No postoperative complications were experienced. These braces help push the weight towards the inside of the knee, and by doing so, they can help serve as an excellent screen to determine if a patient would benefit from a distal femoral osteotomy. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. While rates of required hardware removal secondary to these complications were as high as 72% in 1 group, 7 all remaining articles reported lower rates of hardware removal. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. I am so glad I did! JavaScript is disabled for your browser. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. Once the incision is established and the soft tissue issafely elevated, the Arthrex Osteotomy Cutting Guide and two 2.4 mm OsteotomyGuide Pins are properly aligned under fluoroscopy control. Distal femoral varus osteotomy may be used to treat valgus knee malalignment or to protect a knee compartment in which cartilage restoration surgery (such as osteochondral or meniscus allografting) has been performed. sharing sensitive information, make sure youre on a federal There are a number of different indications for a distal femoral osteotomy. 18. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. The chamfered wedge design of the OSferion implants corresponds to the shape of the osteotomy and can be easily trimmed to size using a rongeur. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. Joint preservation patients satisfied the criteria for osteotomy as described but were younger patients with a mean age of 26 years and were motivated to maintain an active lifestyle. Epub 2019 Nov 27. In general, these are performed for patients with knock knees, which we call valgus alignment, and the goal of the surgery is to realign them such that the weightbearing axis is changed to pass either through the center of the knee or just barely into the inside compartment of the knee. [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Distal femoral varus osteotomy may be used to treat valgus knee malalignment or to protect a knee compartment in which cartilage restoration surgery (such as osteochondral or meni The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. TOURNIQUET TIME: 40 minutes. may email you for journal alerts and information, but is committed
This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. Epub 2019 Mar 26. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. Phil Downer, M.D | Wayne M. Weil, M.D | [4] reported that four of 19 patients who had an opening-wedge osteotomy underwent hardware removal, one patient underwent fracture fixation, and two patients were converted to TKA. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. Predictable healing of the osteotomy was observed. An official website of the United States government. 20. 2021 Oct;29(10):3299-3309. doi: 10.1007/s00167-020-06166-3. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. Concurrent with this, a plate and screws are placed on the outside of the knee and bone graft is placed into the opening wedge which is created to assist with healing of the gap. At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. Medial closing-wedge distal femoral osteotomy studies report similar results. In situations involving lateral unicompartmental arthritis unresponsive to conservative treatment options, the Distal Femoral Opening Wedge Osteotomy System is a safer, more reproducible alternative to traditional closing wedge distal femoral osteotomies. Improvements in the IKDC scores were noted postoperatively. 5. PMC Dr. Garcia will take limb alignment films to identify have much correction is needed. Long-term follow-up of distal femoral varus osteotomy of the knee. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. This work was performed at Scripps Clinic, La Jolla, CA, USA. The opening-wedge plate was then placed and fixed with four screws (Fig. Systematic review, Level of evidence, 4. HSS J. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. A 57-year-old man presented to our orthopedic outpatient . Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Preoperatively, the amount of correction was estimated using a simplified calculation of 1 mm of linear correction at the osteotomy site to 1 of correction of axial alignment. and transmitted securely. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? a distal femoral osteotomy can be performed for osteoarthritis when one has had development of osteoarthritis on the outside part of their knee, their knee alignment has become knock knee and is in valgus, and whereby the cartilage and the meniscus on the inside of the knee is still in good condition to whereby shifting the weight towards the Aglietti P, Menchetti PP. 8600 Rockville Pike Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. However, as a result of the small sample size, it was not appropriate to test the change from preoperatively to followup statistically; thus, no p value is given. Further research with larger groups in this area is needed. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Future studies with more patients and longer followup will provide clarity on this topic. White dotted line: mechanical axes of the femur. The heights of . The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Our institutional review board-approved osteotomy database was used to identify a case series of 40 knees in 38 patients undergoing distal femoral osteotomy from January 2000 to August 2010. In a simplified technique, an opening wedge osteotomy is performed originating from the distal femoral diaphyseal-metaphyseal flare, avoiding surgical exposure to the medial side of the distal femoral region. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. Some error has occurred while processing your request. