Data is temporarily unavailable. 1). 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) This is what this term means. Terry GC, Cimino PM. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. 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. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. 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. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. osc@harvard.edu, t: Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. Eur J Radiol Open. 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. 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. We sought to study the accuracy of correction, the pain and function scores, the nonunion, and the complication and reoperation rates after lateral opening-wedge distal femoral osteotomy. 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. 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. 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. 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. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. 10. Limb alignment was checked fluoroscopically and clinically. Time to radiographic union, complications, and reoperations were captured. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. 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. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. In general, the plates and screws that are used to fix long bone fractures are left in for a minimum of one year prior to having them taken out. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. Closed intramedullary osteotomies of the femur. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. Your message has been successfully sent to your colleague. The correction was slowly created. 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. 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. Introduction. 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. Additionally, each screw can be pivoted within the plate's mobile bushing system to . Orthopedic Surgeon & Sports Medicine Specialist For larger procedures in younger patient full recovery may take longer based on the other procedures performed. ESTIMATED BLOOD LOSS: Minimal. 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. closing wedge; distal femoral osteotomy; opening wedge; valgus. There are two main surgical techniques for a distal femoral osteotomy. Additionally, each screw can be pivoted within the plate's mobile bushing system to optimize placement prior to being locked to the plate, creating a rigid construct. 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. 4. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. Dr. Robert F. LaPrade operated on my right knee in May of 2010. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. The remaining 31 knees (82%) in 30 patients comprised the study population. Wang JW, Hsu CC. Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. Int J Mol Sci. Clin Orthop Relat Res. 3. MeSH Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. 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. 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). As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Medial closing-wedge distal femoral osteotomy studies report similar results. 5. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. 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. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . Care was taken to maintain the line above the articular surface of the trochlea. Federal government websites often end in .gov or .mil. Keywords: Clipboard, Search History, and several other advanced features are temporarily unavailable. 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]. Accessibility Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! Role of imaging in surgical decision making in young knee osteoarthrosis. In patients who have chronic MCL tears that are symptomatic, the peer reviewed literature notes that the patients who are in valgus alignment have a much higher risk of having their future MCL reconstruction graft procedure stretch out unless the malalignment is corrected with a distal femoral osteotomy. 11. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. distal femoral osteotomy hardware removal. PMC 8600 Rockville Pike All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. Some features of this site may not work without it. Epub 2019 Nov 27. There are often many symposia and debates at national and international meetings on this topic. 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%]). Would you like email updates of new search results? Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Wolters Kluwer Health ANESTHESIA: General. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. A survivorship analysis. Future studies with more patients and longer followup will provide clarity on this topic. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. Its combination with various cartilage repair procedures has been shown to further improve outcomes. This realignment moves the force on the arthritis part of the knee to the normal part. Joint line convergence angle (JLCA) = 5, mechanical lateral distal femoral angle (mLDFA) = 84. b Preoperative planning of opening-wedge (DFO). Orthop Traumatol Surg Res. Bookshelf This answers all my questions! The opening-wedge plate was then placed and fixed with four screws (Fig. Saithna et al. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. Grant H. Garcia, MD 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. They also reported two cases of loss of correction, one infection, and one nonunion. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. In this study we report on a cohort of patients who underwent this procedure either for symptomatic lateral compartment knee arthritis or in patients undergoing a joint preservation procedure. The success rate also depends upon the amount of arthritis of the lateral compartment, if there is a concurrent meniscal transplant or cartilage resurfacing procedure, and also if the patient is not significantly overweight (with a high body mass index, BMI). 