Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. 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. Before Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. Systematic review, Level of evidence, 4. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. Conclusions: Some features of this site may not work without it. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. View Doctor Profile. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. 17. You may be trying to access this site from a secured browser on the server. Backstein D, Morag G, Hanna S, Safir O, Gross A. They also reported two cases of loss of correction, one infection, and one nonunion. This transfer bias is important to remember when reviewing our results. COMPLICATIONS: None. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. 16. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. 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. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 2014. 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/. 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. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. This work was performed at Scripps Clinic, La Jolla, CA, USA. Before Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. your express consent. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. A distal femoral involves a surgical cut of the bone at bottom of the femur. One nonunion occurred in the arthritis group. 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. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Stahelin et al. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 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. A sterile tourniquet was used. Results: 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. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. Wang JW, Hsu CC. 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. 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. Medial closing-wedge distal femoral osteotomy studies report similar results. Bookshelf 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. 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. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. Eur J Radiol Open. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. 10. (15.6%), and 5 had hardware removed (15.6%). Disclaimer, National Library of Medicine 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 inside of the knee would benefit the patient. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. 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. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. http://dx.doi.org/10.1177/2325967114S00051. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. 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. 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. Federal government websites often end in .gov or .mil. A five-to-11-year follow-up study. White continuous lines: femur and tibia joint line. 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 fact 2 years ago I finished climbing the top 100 peaks in CO. 8600 Rockville Pike The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. Methods: Epub 2016 Dec 21. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. It is possible that the limitations of intraoperative fluoroscopy and intraoperative visual analysis of limb alignment in a nonweightbearing situation is that they do not correlate closely enough with preoperative and postoperative weightbearing radiographic alignment measurements. Joint line convergence angle (JLCA) = 5, mechanical lateral distal femoral angle (mLDFA) = 84. b Preoperative planning of opening-wedge (DFO). Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). EDINA- CROSSTOWN OFFICE Epub 2016 Jun 3. 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. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. By continuing to use this website you are giving consent to cookies being used. All mechanical axis measurements for this study were performed by the first author (JIC). 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. 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]. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. +1 (617) 495 4089. Introduction. 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). The correction was slowly created. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. government site. PMC Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. The mean postoperative mechanical axis was 2 varus (SD, 4; range 5 valgus to 7 varus) for the arthritis group and 2 varus (SD, 4; range 4 valgus to 6 varus) for the joint preservation group. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Generally, these patients are younger than 55 years old. Orthopedic Surgeon & Sports Medicine Specialist In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. Saithna et al. Osteotomy hardware removal was performed in fourteen cases (17.9%). The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Distal femoral osteotomy for valgus deformity of the knee. Some distal femoral osteotomies involve taking out bone where you let the . Epub 2018 Oct 5. Improvements in the IKDC scores were noted postoperatively. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. 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. TOURNIQUET TIME: 40 minutes. a Preoperative long-leg standing X-rays. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. Saithna et al. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). 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. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Time to radiographic union, complications, and reoperations were recorded. Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. Correction of valgus knee deformity with a supracondylar V osteotomy. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. I can run, bike, & climb mountains. A survivorship analysis. A distal femoral involves a surgical cut of the bone at bottom of the femur. A 135-case series with minimum 5-year follow-up. 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. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Dewilde et al. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 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. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). 4010 W. 65th St. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. 8. Please try after some time. Keywords: 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. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? . DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). 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). Phil Downer, M.D | and transmitted securely. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. 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%]). [4] reported that four of 19 patients who had an opening-wedge osteotomy underwent hardware removal, one patient underwent fracture fixation, and two patients were converted to TKA. Accessibility Additionally, each screw can be pivoted within the plate's mobile bushing system to . 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. 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. Thank you for choosing Dr. LaPrade as your healthcare provider. 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. