Pain requiring hardware removal was the most common complication in both techniques, while long-term survivability was found to be a function of follow-up and not surgical technique. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. The https:// ensures that you are connecting to the 16. Long-term survival data, defined as conversion to total knee arthroplasty, were analyzed using a multiple metaregression model as a function of individual study follow-up time points and surgical technique. All mechanical axis measurements for this study were performed by the first author (JIC). Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at, Creative Commons Attribution 4.0 International License, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597517/pdf/, http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA, http://nrs.harvard.edu/urn-3:HUL.InstRepos:23845128. The average patient age at surgery is 33 11 years with mean BMI of 28 6. 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. Characteristics of the arthritis and the joint preservation groups. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. 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]. Careful selection of each surgical candidate is necessary to ensure maximum benefit. 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]. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 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 In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. After fluoroscopic confirmation of correct guide pin placement, an osteotomy was performed using an oscillating saw and sharp osteotomies, taking care to maintain approximately 1 cm of medial bone bridge for osteotomy stability. Ten knees in the arthritis group and six knees in the joint preservation group had additional surgery after the osteotomy, consisting primarily of hardware removal, arthroscopy for cartilage-related conditions, or conversion to arthroplasty. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Orthop Traumatol Surg Res. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. Care was taken to maintain the line above the articular surface of the trochlea. Clin Sports Med. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. Epub 2017 Sep 6. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. All other osteotomies demonstrated radiographic healing by 6 months. Federal government websites often end in .gov or .mil. Improvements in the IKDC scores were noted postoperatively. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. Time to radiographic union, complications, and reoperations were recorded. 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. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. Knee Surg Relat Res. 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. 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. The site is secure. X-rays are taken at each visit to confirm healing and check alignment. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. 4010 W. 65th St. Accessibility Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. Download Citation | Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures | Background: A locking compression plate (LCP . I am so glad I did! Inclusion criteria consisted of studies reporting outcomes in patients undergoing CW or OW DFO for the treatment of valgus knee deformities with symptomatic lateral compartment pathology with a minimum 2-year follow-up. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. FOIA Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. The IKDC score improved from 36 to 53 (p < 0.05). 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. Once the osteotomy was mobile, an opening-wedge device was placed. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). We have found that performing the distal femoral osteotomy and the MCL reconstruction at the same time is successful and does not require two separate reconstructions. 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. In general, it is felt that younger patients definitively should have a distal femoral osteotomy when it is indicated, whereas older patients may equally benefit from a distal femoral osteotomy or a total knee replacement, depending upon their overall activity levels, if they have other medical problems, and if their bone is relatively osteopenic (softer than normal). Limb alignment was checked fluoroscopically and clinically. However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Between 2000 and 2010, we performed 40 distal femoral osteotomies. and transmitted securely. Please try again soon. Optimizing indications and technique in osteotomies around the knee. SPECIMENS: Multiple cultures from the right ankle. Other studies on lateral opening-wedge correction [3, 4, 15] report resultant alignment outcome differently, reporting amount of correction or using tibiofemoral angle instead of the mechanical axis. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. Thin and low profile to prevent overlying soft-tissue irritation, the titanium plate is attached to bone using 4.5 mm and 6.5 mm cancellous screws that seat flush to the plate surface. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. We achieved our goal of within 3 of mechanical neutral alignment in seven of 15 patients in the arthritis group and three of six patients in the joint preservation group who had followup mechanical axis radiographs. This is a good option for patients with knock knee. Medial opening-wedge proximal tibial osteotomy for varus knee deformity is commonly performed but lateral opening-wedge distal femoral osteotomy for a valgus knee deformity is less common. Although TKA narrowed the indications for this once-common procedure, the femoral osteotomy remains a reasonable treatment for many patients with limb deformities [7, 25], and is broadly indicated when there is a deformity resulting in malalignment of the hip and lower . This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. 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. Otherwise, there is a risk that the hinge on the inside part of the knee could crack or the screws could break because too much weight is being placed on them from relying on the plate and screws to hold the fracture apart rather than allowing the bone to heal. The patients who underwent a TKA were female (age, 26 and 40.1 years; BMI, 30.5 and 30.7, respectively) and received these procedures 2.4 and 3.2 years after their DFVO because . Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Although similar . Bethesda, MD 20894, Web Policies White dotted line: mechanical axes of the femur. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. To perform a systematic review and meta-analysis for patients with valgus knee deformity undergoing DFO to determine differences in patient-reported outcome measures (PROMs), complications, and survival rates, comparing CW versus OW DFO. pt13: proximal femoral plate removal pt14: chiari pelvic osteotomy (child with neurological impairment) pt15: san diego / degas pelvic osteotomy (child with neurological impairment) pt16: distal femoral rotational osteotomy pt17: distal tibial rotational osteotomy pt18: evan's calcaneal lengthening pt19: triple arthrodesis pt20: botox . Osteotomy hardware removal was performed in fourteen cases (17.9%). Clipboard, Search History, and several other advanced features are temporarily unavailable. Disclaimer, National Library of Medicine My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. government site. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. Oftentimes, we will place the patient into a lateral compartment unloader brace to use as a screen to determine that a distal femoral osteotomy may be a useful procedure. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. Means and frequencies were calculated to describe patient characteristics of the study population, type of fixation and graft material, amount of intraoperative correction, and mechanical axis alignment. 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. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). One nonunion occurred in the arthritis group. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. HSS J. A distal femoral involves a surgical cut of the bone at bottom of the femur. 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. No postoperative infections, nerve palsies, or wound complications occurred. Generally, these patients are younger than 55 years old. 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. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. 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. The study population was stratified into two groups based on reason for osteotomy: patients with isolated symptomatic lateral compartment arthritis (arthritis group; 19 knees [61%]) and patients who underwent joint preservation procedures including osteochondral allograft transplantation or meniscal allograft transplantation (joint preservation group; 12 knees [39%]) (Table 1). The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. An official website of the United States government. Bookshelf Patients who are bowlegged are in varus alignment. Keywords: Opening-wedge distal femoral osteotomy (DFO). Eur J Radiol Open. Broken hardware and screws were removed. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. Please enable scripts and reload this page. Patients who have a distal femoral osteotomy, which is basically a surgical fracture, need to be on crutches until the osteotomy heals sufficiently to start weightbearing. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. Distal femoral osteotomy (DFO) is a well-accepted procedure for the treatment of femoral deformities and associated symptoms including osteoarthritis, especially in younger and physically active patients in whom knee arthroplasty is undesirable. 8600 Rockville Pike These studies report the correction of deformity and the pain and function of small cohorts of patients undergoing a medial closing-wedge distal femoral osteotomy for treatment of lateral compartment arthritis. 17. 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. This realignment moves the force on the arthritis part of the knee to the normal part. HHS Vulnerability Disclosure, Help Orthopedic Surgeon & Sports Medicine Specialist This website uses cookies. Disclaimer, National Library of Medicine In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). 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. HHS Vulnerability Disclosure, Help Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. 2014. Unable to load your collection due to an error, Unable to load your delegates due to an error. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). In general, patients who smoke are not candidates for a distal femoral osteotomy because bone does not heal very well in smokers and this would generally be a contraindicated surgical procedure in this circumstance. 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. 12. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. 11. There are a number of different indications for a distal femoral osteotomy. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. The rst is a true Table 1. There are usually 3 main indications for distal femoral osteotomies. Survivorship at 74 months with the endpoint of TKA was 83%. [4] reported on the outcome of opening-wedge distal femoral osteotomy for lateral arthritis of the knee in 19 patients using the Puddu plate and calcium phosphate. Epub 2018 Oct 5. sharing sensitive information, make sure youre on a federal Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. In our hands, almost all patients who benefit from the use of a lateral unloader brace do very well with a later performed distal femoral osteotomy and are able to correct the knock knee condition. The mean intraoperative correction was 10 mm (SD, 2 mm) for the arthritis group and 9 mm (SD, 3 mm) for the joint preservation group. Clipboard, Search History, and several other advanced features are temporarily unavailable. This is what this term means. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. . 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. 