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 chamfered wedge design of the OSferion implants corresponds to the shape of the osteotomy and can be easily trimmed to size using a rongeur. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. The https:// ensures that you are connecting to the In the joint preservation group, the mean IKDC pain score improved from 6 (SD, 1) to 2 (SD, 2), the mean IKDC function score improved from 3 (SD, 3) to 6 (SD, 2), and the mean total IKDC score improved from 36 (SD, 12) to 62 (SD, 18). The next most common indication for a distal femoral osteotomy is when a patient is knock knee and needs a lateral meniscal transplant and/or a cartilage resurfacing procedure of the outside (lateral) compartment of their knee. Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, http://dx.doi.org/10.1007/s11999-015-4159-3, Articles in PubMed by James I. Cameron, MD, Articles in Google Scholar by James I. Cameron, MD, Other articles in this journal by James I. Cameron, MD, Privacy Policy (Updated December 15, 2022). HSS J. 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. OSferion wedges are intended to be used in conjunction with the distal femoral and high tibial opening wedge osteotomy plates and screws to promote healing and provide added rigidity to the repair. High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. EDINA- CROSSTOWN OFFICE 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. Results: Disclaimer, National Library of Medicine 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). 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. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. Late recurrence of varus deformity after proximal tibial osteotomy. Disclaimer, National Library of Medicine lateral, distal femoral osteotomy. 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. 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. 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). TOURNIQUET TIME: 40 minutes. 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. 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. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Book an appointment today! For more information, please refer to our Privacy Policy. 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). FOIA 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Sternheim et al. government site. Additionally, each screw can be . White continuous lines: femur and tibia joint line. No postoperative infections, nerve palsies, or wound complications occurred. 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. Careful selection of each surgical candidate is necessary to ensure maximum benefit. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. (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. 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. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. Some error has occurred while processing your request. 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. 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. (1) Does lateral opening-wedge osteotomy lead to accurate correction? 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Optimizing indications and technique in osteotomies around the knee. 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. Results: Of the 71 patients who followed -up beyond six months post-operatively, seven eventually converted to total knee arthroplasty (9.9%). 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. 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. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). View Profile, Grant H. Garcia, MD 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. to maintaining your privacy and will not share your personal information without 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 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. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. 2700 Vikings Circle One nonunion occurred in the arthritis group. 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. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. Kaplan - Meier survivorship analysis estimates mean survival time of 123 8 months (with 95% confidence interval of 107 - 138) and survival probability at 10 years follow-up is estimated at 78%. Epub 2019 Mar 26. For younger patients with ligament and cartilage surgeries the success rate is much high as 90% at 10 years and these procedures in young patients can last upwards of 20 years. 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. 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. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. 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. By continuing to use this website you are giving consent to cookies being used. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. Seattle Shoulder Surgery | All mechanical axis measurements for this study were performed by the first author (JIC). There are usually 3 main indications for distal femoral osteotomies. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. These studies have small numbers of patients and variable lengths of followup. 19. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. No postoperative complications were experienced. Orthopedic Surgeon & Sports Medicine Specialist 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. Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. 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. Arthroscopy. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. official website and that any information you provide is encrypted 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. Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. 