Distraction surgery (KJD) was performed using an external fixation frame (Monotube Triax, Stryker, Kalamazoo, MI, United States) consisting of two dynamic monotubes, bridging the knee medially and laterally and fixated to the tibia and femur using eight half-pins [25 (link)]. During surgery, the knee was distracted 2 mm, extended for an additional 1 mm per day during a short hospitalization until 5 mm distraction was reached, confirmed radiographically. Subsequently, patients were discharged with a prophylactic anticoagulant prescribed for use during treatment, and were allowed full weight-bearing on the distracted knee, supported by crutches if needed. After six weeks, the frame and pins were surgically removed during day treatment.
For HTO patients, bi-plane medial-based opening-wedge osteotomy was performed. The method of Miniaci was used to preoperatively define the amount of correction needed, and TomoFix medial high tibial plates and screws (DePuy Synthes, Switzerland) or a Synthes locking compression plate (LCP) system (DePuy Synthes, Switzerland) were used for fixation [26 (link)]. After surgery, partial weight-bearing (maximum 20 kg) was allowed for six weeks, after which full weight-bearing was started gradually. Prophylactic anticoagulant was used for six weeks. At 18 months after surgery, the metal plate and screws were removed, to allow imaging at two years.
For HTO patients, bi-plane medial-based opening-wedge osteotomy was performed. The method of Miniaci was used to preoperatively define the amount of correction needed, and TomoFix medial high tibial plates and screws (DePuy Synthes, Switzerland) or a Synthes locking compression plate (LCP) system (DePuy Synthes, Switzerland) were used for fixation [26 (link)]. After surgery, partial weight-bearing (maximum 20 kg) was allowed for six weeks, after which full weight-bearing was started gradually. Prophylactic anticoagulant was used for six weeks. At 18 months after surgery, the metal plate and screws were removed, to allow imaging at two years.