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. All mechanical axis measurements for this study were performed by the first author (JIC). I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. The purpose of our study was to report on a series of opening-wedge distal femoral varus osteotomies used to treat osteoarthritis of the lateral compartment or as an adjunct to correct malalignment with cartilage or meniscal restoration. Unable to load your collection due to an error, Unable to load your delegates due to an error. Multiple metaregression demonstrated that patient follow-up ( P < .001) was significantly associated with knee survival, while surgical technique ( P = .810) was not a predictor of clinical failure. The theoretical advantages of the opening-wedge technique over the medial closing-wedge technique include a single bone cut, avoidance of vascular structures, better control of the amount of correction, and more anatomic correction of the typical pathoanatomy of excessive distal femoral valgus [9]. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. 8600 Rockville Pike Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. Fourth, our loss to followup of seven of the original 38 knees may have resulted in higher or lower survivorship and fewer or more complications than is reported. Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. The indications for osteotomy included symptomatic lateral compartment arthritis with valgus deformity or an isolated cartilage defect in the lateral compartment with valgus or minimal varus alignment. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. Medial closing-wedge osteotomy has demonstrated good success in treatment of osteoarthritis in published series, but few studies have evaluated distal femoral lateral opening-wedge osteotomy in terms of correction of deformity, pain and function, and survivorship. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. government site. Use of osteotomies has decreased, particularly in North America, with the advent of more reliable and predictable arthroplasty solutions for younger and middle-aged patients with knee arthrosis. This realignment moves the force on the arthritis part of the knee to the normal part. This site needs JavaScript to work properly. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. 10. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. Our study had several limitations. Ehlinger M, D'Ambrosio A, Vie P, Leclerc S, Bonnomet F, Bonnevialle P, Lustig S, Parratte S, Colmar M, Argenson JN; French Society of Orthopedic Surgery, Traumatology (SoFCOT). Routine closure was then performed and the patient was placed into a ROM brace. Epub 2016 Jun 3. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). 2021. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Accessibility Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. Before Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. This is the first study to our knowledge to look at both of these groups of patients undergoing the same procedure by the same surgeon. Das et al. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. Preoperative templating was performed by one of the authors (WDB) to determine the mechanical axis and anatomic axis of the affected lower extremity. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. 1). Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. Emed Res 2: 100013. . Some features of this site may not work without it. Sternheim et al. The rst is a true Table 1. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. Further studies on alignment correction are needed for clinicians to determine the optimum position of the mechanical axis and to decide whether opening-wedge or closing-wedge osteotomy provides optimal improvement in alignment. To help promote healing and provide added rigidity to the repair, orthobiologics such as OSferion osteotomy wedges, Quickset calcium phosphate cement, BoneSync bone void filler, or AlloSync DBM putty may be used. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. Between 2000 and 2010, we performed 40 distal femoral osteotomies. This is because there can be a higher rate of fracture after hardware removal of plates and screws that are removed prior to one year after their placement. 17. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Twenty-one of 31 knees had postoperative radiographic data available for review. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. official website and that any information you provide is encrypted COMPLICATIONS: None. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. 2700 Vikings Circle The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. The authors concluded that osteotomy was indicated in younger (mean, 46 years) high-activity patients, but after 20 years most patients were converted to TKA. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. The best way to determine the success rate of distal femoral osteotomies is to assess the success rate in systematic reviews in the peer-reviewed literature. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). Time to radiographic union, complications, and reoperations were captured. This transfer bias is important to remember when reviewing our results. Thirty-eight knees in 36 patients underwent lateral opening-wedge distal femoral varus osteotomy for treatment of symptomatic lateral compartment arthritis (24 knees [63%]) or as an adjunct to an osteochondral allograft or meniscal transplant (14 knees [37%]). Thirty-eight knees (97%) in 36 patients were lateral opening-wedge varus-producing osteotomies; of those, 31 knees (82%) in 30 patients had followup at a minimum of 2 years (mean, 5 years; SD, 2; range, 2-12 years) and comprised the study population. closing wedge; distal femoral osteotomy; opening wedge; valgus. Optimizing indications and technique in osteotomies around the knee. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. Book an appointment today! Careful selection of each surgical candidate is necessary to ensure maximum benefit. All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. Stahelin et al. lateral, distal femoral osteotomy. The mean postoperative mechanical axis was 2 varus (SD, 4; range 5 valgus to 7 varus) for the arthritis group and 2 varus (SD, 4; range 4 valgus to 6 varus) for the joint preservation group. 16. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. These are the lateral opening wedge osteotomy, whereby a bone wedge is placed into the outside portion of the femur to change the alignment or a closing wedge medial distal femoral osteotomy, whereby a bone wedge is taken out and the bone is collapsed down to change the alignment. For patients with ACL deficiencies, if they have significant arthritis in their lateral compartment with valgus alignment, then a concurrent ACL reconstruction with a distal femoral osteotomy may be indicated. Knee Society knee scores improved from 43 to 78. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. SPECIMENS: Multiple cultures from the right ankle. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). The IKDC score improved from 36 to 53 (p < 0.05). Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. Would you like email updates of new search results? In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. In a simplified technique, an opening wedge osteotomy is performed originating from the distal femoral diaphyseal-metaphyseal flare, avoiding surgical exposure to the medial side of the distal femoral region. Some distal femoral osteotomies involve taking out bone where you let the leg compress on itself, this is called a closing wedge distal femoral osteotomy. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. Methods: Another study on the opening-wedge technique [15] reported that the position of the weightbearing axis through the tibial plateau was changed from 75% preoperatively to 37% postoperatively when measured from medial to lateral. 6. At 74 months followup, the Lysholm scores improved from 64 to 77 and the clinical Hospital for Special Surgery knee score improved from 42 to 64. 7. In general, one should be between the ages of 16 (with closed growth plates) and a roughly upper age of 55 to benefit from a distal femoral osteotomy. Time to radiographic union, complications, and reoperations were recorded. . In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Knee Surg Relat Res. However, with renewed interest in biologic restoration and the use of cartilage restoration techniques, osteotomies have seen an increase in popularity, particularly in younger (age 25-40 years) patients. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. Seattle Shoulder Surgery | Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. Survivorship at 74 months with the endpoint of TKA was 83%. Unfortunately, pre-bending the plate may not always be successful at eliminating future hardware irritation in smaller patients, so these patients may have to wait until the osteotomy is completely healed and a minimum of one year after surgery prior to having the plate and screws that are causing any of the hardware irritation removed. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. Backstein D, Morag G, Hanna S, Safir O, Gross A. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. The use of an opening-wedge osteotomy on the tibial side for varus deformity has become well established as the favored alternative to the previously more common closing-wedge techniques [8]. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | Medial closing-wedge osteotomy A medial-side distal femoral approach is normally used with a skin incision starting 2 cm distal to the medial epicondyle and extending 15 cm proximally. Conclusions: Thedesired amount of angular correction is achieved utilizing the Osteotome Jackor Osteotomy Wedge and the osteotomy site is packed with allograft or autograftbone void filler. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. The osteotomy is supported by one in a series of Femoral Osteotomy Plates and secured with traditional proximal bicortical screw and distal cancellous screw fixation. Bethesda, MD 20894, Web Policies Patients completed the IKDC preoperatively during their history and physical examination with a lower-extremity reconstruction fellow and nurse clinician and postoperatively during their followup examination with the surgeon (WDB). One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. All surgeries were performed by two of the senior authors and 60.3% were done in conjunction with cartilage repair procedures such as autologous chondrocyte implantation and osteochondral graft transfer. Disclaimer, National Library of Medicine Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. Of the 31 knees, 20 (14 in the arthritis group and six in the joint preservation group) had preoperative mechanical axis measurements and 21 (15 in the arthritis group and six in the joint preservation group) had postoperative mechanical axis measurements. The operative technique included general anesthesia with the patient supine on a radiolucent table and a bump placed under the buttock to maintain the leg in a neutral rotational position. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Second, three different fixation devices were used in the series to secure the osteotomy site and insufficient numbers of patients with each device did not allow analysis of a difference in outcome. . The site is secure. 11. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. doi:10.1177/2325967114S00051. Epub 2021 Oct 27. Preoperative planning on long-leg x-rays. Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than expected, but the procedure was associated with improved knee pain and function scores. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. +1 (617) 495 4089. Apply the anatomically contoured two hole plate over the fracture site and secure it with two 4 mm x 30 mm titanium self-tapping cancellous screws. In situations where the lateral cortex or anteromedial cortex has been inadvertently fractured, the Two-Hole Osteotomy Support Plate Implant System can be utilized to help fixate these fractures. Orthopedic Surgeon & Sports Medicine Specialist OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process.
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