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Distal femoral osteotomy in patient with valgus knee due to hereditary multiple osteochondromas
ESSKA Academy. Amaro P. Nov 8, 2019; 284369; epEKA-29 Topic: Open Surgery
Pedro Amaro
Pedro Amaro
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Distal femoral osteotomy in patient with valgus knee due to hereditary multiple osteochondromas

ePoster - epEKA-29

Topic: HTO

Amaro P., Viegas R., Cardoso A., Barbosa L., Coelho A.M., Jesus M., Carvalho Silva R.
Hospital Beatriz Angelo, Lisbon, Portugal

Introduction: Hereditary multiple exostosis (HME) is a dominantly inherited genetic disorder characterized by multiple benign tumours with an overlying hyaline cartilage cap, primarily on long bones. It has a wide spectrum of clinical manifestations, the most common presentation being exostosis in the lower limbs, expressed by pain, bowing of long bones and limb length discrepancy. Various methods have been described to correct the valgus deformity at the knee, but limb alignment in HME patients is challenging.
Methods: We present a case of a 40 year-old Caucasian male personal history of HME. He complained of chronic lateral compartment knee pain with ambulation and impact activities. On physical examination multiple palpable lesions at the proximal tibial and distal femur were identified. The range of motion of the knee was not impaired and there was no neurovascular deficit. Anteroposterior, lateral and Skyline view radiographs showed preservation of the joint space. Full-length standing alignment view revealed a 17º valgus alignment. The mechanical medial-proximal tibial angle and the mechanical lateral-distal femoral angle were evaluated and the femoral malalignment was confirmed as the deformity origin. The magnetic resonance imaging revealed multiple osteochondromas, the largest one, located at the distal femur with 5 cm diameter. Also, showed isolated lateral compartment osteoarthritis, with no medial or patellofemoral chondral lesions. A lateral meniscus bucket handle tear was also revealed.
Diagnostic arthroscopy was performed to confirm that there was isolated lateral compartment disease. Patient was submitted to arthroscopic lateral partial meniscectomy and medial closing-wedge distal femoral osteotomy.
Results: One year after the procedure the patient is asymptomatic with no limitation on his daily activities. The full-length standing view radiographs reveals a 3º valgus alignment and no osteoarthritis progression according to Kellgren and Lawrence classification.
Conclusions: Osteochondromas generally affect the extremities of the long bones in an immature skeleton and deform them. Although osteochondromas do not directly affect these patients' life expectancy, lower limb valgus alignment can result in early-onset osteoarthritis. As shown in this case, varus-producing distal femoral osteotomy can be an excellent option to improve pain and function in patients with isolated lateral compartment disease and valgus alignment.
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