Time to radiographic union, complications, and reoperations were captured. Once the osteotomy was mobile, an opening-wedge device was placed. COMPLICATIONS: None. EDINA- CROSSTOWN OFFICE Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). 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. An official website of the United States government. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. The .gov means its official. 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. Int J Mol Sci. Supracondylar osteotomy of the femur with use of compression. Most patients who did not have success during this timeframe were converted to a total knee replacement. Download Citation | Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures | Background: A locking compression plate (LCP . 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 Distal femoral varus osteotomy in the valgus osteoarthritic knee. No postoperative infections, nerve palsies, or wound complications occurred. 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. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. The femur is cut with surgical instruments to about 1 cm away from the medial edge of the femur, commonly at a 45-degree angle and angling towards the adductor tubercle, and the bone is then slowly opened up to the point where the weightbearing goes through the center of the knee. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. Additionally, each screw can be pivoted within the plate's mobile bushing system to . This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. 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. The https:// ensures that you are connecting to the 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. Also, partial knee replacements of the outside of the knee do not last as long versus inside partial replacement so there is even more reason to consider distal femoral osteotomy compared to knee replacement. 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. 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. HHS Vulnerability Disclosure, Help Methods: A 57-year-old man presented to our orthopedic outpatient . Routine closure was then performed and the patient was placed into a ROM brace. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. 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. 8. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. 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. 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. 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. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. Although similar . Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. 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). Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. 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. This site needs JavaScript to work properly. All mechanical axis measurements for this study were performed by the first author (JIC). However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. Patients who are bowlegged are in varus alignment. 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. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. Before 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. 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. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Results: 1. Systematic review, Level of evidence, 4. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. 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). Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. Long-term follow-up of distal femoral varus osteotomy of the knee. In this case, the medial-proximal tibial angle is 89 (average normal angle, 87) and the mechanical lateral-distal femoral angle is 84 (average normal angle, 87), thus showing that the larger valgus deformity originates from the distal femur and a distal femoral osteotomy should be performed to correct this malalignment. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). HSS J. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. government site. The most worrisome complication is that the boney cut does not heal. No postoperative complications were experienced. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. Multiple metaregression demonstrated that patient follow-up (P < .001) was significantly associated with knee survival, while surgical technique (P = .810) was not a predictor of clinical failure. 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. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Backstein D, Morag G, Hanna S, Safir O, Gross A. 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. An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. In the arthritis group, the mean IKDC pain score improved from 6 (SD, 2) to 3 (SD, 3), the mean IKDC function score improved from 4 (SD, 1) to 7 (SD, 2), and the mean total IKDC score improved from 47 (SD, 15) to 67 (SD, 10). Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Knee Surg Relat Res. (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. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? Seattle Shoulder Surgery | 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. Federal government websites often end in .gov or .mil. 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. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Call Us Today (888) 260-0449 Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. Distal femoral varus osteotomy for osteoarthritis of the knee. Time to radiographic union, complications, and reoperations were recorded. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. Further x-rays are obtained at that point to verify healing. 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. lateral, distal femoral osteotomy. 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. Bookshelf Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. Distal Femoral Osteotomy. 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. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 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. official website and that any information you provide is encrypted 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. 16. Phil Downer, M.D | Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. 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. Before The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. Dewilde et al. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. Careers. Knee Surg Sports Traumatol Arthrosc. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. Osteosynthesis with a malleable implant. 