Epub 2022 Jun 8. This realignment moves the force on the arthritis part of the knee to the normal part. 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. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. Our study had several limitations. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Distal femoral varus osteotomy for osteoarthritis of the knee. 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. official website and that any information you provide is encrypted Objectives: Distal femoral osteotomy (DFO) is a useful procedure in the young patient with symptomatic unicompartmental osteoarthritis and valgus malalignment to avoid or postpone knee arthroplasty. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Dewilde et al. 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. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. 1 Even with evolving fixation strategies and implants, . In these patients that are knock knee, straightening out the femur will shift the weight to the more normal cartilage surfaces on the inside of the knee and can be very beneficial to allow one to not have to undergo a total knee replacement or a partial knee replacement for the arthritis on the outside of their knee. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. X-rays are taken at each visit to confirm healing and check alignment. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. In general, this is a successful procedure if done for the right indications. 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. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. Knee Surg Sports Traumatol Arthrosc. Sternheim et al. 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 iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. Epub 2017 Sep 6. closing wedge; distal femoral osteotomy; opening wedge; valgus. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Conclusions: After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. [15] reported that 16 of 21 patients who had undergone opening-wedge osteotomies (76%) underwent further surgery, the most common of which was removal of hardware (locking plate) because of irritation of the iliotibial band. 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. The .gov means its official. The average patient age at surgery is 33 11 years with mean BMI of 28 6. This answers all my questions! The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. 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. 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. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | Twenty-one of 31 knees had postoperative radiographic data available for review. 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. Please enable scripts and reload this page. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. 15. 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. Call Us Today (888) 260-0449 2). [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. 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. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. 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). For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. This AP radiograph demonstrates a healed nonunion (left). 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. By continuing to use this website you are giving consent to cookies being used. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. Bookshelf Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. 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). 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. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Careers. Distal Femoral Osteotomy vlog: Hardware removal - YouTube Last vlog!My blog: https://orbite-beast.tumblr.com/ Last vlog!My blog: https://orbite-beast.tumblr.com/. Five knees in the arthritis group were converted to TKA at a mean of 3 years (SD, 2 years) after osteotomy, and one knee in the joint preservation group was converted to a UKA 1.7 years after osteotomy. 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. 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. I am so glad I did! This transfer bias is important to remember when reviewing our results. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. SPECIMENS: Multiple cultures from the right ankle. http://dx.doi.org/10.1177/2325967114S00051. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). *StimuBlast is a registered trademark of AlloSource. Please enable it to take advantage of the complete set of features! 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. View Profile, Grant H. Garcia, MD Some distal femoral osteotomies involve taking out bone where you let the . 7. Supracondylar osteotomy of the femur with use of compression. The distal femur was resected en bloc . Routine closure was then performed and the patient was placed into a ROM brace. 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. eCollection 2022. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. to maintaining your privacy and will not share your personal information without 8600 Rockville Pike No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. Distal femoral osteotomy for valgus deformity of the knee. 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 . In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. This was an unexpected but noteworthy finding. Please try after some time. Accessibility Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. 12. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. Background: . Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. There are two main surgical techniques for a distal femoral osteotomy. 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. 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). Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. 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. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. PMC 2014. Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. Clin Orthop Relat Res. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Distal femoral osteotomy (DFO) is a useful procedure in the young patient with symptomatic unicompartmental osteoarthritis and valgus malalignment to avoid or postpone knee arthroplasty. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. Characteristics of the arthritis and the joint preservation groups. The indications for osteotomy included symptomatic lateral compartment arthritis with clinical valgus deformity or a cartilage or meniscal defect in the lateral compartment with clinical valgus alignment. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. 18. and transmitted securely. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. J Knee Surg. Osteotomy hardware removal was performed in fourteen cases (17.9%). The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. 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 osteotomy is supported by one in a series of Femoral Osteotomy Plates and secured with traditional proximal bicortical screw and distal cancellous screw fixation. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Das et al. White dotted line: mechanical axes of the femur. Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License, which allows anyone to share and adapt our material as long as proper attribution is given. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re 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. 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. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. Another study on the opening-wedge technique [15] reported that the position of the weightbearing axis through the tibial plateau was changed from 75% preoperatively to 37% postoperatively when measured from medial to lateral. Patients who are bowlegged are in varus alignment. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. The most worrisome complication is that the boney cut does not heal. 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 only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. 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. Its combination with various cartilage repair procedures has been shown to further improve outcomes. HSS J. a distal femoral osteotomy can be performed for osteoarthritis when one has had development of osteoarthritis on the outside part of their knee, their knee alignment has become knock knee and is in valgus, and whereby the cartilage and the meniscus on the inside of the knee is still in good condition to whereby shifting the weight towards the 10. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. Book an appointment today! Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. 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. 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. Optimizing indications and technique in osteotomies around the knee. 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. Orthop J Sports Med. Federal government websites often end in .gov or .mil. 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. official website and that any information you provide is encrypted Epub 2020 Jul 20. The https:// ensures that you are connecting to the This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. No postoperative complications were experienced. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . Time to radiographic union, complications, and reoperations were recorded. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. 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). 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. 3. 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 leg compress on itself, this is called a closing wedge distal femoral osteotomy. Between 2000 and 2010, we performed 40 distal femoral osteotomies. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. HHS Vulnerability Disclosure, Help 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 (1) Does lateral opening-wedge osteotomy lead to accurate correction? Time to radiographic union, complications, and reoperations were captured. Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). 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. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. Robert LaPrade, MD, PhD Preoperative planning on long-leg x-rays. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. Thank you for choosing Dr. LaPrade as your healthcare provider. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 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. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. 6. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. In general, one should be between the ages of 16 (with closed growth plates) and a roughly upper age of 55 to benefit from a distal femoral osteotomy. Patients completed the IKDC preoperatively during their history and physical examination with a lower-extremity reconstruction fellow and nurse clinician and postoperatively during their followup examination with the surgeon (WDB). An official website of the United States government. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Further x-rays are obtained at that point to verify healing. 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 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). Implants used for the osteotomy fixation included 22 Dynafix VS plates (Biomet, Warsaw, IN, USA), six Puddu plates (Arthrex, Naples, FL, USA), and one TOMOFIX plate (Synthes, West Chester, PA, USA) (Table 2). 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. [7] reported on 21 knees in 20 patients with a mean 11-year followup. Please enable it to take advantage of the complete set of features! Of these, 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. Saithna et al. I can run, bike, & climb mountains. Purpose: ANESTHESIA: General. 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.
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