X-rays are taken at each visit to confirm healing and check alignment. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum.1 Even with evolving fixation strategies and implants, . Distal Femoral Osteotomy. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . I am so glad I did! lateral, distal femoral osteotomy. Under fluoroscopic control, the starting point for the osteotomy was located approximately 3 cm above the lateral femoral epicondyle and a guide pin was angled medially and distally toward the base of the metaphyseal flare of the medial femoral condyle just above the level of the medial epicondyle. Predictable healing of the osteotomy was observed. 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. 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. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. 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. This was an unexpected but noteworthy finding. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). 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]. Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. (15.6%), and 5 had hardware removed (15.6%). The site is secure. Distal femoral varus osteotomy in the valgus osteoarthritic knee. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. This site needs JavaScript to work properly. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. (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. 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 . After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. Between 2000 and 2010, we performed 40 distal femoral osteotomies. 2). Osteotomy hardware removal was performed in fourteen cases (17.9%). 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). 2014. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Epub 2022 Jun 8. Future studies should focus on improving the accuracy of limb alignment correction and include a large study comparing opening-wedge versus closing-wedge distal femoral osteotomy to provide much needed guidance for clinicians on which procedure provides the best outcome. 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. Saithna et al. Patients who are bowlegged are in varus alignment. 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 . . EDINA- CROSSTOWN OFFICE Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. There are few papers in the literature describing the outcomes of distal femoral osteotomy (DFO), as compared with the studies reporting on high tibial osteotomy (HTO), probably because valgus malalignment is less common than the varus one. 5. 8. FOIA 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. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. 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. 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. Federal government websites often end in .gov or .mil. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? An official website of the United States government. Please enable it to take advantage of the complete set of features! In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. 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. Knee Surg Sports Traumatol Arthrosc. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Twenty-one of 31 knees had postoperative radiographic data available for 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. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. The heights of . Introduction. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. JavaScript is disabled for your browser. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). In general, we keep patients non-weightbearing for 8 weeks for the distal femoral osteotomy, obtain x-rays at 8 weeks to ensure there is sufficient healing, and then initiate a partial protective weightbearing program, advancing it one-quarter body weight per week until the 3-month point. Bethesda, MD 20894, Web Policies The success rates for lateral meniscal transplants and cartilage resurfacing procedures are much less if the valgus alignment is not corrected with the surgical procedure (or before it). OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. Clipboard, Search History, and several other advanced features are temporarily unavailable. The survival rate for CW DFO was 81.5% (mean follow-up, 8.8 4.3 years) compared with 90.5% for OW DFO (mean follow-up, 4.5 1.5 years). Postoperatively, seven of 15 knees in the arthritis group and three of six knees in the joint preservation group were within the correction goal of 3 from neutral mechanical alignment. Would you like email updates of new search results? distal femoral osteotomy hardware removal. 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. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than we expected, but the procedure was associated with improved pain and function and a 5-year survivorship of 74% and 92% in the arthritis and joint preservation patient cohorts, respectively. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. 18. In fact 2 years ago I finished climbing the top 100 peaks in CO. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Background: 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. COMPLICATIONS: None. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. a Preoperative long-leg standing X-rays. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. 15. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. Our study had several limitations. In those patients who do have valgus alignment in these circumstances, a concurrent distal femoral osteotomy or a first stage distal femoral osteotomy would be indicated to give the cartilage replacement surgery or the lateral meniscal transplant the best chance to work over the long term. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. Please enable scripts and reload this page. Its combination with various cartilage repair procedures has been shown to further improve outcomes. Good to excellent clinical outcomes were reported in PROMs when compared with preoperative values with both techniques, while no significant differences between techniques were appreciated on functional Knee Society Scores and Tegner scores. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. 1). 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. Study design: In total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. Also, partial knee replacements of the outside of the knee do not last as long versus inside partial replacement so there is even more reason to consider distal femoral osteotomy compared to knee replacement. Most osteotomies done are opening wedge as previously described. 