Surgical approach to correction of severe knee malalignment in a pediatric population in Tanzania

Abstract

Aim: Severe knee malalignment in children usually needs surgery with different options available in surgical approaches. The aim of this study was to report the results of the surgical correction of severe knee malalignment in children treated with femoral and tibial osteotomy, temporarily fixed with percutaneous Kirschner wires, in a low- and middle-income country (LMIC), with limited medical resources. Materials and methods: Thirty children (age range 4–9 years) with severe knee malalignment were observed and surgically treated in a small children hospital located in the Tanzanian rural outback. A total of 53 deformities were treated. Thirty-two knees presented varus deformity and 21 knees presented valgus deformity. In 9 cases, femoral osteotomy alone was performed, tibial osteotomy alone in 28 cases, combined femoral and tibial osteotomy in 16 cases. Fixation was obtained with crossed percutaneous Kirschner wires, and a post-operative long-leg cast immobilization was applied. Results: Mean pre-operative varus passed from 40°±4 to post-operative 5°±6 valgus. Mean pre-operative valgus passed from 39°±4 to post-operative 8°±5 valgus. Complications included delayed healing of the wounds, skin suffering at the outlet of Kirschner wires, knee stiffness, undercorrection and overcorrection of the deformity. Results were considered excellent in 18 cases, good in 21, fair in 11, poor in 3. Conclusions: This technique allowed us to obtain satisfactory correction of severe knee malalignment with less invasive surgery. Inexpensive hardware such as Kirschner wires, combined with cast immobilization, allowed satisfactory fixation of the osteotomy, and reduction of the overall cost of surgery, as it should be desirable in LMICs.