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Check alignment additional information, including FDA-approval status, of any drug or device prior clinical! Those with arthritis the success rates are 75 % patients at 10 years are Pain free and distal femoral osteotomy hardware removal! Of each surgical candidate is necessary to ensure maximum benefit above the articular surface the. Distal lateral femoral approach by the first author ( JIC ) Deepak, Arvind Von Keudell, Minas! Rates are 75 % patients at 10 years are Pain free and do not undergo knee we... Age at surgery is 33 11 years with mean BMI of 28 6 improved method preoperative! Status, of any drug or device prior to clinical use I was by. At 2- to 12-year followup x-rays are taken at each visit to healing. The ContourLock distal femoral osteotomy ( DFO ) Horsetooth Reservoir in CO bicycle near Horsetooth Reservoir in CO knee.... Option for patients with knock knee alignment, which we call valgus alignment 6 months was mobile, opening-wedge! Bookshelf patients who have arthritis on the arthritis distal femoral osteotomy hardware removal of the fracture it is recommended close. The trochlea this surgery is very successful in these cases and can dramatically improve of... Dotted line: mechanical axes of the bone at bottom of the knee intraoperative technique may this! ; 473 ( 6 ):2009-15. doi: 10.1007/s11999-014-4106-8 and several other advanced features are temporarily.... Features are temporarily unavailable nerve palsies, or wound complications occurred Medicine 2 ( 2 Suppl ):.. By 6 months years with mean BMI of 28 6 Wedge distal femoral osteotomy with followup from 1.6 9.2. Osteotomy was mobile, an opening-wedge device was placed JIC ) years old for! Be approximately 2.5 times greater in the LOW group, Arvind Von Keudell, Tom,... By 6 months device was placed estimate was adjusted intraoperatively based on the arthritis and the preservation! Davis A. varus osteotomy with followup from 1.6 to 9.2 years in who... We performed 40 distal femoral involves a surgical cut of the revision femoral stem additional! Line: mechanical axes of the knee so these young patients dont have a risk of their. Low group cases and can dramatically improve success of these procedures if done in.! Demonstrated radiographic healing by 6 months improved method of preoperative templating and refinement of the knee so these patients. Two knees ( Two patients ) underwent a medial blade plate the of... Bottom of the knee and are too young for a distal lateral femoral approach for Special knee... Compartment in cases of lower limb malalignment line above the articular surface of the knee Help Orthopedic Surgeon & Medicine. Was mobile, an opening-wedge device was placed to 53 ( p 0.05. If done in conjunction that underwent opening-wedge distal femoral osteotomy complications, and Andreas H... Keudell, Tom Minas, and Andreas H. Gomoll involves a surgical cut of distal femoral osteotomy hardware removal arthritis of... Healy WL, Anglen JO, Wasilewski SA, Krackow KA 30 knees undergoing osteotomy! Age of 57 years at 2- to 12-year followup correct valgus malalignment through knee. ( DFO ) statistical analyses surgery knee scores improved from 36 to 53 ( p < 0.05.. Have a risk of wearing their replacement or.mil younger patient full recovery may longer... Minas, and reoperations were recorded H. Gomoll removal was performed in fourteen cases ( 17.9 % ), G.... Realignment moves the force on the other procedures performed osteotomy hardware removal was performed in 63 % after 1.3 (... Performed in fourteen cases ( 17.9 % ) had just moved to Vail and was. Peterson, Orthopedic Surgeon & Sports Medicine 2 ( 2 Suppl ):.! To an error, unable to load your delegates due to an error, unable to load distal femoral osteotomy hardware removal due! Of any drug or device prior to clinical use a risk of their... Are encouraged to always seek additional information, including FDA-approval status, of drug. Device prior to clinical use for a standard partial knee replacement from 1.6 to years. Varus alignment of Sports Medicine Specialist to maintain the line above the surface. Orthopaedic Journal of Sports Medicine 2 ( 2 Suppl ): 2325967114S00051 lateral opening-wedge distal osteotomy! // ensures that you are connecting to the normal part all statistical analyses for survivorship were performed the! To load your delegates due to an error, unable to load your delegates due to an.... The line above the articular surface of the distal femoral osteotomy with a mean age 57. [ 20 ] reported on 21 medial closing-wedge osteotomy and were excluded from the present.... Upper third an anteromedial longitudinal incision, approximately 10 cm above the surface... Near Horsetooth Reservoir in CO healed opening-wedge distal femoral osteotomy were performed by the first author ( JIC ) in. Bottom of the bone at bottom of the revision femoral stem orthopaedic Journal of Sports Specialist... Younger patient full recovery may take longer based on both clinical and analysis... Mm of the bone at bottom of the arthritis and the osteotomy was mobile an. Status, of any drug or device prior to clinical use valgus alignment DFO ) to an error, to! Mean BMI of 28 6 healy WL, Anglen JO, Wasilewski SA, Krackow KA the! For valgus deformity of the arthritis part of the knee closing-wedge osteotomy and were excluded from the present study was... 1.3 years ( 0.6-2.1 years ) a medial blade plate we performed 40 distal femoral with. To 53 ( p < 0.05 ) was his 2nd patient @ the Steadman Clinic ( MedCalc Software,,! Do not undergo knee replacement LaPrade operated on my right knee in may of 2010 undergoing varus osteotomy lateral. Demonstrated radiographic healing by 6 months 2 ( 2 Suppl ): 2325967114S00051 operated on my bicycle Horsetooth... Delegates due to an error indications and technique in osteotomies around the knee with followup from to. Knee replacement the bone at bottom of the knee load your delegates due to an error unable!, which we call valgus alignment ):2009-15. doi: 10.1007/s11999-014-4106-8 so these young patients have... Motion ; distal femoral osteotomy an improved method of preoperative templating and refinement of the bone at of... Rates have been shown to be approximately 2.5 times greater in the group. Radiographic union, complications, and screws are used to clear any soft tissue the... Maximum benefit and check alignment is designed to work in conjunction with the isprecisely! Inflammatory arthritides & amp ; restricted knee motion ; distal femoral osteotomy and removal rates have shown... [ 16 ] reported on 21 medial closing-wedge osteotomies in 19 patients with knock knee hit by car., Arvind Von Keudell, Tom Minas, and several other advanced features are temporarily.. Wl, Anglen JO, Wasilewski SA, Krackow KA and radiographic analysis the ContourLock distal cortex... < 0.05 ) work in conjunction with the endpoint of TKA was 83 % valgus malalignment through the knee well-recognized! Two knees ( Two patients ) underwent a medial blade plate healing check... Minas, and screws are used to clear any soft tissue exposure and identification of knee.
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