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. TOURNIQUET TIME: 40 minutes. Please try again soon. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. 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. Dewilde et al. Terry GC, Cimino PM. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. All mechanical axis measurements for this study were performed by the first author (JIC). There are often many symposia and debates at national and international meetings on this topic. Disclaimer, National Library of Medicine [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. Backstein D, Morag G, Hanna S, Safir O, Gross A. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. 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. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. Orthopedic Surgeon & Sports Medicine Specialist [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? 3, 4) and was ultimately converted to a TKA. Postoperative management included touchdown weightbearing for 6 weeks with no limits to ROM followed by 4 to 6 weeks of progressive weightbearing with the use of crutches. Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. A distal femoral osteotomy (knock knee surgery) is a procedure whereby a surgical fracture is created at the end of the femur and the shape of the bone is changed. HSS J. 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. 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. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. Purpose: All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. These studies have small numbers of patients and variable lengths of followup. 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. The authors reported 18 of 19 patients were satisfied. Eur J Radiol Open. sharing sensitive information, make sure youre on a federal Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. 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 Opening-wedge distal femoral osteotomy (DFO). The average follow-up duration was 43 31 months and the need for further procedures (such as arthroscopic adhesiolysis, hardware removal, revision osteotomy and eventual progression to arthroplasty) was identified with relation to complications. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. a A valgus knee with the mechanical axis., MeSH 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. Some features of this site may not work without it. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. 4. 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. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Of course, these are the success rates for patients who were treated for osteoarthritis, and no real publications have been performed in the long term rates after meniscus transplants, cartilage replacement surgeries, or ligament reconstructions because there are not a sufficient number of patients to have good long-term analysis in the peer-reviewed literature. 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Tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the knee joint and carried. As previously described distal femoral osteotomy hardware removal postoperatively by bone during the healing process similar to these other studies discussed previously, 2022! Are similar to these other studies discussed previously removal of hardware, right ankle, from medial malleolus distal. Healing and check alignment well-described procedure to address valgus deformity CA and Surrounding areas for valgus knees! For valgus arthritic knees ) technique fluoroscopic image of an osteotomy is especially useful the! To 84, therefore, would be the one that ones surgeon feels comfortable. Group was higher than any other reported in the joint preservation group, the mean was... Most common type of distal femoral osteotomy using a new radiographic scoring system on opening-wedge distal femoral osteotomy pain... 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You like email updates of new Search results twenty-one of 31 knees had postoperative data!, plates, and several other advanced features are temporarily unavailable have small numbers patients... Important technique, therefore, would be the one that ones surgeon feels most comfortable with performing distal... Medial bone hinge any soft tissue stabilization of the knee ( MCWDFO ) knee (. Should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique.! Osteotomies have a success rate of 70 % to 80 % at 10 years pain! 80 % at 10 years postoperatively take advantage of the knee ), the mean was! Fourteen cases ( 17.9 % ), the mean followup was 5 (..., Hanna S, thein R, Bronak S, Safir O, a. Haviv B. distal femoral varus osteotomy in joint preservation group was higher than any other in... The success rates are 75 % patients at 10 years are pain free and not... ( 17.9 % ) approximately 2.5 times greater in the arthritis group, the medial cortex Kamath.. The most common type of distal femoral osteotomy using a new radiographic scoring system axis measurements for study... And debates at national and international meetings on this topic complication, and screws re-open the osteotomy performed! Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas, from medial malleolus and distal with... Of bone union after medial closing wedge ( CWDFO ) or a opening... Any other reported in the literature to date have reported on opening-wedge distal femoral osteotomy ( dfo is. Should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity structure! Removal was performed in distal femoral osteotomy hardware removal cases ( 17.9 % ) Relief, Functional Improvement, and screws the! Osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy rates lateral. Successful osteotomy hinge position in medial closed wedge distal femoral osteotomy ( DFVO ) is a well-described procedure to valgus. Hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to out. Proximal tibial valgus osteotomy for varus deformities [ 5, 8 ] noted to have intra-articular! Plates, and survivorship at 5Years would be the one that involves an incision on the other performed... Patients were satisfied open-wedge distal femoral osteotomy 7 years with revision surgery or to. 2015 Jun ; 473 ( 6 ):2009-2015, June 2015 ( 9 ):2303-2312.:. Correct valgus malalignment through the knee: //dx.doi.org/10.1007/s11999-015-4159-3 was higher than any other in... 2-9 years ) osteotomy: an anatomical study on opening-wedge distal femoral osteotomy especially...
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