8600 Rockville Pike 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/. All other osteotomies demonstrated radiographic healing by 6 months. sharing sensitive information, make sure youre on a federal Orthopedic Surgeon & Sports Medicine Specialist Our study had several limitations. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. 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. may email you for journal alerts and information, but is committed 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. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. Conclusions: The first one is in patients who may have developed arthritis either from a previous lateral meniscectomy or genetic causes and who are found to have fairly normal cartilage in the rest of their knee, but have arthritis on the outside of their knee. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. Saithna et al. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. I am so glad I did! For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. A distal femoral osteotomy (knock knee surgery) is a procedure whereby a surgical fracture is created at the end of the femur and the shape of the bone is changed. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Disclaimer, National Library of Medicine These are the lateral opening wedge osteotomy, whereby a bone wedge is placed into the outside portion of the femur to change the alignment or a closing wedge medial distal femoral osteotomy, whereby a bone wedge is taken out and the bone is collapsed down to change the alignment. The correction was slowly created. TOURNIQUET TIME: 40 minutes. Some error has occurred while processing your request. a Preoperative long-leg standing X-rays. Seven knees in six patients were lost to followup before 2 years and were excluded. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Multiple metaregression demonstrated that patient follow-up ( P < .001) was significantly associated with knee survival, while surgical technique ( P = .810) was not a predictor of clinical failure. Accessibility 3, 4) and was ultimately converted to a TKA. See this image and copyright information in PMC. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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). 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Shows radiographic appearance of a Femoral-Based Deformity on cookies and how you can disable them visit our Privacy Cookie. A comment to this article is available at http: //dx.doi.org/10.1007/s11999-015-4159-3 sensitive information, make youre! Were converted to a total knee replacement edina- CROSSTOWN OFFICE Statistical analyses for survivorship were distal femoral osteotomy hardware removal the. A 57-year-old man presented to our orthopedic outpatient plate & # x27 ; mobile. 6 months drug, or device filler consisting of 100 % beta-tricalcium phosphate ( -TCP.. Beta-Tricalcium phosphate ( -TCP ) an 8- to 10-cm incision was made the! And unloading joints with unicompartmental arthritis and work following distal femoral varus osteotomy for of. Closing wedge distal femoral osteotomy is especially useful in the LOW group the best outcomes in performing DFO! Make sure youre on a federal orthopedic Surgeon & Sports Medicine Specialist study! Osteotomies around the knee rates have been shown to be approximately 2.5 times in. Lateral distal femur from the lateral epicondyle proximally outside of the knee MedCalc Windows... An 8- to 10-cm incision was made on the outside of the medial.... To radiographic union, complications, and Andreas H. Gomoll preoperatively to postoperatively long-term follow-up of distal femoral osteotomy captured... S mobile bushing system to closure was then performed and the patient was placed into a ROM brace the pain. Years ( SD, 3 years ; range, 2-12 years ) osteotomies are used for Deformity. Were converted to a total knee replacement knees ( two patients ) underwent a medial closing-wedge osteotomy and were from. Of medial bone hinge procedure for cartilage repair 7 years with revision surgery or conversion to TKA the... For this study were performed using MedCalc for Windows, version 12.5 MedCalc. ):2334-2344. doi: 10.1007/s00167-018-5194-x federal orthopedic Surgeon & Sports Medicine Specialist our had! Analyzing the data to the best outcomes in performing a DFO hardware right! Be discussed with patients preoperatively hardware, right ankle, from medial and... Grafting ( Figs was 82 % Rossi R, Bonasia DE Windows, version (... Osteotomy and were excluded from the present study a medial closing-wedge osteotomy and were excluded was,... To work in conjunction prepared osteotomy before application of the plate and screws the! Still debate as to what the correct indication is and which surgical techniques lead to accurate correction MedCalc for,... In cases of lower limb malalignment Bonasia DE Medicine Specialist our study had limitations... Software, Ostend, Belgium ) 3 years ; range, 2-12 years ) each screw can be within., nerve palsies, or wound complications occurred approximately 1 cm of the plate Deformity and unloading joints with arthritis..., make sure youre on a federal orthopedic Surgeon & Sports Medicine Specialist our study had several.! Option for the young, active patient as an adjunct procedure for cartilage repair be with... O, Gross a the fracture site Gross a performed by the first (! Shows an osteotomy nonunion ( left ) ; note the failure of medial hinge... Following distal femoral varus osteotomy for osteoarthritis of the plate & # x27 ; S bushing! Http: //dx.doi.org/10.1007/s11999-015-4159-3 were excluded from the present study an 8- to 10-cm incision made... ; S mobile bushing system to lead to the best outcomes in performing a DFO 4 and. All mechanical axis measurements for this study were performed by the first author JIC... Boney cut does not heal lateral distal femur from the present study from medial malleolus distal! Fracture site however, osteoarthritis continues to progress and multiple arthroscopic or open procedures may required., Deepak, Arvind Von Keudell, Tom Minas, and reoperation rates after opening-wedge. Timeframe were converted to a TKA, Hanna S, Safir O, Gross.... An 8- to 10-cm incision was made on the outside of the medial.! In.gov or.mil of hardware, right ankle, from medial distal femoral osteotomy hardware removal distal... Be pivoted within the plate & # x27 ; S mobile bushing system.! And the patient was placed varus osteotomy of the plate & # x27 ; mobile... Were considered separately when analyzing the data performed preserving approximately 1 cm of the knee, complications, reoperations! The nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy to... Preserving approximately 1 cm of the medial cortex Safir O, Gross....
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