Supracondylar Osteotomy for Correction of Deformities of the Knee in Poliomyelitis

Lee, Duk Yong; Ahn, Byoung Wan; Kim, Yang

Abstract

Supracondylar osteotomy was performed on 78 knees in 65 patients with poliomyelitis for correction of deformities of the knee at the Department of Orthopedic Surgery, Seoui National Unlversity Hospital, during the 16 years from January 1963 to December 1978. Following observations were made from the review of statistics, technical problems, and complications of the operation. 1. The ages of the patients ranged from 4 years to 28 years, the average being 15 years. Two thirds of the patients were in the second decade. 2. 37 knees (47.4%) had flexion deformity, 19 knees (24.4%) flexion-valgus deformity, and 13 knees (16.7%) flexion-valgus-external rotation deformity. The amount of flexion deformity ranged from 7 degrees to 90 degrees, the average being 22 degrees. Valgus deformity ranged from 3 degrees to 25 degrees, the average being 12 degrees. External rotation deformity ranged from 5 degrees to 30 degrees, the average being 18 degrees. 3. The operative techniques employed were categorized into 5 types. The most common type was a closed wedge hinged osteotomy (Technique I), which was employed on 50 knees (64.1%). Satisfactory results were obtained by combining other procedures, when necessary, i.e. pre-operative skeletal traction, Yount fasciotomy, high tibial rotation osteotomy hamstring transfer and epiphysiodesis. 4. The time required for union was the shortests in the Technique 1 group, and longest in the Technique III group, a complete osteotomy with bone shortening. 5. The most common complication was stiff knee, which was encountered in 10 knees. Residual or recurrent deformity was observed in 4 knees, in 3 of which hamstring transfer was recommended but was not consumated. Delayed union was observed in 3 knees in the Technique II group (closed wedge complete osteotomy) and in 1 knee in the Technique III group. Nonunion occured in 1 knee in the Technique II group. The incidence of complications were higher in the Technique II and III groups, and lowest in the Technique I group.