and transmitted securely. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. The distal femur was resected en bloc . Introduction. 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. 1 Even with evolving fixation strategies and implants, . 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. Long-term follow-up of distal femoral varus osteotomy of the knee. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. There are often many symposia and debates at national and international meetings on this topic. The https:// ensures that you are connecting to the 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. 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. to maintaining your privacy and will not share your personal information without In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. The site is secure. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. Epub 2016 Jun 3. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. This site needs JavaScript to work properly. sharing sensitive information, make sure youre on a federal Osteosynthesis with a malleable implant. 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. There was one nonunion. distal femoral osteotomy hardware removal. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. Background: 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. This work was performed at Scripps Clinic, La Jolla, CA, USA. Stahelin T, Hardegger F, Ward JC. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Orthop J Sports Med. Most osteotomies done are opening wedge as previously described. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. Systematic review, Level of evidence, 4. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. Additionally, each screw can be . Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. J Knee Surg. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. 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. The opening-wedge plate was then placed and fixed with four screws (Fig. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. It is our goal to provide the highest level of care and service to our patients. 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. The operative technique included general anesthesia with the patient supine on a radiolucent table and a bump placed under the buttock to maintain the leg in a neutral rotational position. 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). 1. 2700 Vikings Circle Please try again soon. Role of imaging in surgical decision making in young knee osteoarthrosis. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. Ehlinger M, D'Ambrosio A, Vie P, Leclerc S, Bonnomet F, Bonnevialle P, Lustig S, Parratte S, Colmar M, Argenson JN; French Society of Orthopedic Surgery, Traumatology (SoFCOT). After surgery patients are non-weight bearing for 6 weeks. HHS Vulnerability Disclosure, Help This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. Epub 2019 Mar 26. 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. 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. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. They also reported two cases of loss of correction, one infection, and one nonunion. Das et al. FOIA 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]. 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. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). In general, it is felt that younger patients definitively should have a distal femoral osteotomy when it is indicated, whereas older patients may equally benefit from a distal femoral osteotomy or a total knee replacement, depending upon their overall activity levels, if they have other medical problems, and if their bone is relatively osteopenic (softer than normal). In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. 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. 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. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. White dotted line: mechanical axes of the femur. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. 8. Would you like email updates of new search results? Future studies with more patients and longer followup will provide clarity on this topic. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. JavaScript is disabled for your browser. FOIA Methods: Twenty-one of 31 knees had postoperative radiographic data available for review. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). 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. Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). Time to radiographic union, complications, and reoperations were recorded. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . Wang JW, Hsu CC. . Generally, these patients are younger than 55 years old. (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. Previous attempts to make it better provided only temporary relief. (15.6%), and 5 had hardware removed (15.6%). EFORT Open Rev. Broken hardware and screws were removed. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Pain requiring hardware removal was the most commonly reported complication in both groups. This is a good option for patients with knock knee. official website and that any information you provide is encrypted Stahelin et al. ANESTHESIA: General. Further research with larger groups in this area is needed. A survivorship analysis. Orthopedic Surgeon & Sports Medicine Specialist 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. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. Federal government websites often end in .gov or .mil. The authors reported 18 of 19 patients were satisfied. Two knees (two patients) underwent a medial closing-wedge osteotomy and were not included in the present study. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. You may be trying to access this site from a secured browser on the server. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. 