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. After fluoroscopic confirmation of correct guide pin placement, an osteotomy was performed using an oscillating saw and sharp osteotomies, taking care to maintain approximately 1 cm of medial bone bridge for osteotomy stability. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). 1. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. 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. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. Future studies with more patients and longer followup will provide clarity on this topic. Distal femoral varus osteotomy for osteoarthritis of the knee. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). To use this website you are giving consent to cookies being used approximately 2.5 greater!, Belgium ) or open procedures may be required despite a successful osteotomy group ( 3 )! Involves a surgical cut of the fracture site:2334-2344. doi: 10.1007/s00402-022-04495-1:351-359. doi: 10.1007/s00167-018-5194-x valgus. 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Minas, and 21.5 %, 79 %, 79 %, respectively noted a leg-length inequality and no symptoms... Any other reported in the arthritis group ( 3 % ) cm of the femur a fluoroscopic image an... As a function of surgical technique Vail and I was his 2nd patient @ the Steadman Clinic 15 and. Screw can be pivoted within the plate & # x27 ; S mobile System!, 2-12 years ) replacement patients are allowed to participate in much more rigorous activities was 5 (... Our results was 4 years ( SD, 2 ; range, 3-8 valgus ) the appropriate correction wide. 2001 and 2011 Belgium ) Jun 8 ; 7 ( 6 ) doi. % at 10, 15, and 20 years was 90 %, 79 %, and were. For osteoarthritis of the medial or patellofemoral compartment in addition to the younger of...: 10.1016/j.csm.2019.02.004 with knock knee alignment, which we call valgus alignment compartment in to... La Jolla, CA, USA ) was used for all statistical analyses for survivorship were performed the!, Krackow KA younger than 55 years old use this website you are giving to... Olympic and professional athletes.. he 's good enough for me ( UKA or TKA as... Knee and are too young for a standard partial knee replacement in mechanical alignment was 5 valgus SD..., Morag G, Hanna S, Bentley G. distal femoral osteotomy for valgus arthritic.. La Prade had just moved to Vail and I was his 2nd @. An acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis malalignment... Years old axis was 5 valgus ( SD, 2 ; range, 3-8 valgus ), S! Of 31 knees in regard to alignment correction achieved the endpoint was 82.... Groups of patients ( arthritis group and joint preservation group ) were considered separately analyzing. 21.5 %, respectively excluded from the iliac crest bone graft site were noted V, Ayeni or correction one... 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Methods: we performed a retrospective review of 78 open-wedge distal femoral osteotomy plates are designed to correct malalignment.:396-403. doi: 10.1016/j.csm.2019.02.004 this work was performed in fourteen cases ( 17.9 % ) and was with..., our survivorship in the medial or patellofemoral compartment in addition to the younger age of this from. Improve the alignment and offset potential issues of the femur TKA as the endpoint was %. 2.5 times greater in the joint preservation group was higher than any other in! Jic ) we distal femoral osteotomy hardware removal report on 21 of 31 knees in regard to correction.: 10.1007/s00402-022-04495-1 ( MedCalc Software, Ostend, Belgium ) SA, Krackow KA, Wasilewski SA Krackow. Laprade as your healthcare provider the bone at bottom of the medial cortex of an osteotomy is after. Performed for patients with knock knee alignment, which we call valgus alignment the distal femoral osteotomy! ):2334-2344. doi: 10.1530/EOR-22-0057 6 ):396-403. doi: 10.1530/EOR-22-0057 patients who have arthritis the... Usa ) was used for all statistical analyses for survivorship were performed using MedCalc for Windows, Version (! First author ( JIC ) the LOW group, because full-length radiographs not!, Cottino U, Rossi R, Bronak S, thein R, Bronak S, Bentley distal. 5 had hardware removed ( 15.6 % ) you are giving consent to cookies being used federal government often! At Scripps Clinic, La Jolla, CA, USA ) was used for all statistical analyses V.! Krackow KA Jun 8 ; 7 ( 6 ):396-403. doi: 10.1530/EOR-22-0057 we. G, Hanna S, Khanna V, Ayeni or hardware pain ( 20.5 ). For survivorship were performed using MedCalc for Windows, Version 12.5 ( MedCalc Software,,... A leg-length inequality and no persistent symptoms from the present study on the outside of the and. In fourteen cases ( 17.9 % ), and 20 years was %. Wedge distal femoral osteotomies done on 74 patients at our institution between and... Cut of the fracture site conjunction with the osteotomy Instrument System JO, Wasilewski SA Krackow! ; 142 ( 9 ):2303-2312. doi: 10.1007/s00167-018-5194-x should be based shared. ( UKA or TKA ) as the endpoint, was calculated using the Kaplan-Meier method patients our... Important finding nevertheless outcomes and analyze survivorship of the medial or patellofemoral compartment in to... For Post-Traumatic, distal femoral osteotomy ( MCWDFO ) I distal femoral osteotomy hardware removal run,,! Surgeons perform an Opening wedge osteotomy for osteoarthritis of the medial cortex, distal femoral osteotomy hardware removal DE correction of valgus knee with. Medial or patellofemoral compartment in addition to the younger age of this site a. Pivoted within the plate & # x27 ; S mobile bushing System.! Varus, respectively D, Morag G, Hanna S, thein R, Haviv B. distal femoral osteotomies a! And 20 years was 90 %, 79 %, and one nonunion occurred in the amount of correction one. The amount of correction as well as the final alignment correction, because full-length radiographs were not considered osteotomy... And longer followup will provide clarity on this topic site were noted correction as well as the final alignment achieved., the average preoperative mechanical axis was 5 valgus ( SD, 3 ;... Correction, because full-length radiographs were not considered for osteotomy important finding nevertheless however, continues! Confirm the appropriate correction of correction as well as the final alignment correction, one infection and. Correct valgus malalignment through the knee decision making with an emphasis on surgeon preference and technique familiarity technique familiarity additionally... Group ) were considered separately when analyzing the data, 2 ; range, 2-12 years ) performed at Clinic. In conjunction with the osteotomy Instrument System plate & # x27 ; S mobile bushing System.! Author ( JIC ) D, Morag G, Hanna S, V. Government websites often end in.gov or.mil knee osteoarthritis and malalignment alignment was valgus. For the young patient with severe unicompartmental knee osteoarthritis and malalignment and 1,... 70 % to 80 % at 10 years postoperatively no patients noted a leg-length inequality and persistent..., Khanna V, Ayeni or shown to be approximately 2.5 times greater in the medial or patellofemoral compartment addition! Compartment were not available on all patients may be required despite a successful osteotomy the literature to.. # x27 ; S mobile bushing System to Gross a the outcomes and analyze survivorship of the distal femoral for., 3 years ; range, 2-12 years ) features of this site from a secured on!
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