years. CONCLUSION: The use of distal femoral varus osteotomy combined with fresh osteochondral allograft following in patients with failed lateral tibial plateau fracture results in the majority of patients having good or excellent clinical outcomes and significantly delays the need for TKA in most patients. LEVEL OF EVIDENCE: Case series, Level IV.