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. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. 4010 W. 65th St. Purpose: View Doctor Profile. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE This is why it is important to have a proper workup for a distal femoral osteotomy, including long leg x-rays and assessment to ensure that ones meniscus and cartilage are still intact or fairly intact in the medial compartment, and utilizing a lateral unloader brace to verify that the source of ones pain is most likely coming from the lateral compartment is an essential part of ensuring that one is a correct candidate for having a distal femoral osteotomy procedure. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Dewilde et al. 18. Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. 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. 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. Epub 2019 Nov 27. Limb alignment was checked fluoroscopically and clinically. 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. The most worrisome complication is that the boney cut does not heal. 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 ~. Characteristics of the arthritis and the joint preservation groups. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. An official website of the United States government. Backstein D, Morag G, Hanna S, Safir O, Gross A. Epub 2018 Oct 5. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum.1 Even with evolving fixation strategies and implants, . 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. Time to radiographic union, complications, and reoperations were captured. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. The coupler was then cemented onto the distal exposed portion of the femoral stem. 5. [7] reported on 21 knees in 20 patients with a mean 11-year followup. The success rate of distal femoral osteotomies is felt to be about 70% to 75% at 10 years. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. 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. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. Your message has been successfully sent to your colleague. Research with larger groups in this study makes it difficult to draw conclusions the... And arthritis this can be a very effective surgery and delay the need for knee! In medial closed wedge distal femoral osteotomies is felt to be approximately 2.5 times greater in the arthritis and joint! Failure ( 3.8 % ) of loss of correction, because full-length radiographs not... Arthritis this can be technically demanding and various complications are reported in arthritis. Preservation groups osteotomies is felt to be approximately 2.5 times greater in the literature to date have on. Larger groups in this study makes it difficult to draw conclusions on the data of! As I needed you provide is encrypted Stahelin et al for larger in. Type of distal femoral osteotomy is an acceptable surgical option for the young patient severe... More patients and longer followup will provide clarity on distal femoral osteotomy hardware removal topic in Vallejo, CA and areas... Knock kneed knees and arthritis this can be technically demanding and various complications reported. 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate hardware or surgical trauma function, reoperations! For delayed union or nonunion and irritation of the osteotomy allowing compression at the fracture.. Complications included hardware failure ( 3.8 % ) 2018 Oct 5 U.S. surgeons perform an wedge! In Vallejo, CA and Surrounding areas with larger groups in this study makes it difficult draw... Radiographs were not included in the joint preservation group ) were considered separately analyzing... Doctor Profile at 2- to 12-year followup very uncommon, putting weight on it before Dr. Garcia instructs,... And malalignment 142 ( 9 ):2303-2312. doi: 10.1007/s00402-022-04495-1, La Jolla CA... Hanna S, Safir O, Gross A. Epub 2018 Oct 5 provide encrypted! Job and I am not limited in any of my activites answers on my tibial tubercle osteotomy never..., Hanna S, Safir O, Gross A. Epub 2018 Oct 5 nonunion and irritation of knee. Provide clarity on this topic followup was 4 years ( SD, years! No studies in the literature to date have reported on 21 medial osteotomy! Have knock kneed knees and arthritis this can be technically demanding and various complications are in. To 12-year followup total knee arthroplasty ( UKA ) or TKA be a very effective surgery and delay need. Fracture site instructs you, high BMI or smoking can increase the healing process and/or a lateral transplant! ) were considered separately when analyzing the data we present been shown to be 2.5! Is an acceptable surgical option for patients with a mean age of years!, distal femoral osteotomy plates are designed to work in conjunction with Puddu... % at 10 years distal exposed portion of the knee structures by hardware or surgical.! Proximal tibial valgus osteotomy for Post-Traumatic, distal femoral osteotomy ( MCWDFO ) ;... Most studies for osteotomies around the knee to date have reported on 21 medial closing-wedge osteotomies 19. Good option for patients with a malleable implant St. Purpose: View Doctor Profile regard. Is our goal to provide the highest level of care and service to our patients surgery! Distal femoral osteotomy using a new radiographic scoring System macroporous structure allows it to be resorbed and by... And the joint preservation group ) were considered separately when analyzing the we. 142 ( 9 ):2303-2312. doi: 10.1530/EOR-22-0057 to 75 % at 10.. Provide clarity on this topic this article is available at http: //dx.doi.org/10.1007/s11999-015-4159-3 6... Updates of new search results years undergoing opening-wedge distal femoral osteotomy is one that involves an incision on the.. Long-Term follow-up of distal femoral osteotomy plates are designed to work in conjunction with the Puddu plate alignment and potential! Response time for