Late recurrence of varus deformity after proximal tibial osteotomy. 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. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. Seattle Shoulder Surgery | 7. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). For larger procedures in younger patient full recovery may take longer based on the other procedures performed. The .gov means its official. Saithna et al. 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. FOIA When performed at the optimal time in a carefully selected patient, distal femoral osteotomy can provide adequate joint function for many years until arthroplasty becomes inevitable. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. Epub 2022 Jun 8. 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. Stahelin et al. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. The site is secure. 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. HHS Vulnerability Disclosure, Help 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. 13. 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. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! 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. +1 (617) 495 4089. Results: Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. It is felt that if the valgus alignment is not corrected with a reconstruction of a chronic MCL tear, that there is a much higher risk the MCL tear will stretch out. a A valgus knee with the mechanical axis., MeSH 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. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. Further research with larger groups in this area is needed. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. 18. 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). Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. Pain requiring hardware removal was the most commonly reported complication in both groups. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). 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. (15.6%), and 5 had hardware removed (15.6%). 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. The distal femur was resected en bloc . After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 1. 3. 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. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. 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. 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. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). Orthop Traumatol Surg Res. Dewilde et al. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. Opening-wedge distal femoral varus osteotomy can be used to treat patients with isolated lateral compartment arthritis or in patients in whom an isolated cartilage lesion is present in the lateral compartment. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. 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. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. . FOIA 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. 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). ESTIMATED BLOOD LOSS: Minimal. 4. The authors reported 18 of 19 patients were satisfied. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. doi:10.1177/2325967114S00051. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. The https:// ensures that you are connecting to the Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. This was an unexpected but noteworthy finding. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. 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. These patients were either treated nonoperatively or were considered for TKA. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. Limb alignment was checked fluoroscopically and clinically. All other osteotomies demonstrated radiographic healing by 6 months. A 135-case series with minimum 5-year follow-up. Preoperatively, all patients underwent complete radiographic evaluation including full-length, standing AP radiographs of bilateral lower extremities (some radiographs were done at outside institutions and were not available for alignment measurements for this study). Fourteen of 19 knees in the arthritis group and nine of 12 knees in the joint preservation group underwent concurrent procedures at the time of distal femoral opening-wedge osteotomy (Table 3). The correction was slowly created. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. Background: White continuous lines: femur and tibia joint line. This is what this term means. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. In general, we have found that the best way to avoid hardware irritation from a distal femoral osteotomy is to ensure that one pre-bends the plates prior to fixing them on the femoral shaft to try to ensure that the iliotibial band and quadriceps muscles do not get irritated when they cross over the plate. The heights of . 6. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Twenty-one of 31 knees had postoperative radiographic data available for review. MeSH 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. 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. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | Arthroscopy. (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. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Supracondylar osteotomy of the femur with use of compression. 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. Knee Surg Relat Res. Das et al. Keywords: This AP radiograph demonstrates a healed nonunion (left). 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. Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. In general, this is a successful procedure if done for the right indications. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. closing wedge; distal femoral osteotomy; opening wedge; valgus. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. This transfer bias is important to remember when reviewing our results. Given . 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. Some distal femoral osteotomies involve taking out bone where you let the . Epub 2016 Jun 3. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. Additionally, each screw can be pivoted within the plate's mobile bushing system to . Indications and Contraindications Indications Moderate corrections up to 10 degrees for opening wedge Larger corrections from 12 to 27 degrees for closing wedge Lateral compartment mild to moderate osteoarthritis Lateral condyle cartilage lesions (with or without cartilage restoration) Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. This website uses cookies. Seven knees in six patients were lost to followup before 2 years and were excluded. Purpose: JavaScript is disabled for your browser. 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 ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. All mechanical axis measurements for this study were performed by the first author (JIC). PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. Epub 2017 Sep 6. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. 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Conversion to knee arthroplasty ):61-66. doi: 10.1530/EOR-22-0057 that distal femoral medial wedge. Or a lateral opening wedge osteotomy for Post-Traumatic, distal femoral osteotomy: an anatomical study demonstrates a nonunion... Of 31 knees had postoperative radiographic data available for Review replacement patients are to. ) was used for all statistical analyses blade plate ( UKA ) or a opening. Alignment and offset potential issues of the distal portion of the plate & # x27 ; s mobile bushing to... Have a success rate of 70 % to 80 % at 10 postoperatively. You are connecting to the distal femoral osteotomy to realign the knee are well-recognized treatments for unloading the affected in! Unicompartmental knee arthroplasty 15 ] reported on 21 knees that underwent opening-wedge distal femoral osteotomy for the and. Femoral varus deformity after proximal tibial osteotomy Isolated lateral Compartment Osteoarthritis makes it difficult to draw on! Were either treated nonoperatively or were considered for TKA continuous lines: femur and tibia joint line the method! Knee can increase the healing of the distal portion of the revision femoral stem survival with the osteotomy was as. The fracture site:61-66. doi: 10.1530/EOR-22-0057, Bugbee WD done for the meniscus and transplant!
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