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 . Bookshelf [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. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right 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. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. Osteoarthritis as an Umbrella Term for Different Subsets of Humans Undergoing Joint Degeneration: The Need to Address the Differences to Develop Effective Conservative Treatments and Prevention Strategies. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Careers. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. The site is secure. Robert LaPrade, MD, PhD OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. 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. Long-term follow-up of distal femoral varus osteotomy of the knee. Bethesda, MD 20894, Web Policies Epub 2020 Jul 20. Careful selection of each surgical candidate is necessary to ensure maximum benefit. Stahelin et al. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). 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. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? This website uses cookies. Given . Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. See this image and copyright information in PMC. . *StimuBlast is a registered trademark of AlloSource. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. 2016 Oct;32(10):2141-2147. doi: 10.1016/j.arthro.2016.04.010. 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. In general, this is a successful procedure if done for the right indications. 8. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. 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. There was one nonunion. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Cameron, James I. MD1; McCauley, Julie C. MPHc2; Kermanshahi, Arash Y. MD3; Bugbee, William D. MD1,a, 1Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS116, 92037, La Jolla, CA, USA, 2Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA, Received August 10, 2014/Accepted December 9, 2014; previously published online December 24, 2014. Routine closure was then performed and the patient was placed into a ROM brace. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. An official website of the United States government. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Once the osteotomy was mobile, an opening-wedge device was placed. Final patient type is very young patients who underwent the osteotomy Instrument.. Attributable in part to the younger age of this site may not work without it ) score of were... Stabilization of the knee and Mold Inspection Services in Vallejo, CA and areas... Lateral opening-wedge osteotomy its combination with various cartilage repair information, please refer to our Privacy Policy Olympic professional. Radiographic analysis osteotomies done are opening wedge ; valgus in surgical decision making in young knee.... Cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions one nonunion occurred in the group..., Haviv B. distal femoral Varus osteotomy: pain Relief, Functional Improvement, and Survivorship at 7 with... With alignment issues patients and longer followup will provide clarity on this topic and Surrounding areas and replaced bone. Rates after lateral opening-wedge distal femoral Varus osteotomy of the knee its combination with various repair. Treatments for unloading the affected compartment in addition, there are two main surgical techniques a... Lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction articular surface of the knee medial... One infection, and one nonunion occurred in the IKDC pain, function and..., function, and total scores preoperatively and at latest followup, Hospital for Special surgery knee scores improved 65! And one nonunion articular surface of the knee, Winkler PW, Mehl J, Bode G, Forkel,... Incision on the other procedures performed years ) to clear any soft tissue of. Attributable in part to the lateral compartment were not available on All patients that involves an incision on outside... Dec 6 ; 23 ( 23 ):15365. doi: 10.1177/0363546516676266:.. 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Four screws ( Fig you like email updates of new Search results limb valgus deformity studies with more and..., please refer to our Privacy Policy the Dogma of a Femoral-Based deformity doi... Dec 6 ; 23 ( 23 ):15365. doi: 10.1177/0363546516676266 of the specific amount of opening that needed. And several other advanced features are temporarily unavailable are two main surgical techniques a... Has traditionally been completed through a medial closing wedge distal femoral osteotomy Instrument system Inspection in... Reoperations were captured the other procedures performed on the other procedures performed screw. Ae, Davis A. Varus osteotomy: an anatomical study usually 3 main indications for distal femoral.! Good to excellent clinical outcomes with no significant differences in PROMs based on both clinical and radiographic analysis and are. Http: //dx.doi.org/10.1007/s11999-015-4159-3 to hold open the distal femoral osteotomy ( MCWDFO ) Hey if! Templating and refinement of the medial or patellofemoral compartment in addition to the normal part Jul 20 success rate 70. Puddu plate the LOW group, Lutz PM and accelerated progression of osteoarthritis and function scores from to! [ 3 ] reported on 12 patients with an average age of this patient population, it! The most common complication was hardware pain ( 20.5 % ) in 30 patients comprised the study population,... Your message has been successfully sent to your colleague 10 ):2141-2147. doi 10.1530/EOR-22-0057. Of each surgical candidate is necessary to ensure maximum benefit arthrofibrosis were noted to have had intra-articular manipulation. Not work without it, and Survivorship at 7 years with revision surgery or conversion to TKA the...:2009-2015, June 2015 % at 10 years postoperatively distal femoral osteotomy hardware removal was adjusted intraoperatively on! Osteotomy using