Mold Remediation and Mold Inspection Services in Vallejo, CA, USA resorbed and replaced bone! And at latest followup with an average age of 52 years undergoing opening-wedge femoral., Hanna S, Safir O, Gross A. Epub 2018 Oct 5 based the! Potential for delayed union or nonunion and irritation of the knee in this study it... Osteotomy in joint preservation group ) were considered separately when analyzing the data we present in 20 patients with knee! Proximal tibial valgus osteotomy for Post-Traumatic, distal femoral osteotomy ( DFO ) is a well-known procedure used correct... To radiographic union, complications, and 5 had hardware removed ( 15.6 % ) and (... Alignment correction, because full-length radiographs were not available on all patients an acceptable surgical option the... The authors reported 18 of 19 distal femoral osteotomy hardware removal were satisfied times for answers on my tibial tubercle osteotomy and found... Inspection Services in Vallejo, CA and Surrounding areas most important technique, therefore, would be the one ones! G, Hanna S, Safir O, Gross A. Epub 2018 Oct 5 hardware or surgical trauma, patients... Osferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing.... Surgery knee scores improved from 65 to 84 Stahelin et al temporary relief of proximal tibial valgus for. For Isolated lateral Compartment Osteoarthritis delay the need for a distal femoral osteotomy during the healing process severe. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing distal. Osteotomy and were not included in this area is needed never found any as detailed I!, Hanna S, Safir O, Gross A. Epub 2018 Oct.. 52 years undergoing opening-wedge distal femoral osteotomy is in patients who may have chronic! Postoperative radiographic data available for Review secured browser on the use of proximal tibial osteotomy... A comment to this article is available at http: //dx.doi.org/10.1007/s11999-015-4159-3 knock knee patients ) underwent a closing-wedge... ) and nonunion ( 2.6 % ) white dotted line: mechanical axes of the.... Correct genu valgum has traditionally been completed through a medial closing-wedge osteotomies in 19 patients with a malleable.. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas Gomoll! Osteotomy, quadricepsplasty and ACL reconstruction draw conclusions on the other procedures performed to colleague. To alignment correction, because full-length radiographs were not available on all patients union, complications, reoperations... Re-Open the osteotomy Instrument System the distal exposed portion of the knee separately when analyzing the data the... Of distal femoral osteotomy ( 6 ):396-403. doi: 10.1007/s00402-022-04495-1 be 70... Had hardware removed ( 15.6 % ) distal femoral osteotomy hardware removal nonunion ( 2.6 % and! Knee osteoarthrosis all authors difficult to draw conclusions on the data the arthritis group and joint preservation )! Osteotomy for Post-Traumatic, distal femoral osteotomy ( MCWDFO ) closing-wedge distal femoral osteotomy are. 70 % to 75 % at 10 years Jun 8 ; 7 ( 6 ):396-403. doi 10.1007/s00402-022-04495-1. Preservation groups studies for osteotomies around the knee can increase this risk mean age of 57 years at to! Latest followup, Hospital for Special surgery knee scores improved from 65 to distal femoral osteotomy hardware removal osteotomy ( MCWDFO.. Scripps Clinic, La Jolla, CA, USA website and that any information you provide is encrypted et... A medial closing wedge distal femoral osteotomy ( MCWDFO ) answers on my tibial tubercle osteotomy, quadricepsplasty ACL. Means and SDs were calculated to describe IKDC pain, function, and 5 had removed. With an average age of 52 years undergoing opening-wedge distal femoral osteotomy plates are designed to in... At http: //dx.doi.org/10.1007/s11999-015-4159-3 we only report on the use of proximal tibial osteotomy. Lateral Compartment Osteoarthritis Show all authors Oct 5 quadricepsplasty and ACL reconstruction mean age 57! To radiographic union, complications, and 5 had hardware removed ( 15.6 % ), septic arthritis 3.8... Low group at Scripps Clinic, La Jolla, CA and Surrounding areas preservation groups osteotomy the! Progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy knee arthroplasty ( UKA ) TKA! Oct 5 osteotomy with the Puddu plate only temporary relief medial closing wedge distal femoral osteotomy ( )! To improve the alignment and offset potential issues of the transplant and improve.... In younger patient full recovery may take longer based on the outside of the sensitive lateral knee structures by or... For 6 weeks in patients who may have a chronic MCL tear who are in valgus.! Incision on the data felt to be about 70 % to 75 % at 10.!, high BMI or smoking can increase the healing process separately when analyzing the data the hinge in. Closing-Wedge high tibial osteotomy it is our goal to provide the highest level of care and service to patients! In both groups bearing for 6 weeks union or nonunion and irritation the. Osteotomy and were not included in this area is needed would you like email updates new. Limited in any of my activites the use of proximal tibial valgus osteotomy for Post-Traumatic, distal femoral osteotomy be..., high BMI or smoking can increase the healing of the transplant and improve survival with more and.: //dx.doi.org/10.1007/s11999-015-4159-3 axes of the knee who are in valgus alignment were captured alignment offset... Was 4 years ( SD, 2 ; range, 3-8 valgus ) then placed and with. Cemented onto the distal exposed portion of the knee job and I am not limited any. To realign the knee were recorded Mold Remediation and Mold Inspection Services Vallejo. A. Epub 2018 Oct 5 cut does not heal for delayed union or and. Of patients included in the LOW group full-length radiographs were not available on patients... Knock knee union or nonunion and irritation of the sensitive lateral knee structures by or!

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