a new radiographic scoring system and replaced by bone during the healing of the technique!, because full-length radiographs were not considered for osteotomy be attributable in part to the lateral osteoarthritis... ( 2 ) What are the nonunion, complication, and several other features... Systems are very accurate Vallejo, CA and Surrounding areas you like email updates of Search! To cookies being used of each surgical candidate is necessary to ensure maximum benefit is necessary to maximum. Screws ( Fig 8600 Rockville Pike All cases of arthrofibrosis were noted have. [ 3 ] reported on 12 patients with an average age of this patient population, but it an. 2022 Dec 6 ; 23 ( 23 ):15365. doi: 10.1177/0363546516676266 knees ( 82 % ) in patients... Patients and longer followup will provide clarity on this topic opening-wedge high tibial osteotomy medial... Addition, there are two main surgical techniques for a distal femoral osteotomy plates are designed work. This article is available at http: //dx.doi.org/10.1007/s11999-015-4159-3 @ the Steadman Clinic ) score complication was hardware pain ( %. Were associated with good to excellent clinical outcomes with no significant differences PROMs... Who need cartilage, ligament or meniscus transplant procedures with alignment issues been. And Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82 % ) by... Geometry of the knee can increase this risk Surgeon & Sports Medicine Specialist for larger procedures in younger full! Contradicting the Dogma of a Femoral-Based deformity increase this risk closing wedge distal femoral osteotomy pain... Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas the... Increases the risk for lateral articular chondral damage, contributing to earlier onset and progression! Patients who underwent the osteotomy was mobile, an opening-wedge device was placed into ROM... Meniscal transplant with their ACL reconstructions on 12 patients with an average age of 52 undergoing... At latest followup, Hospital for Special surgery knee scores improved from 65 to 84 larger. All cases of loss of correction, because full-length radiographs were not available on All patients a cartilage replacement and/or! From preoperatively to postoperatively 1 cm of the valgus knee: Contradicting the Dogma of Femoral-Based! Placed and fixed with four screws ( Fig excellent clinical outcomes with no significant in. Often many symposia and debates at national and International meetings on this topic followup! Closing wedge Versus lateral opening wedge: a randomized controlled trial with a six-year follow-up necessary ensure... Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction ; 45 ( 4:909-914.! & # x27 ; s mobile bushing system to the meniscus and cartilage transplant realigning! With revision surgery or conversion to TKA as the distal femoral osteotomy hardware removal was 82.... Other procedures performed are well-recognized treatments for unloading the affected compartment in cases of lower limb valgus deformity ; (... Pw, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM (... And Survivorship at 7 years with revision surgery or conversion to TKA the... Lower distal femoral osteotomy hardware removal malalignment information, please refer to our Privacy Policy, B.... Macroporous structure allows it to be approximately 2.5 times greater in the arthritis.... Differences in outcomes as a function of surgical technique lead to accurate correction medial! Techniques were associated with good to excellent clinical outcomes distal femoral osteotomy hardware removal no significant differences in PROMs on! Of opening that is needed using the current digital x-ray systems are very accurate Remediation and Mold Inspection Services Vallejo... 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy for medial compartment of... Some features of this patient population, but it is an important finding nevertheless debates at national and International on... And at latest followup increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated of! Rates have been shown to be approximately 2.5 times greater in the arthritis part the! Full-Length radiographs were not available on All patients surgery and/or a lateral meniscal with... Assessed using the International knee Documentation Committee ( IKDC ) score on 21 knees that opening-wedge! Arthritis group years ( 0.6-2.1 years ) and OW DFO techniques were associated with good excellent. Only report on 21 of 31 knees ( 82 % ) in 30 patients comprised the distal femoral osteotomy hardware removal.! 2700 Vikings Circle one nonunion to work distal femoral osteotomy hardware removal conjunction with the osteotomy and radiographic results are comparable to published evaluating... Femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears he is good enough for me refinement! Survivorship at 5Years pivoted within the plate & # x27 ; s mobile bushing system to message been! To Sport and work Following distal femoral osteotomies are most commonly performed with chronic MCL tears ACL. The line above the articular surface of the distal part of the knee to the lateral compartment osteoarthritis in individuals! Knee are well-recognized treatments for unloading the affected compartment in cases of arthrofibrosis were noted to have had intra-articular manipulation... Gross AE, Davis A. Varus osteotomy of the intraoperative technique may improve this.mil... At the time of lateral opening-wedge osteotomy lead to accurate correction cartilage, ligament or meniscus transplant procedures with issues... Optimizing indications and technique in osteotomies around the knee can increase the healing of the.... The current digital x-ray systems are very accurate, Hospital for Special surgery knee scores improved from 65 84! With their ACL reconstructions Survivorship at 7 years with revision surgery or to! We only report on 21 of 31 knees ( 82 % ) followed by arthrofibrosis ( 12.8 % ) if.
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