Bethesda, MD 20894, Web Policies Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. Bookshelf Knee Surg Sports Traumatol Arthrosc. In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. Careful selection of each surgical candidate is necessary to ensure maximum benefit. All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. Care was taken to maintain the line above the articular surface of the trochlea. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. Oftentimes, we will place the patient into a lateral compartment unloader brace to use as a screen to determine that a distal femoral osteotomy may be a useful procedure. A sterile tourniquet was used. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. 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. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Survivorship at 74 months with the endpoint of TKA was 83%. Achieving our desired correction of 3 from neutral alignment was clinically difficult. 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. This site needs JavaScript to work properly. 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. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Epub 2019 Nov 27. Orthop Traumatol Surg Res. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. The IKDC score improved from 36 to 53 (p < 0.05). Epub 2018 Oct 5. 15. 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. closing wedge; distal femoral osteotomy; opening wedge; valgus. 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. Improvements in the IKDC scores were noted postoperatively. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. J Knee Surg. for hardware removal following operative xation of distal radius fractures. This AP radiograph demonstrates a healed nonunion (left). Thirty-eight knees (97%) in 36 patients were lateral opening-wedge varus-producing osteotomies; of those, 31 knees (82%) in 30 patients had followup at a minimum of 2 years (mean, 5 years; SD, 2; range, 2-12 years) and comprised the study population. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. Dr. Garcia will take limb alignment films to identify have much correction is needed. HHS Vulnerability Disclosure, Help Distal femoral varus osteotomy for painful genu valgum. The first is if patients are extremely knock kneed and there is a need to realign the knee to prevent further damage to the area seeing the most load or the outside of the knee. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. [7] reported on 21 knees in 20 patients with a mean 11-year followup. In total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. These studies report the correction of deformity and the pain and function of small cohorts of patients undergoing a medial closing-wedge distal femoral osteotomy for treatment of lateral compartment arthritis. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. For more information, please refer to our Privacy Policy. Careers. In our hands, almost all patients who benefit from the use of a lateral unloader brace do very well with a later performed distal femoral osteotomy and are able to correct the knock knee condition. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. doi:10.1177/2325967114S00051. 8600 Rockville Pike For larger procedures in younger patient full recovery may take longer based on the other procedures performed. HHS Vulnerability Disclosure, Help Orthopedic Surgeon & Sports Medicine Specialist 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. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re 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. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. Distally the coupler was mated to a DFR in the usual fashion . The 5-year survival with the endpoint of conversion to arthroplasty was 79%. I can run, bike, & climb mountains. Phil Downer, M.D | An official website of the United States government. 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. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? The .gov means its official. 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. 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. Dewilde et al. Knee Society knee scores improved from 43 to 78. 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. The authors reported 18 of 19 patients were satisfied. 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/. JavaScript is disabled for your browser. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Dr. Robert F. LaPrade operated on my right knee in May of 2010. a Preoperative long-leg standing X-rays. This is a good option for patients with knock knee. The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. 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, . View Doctor Profile. All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. 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. Orthop J Sports Med. Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. This website uses cookies. Most patients who did not have success during this timeframe were converted to a total knee replacement. The rst is a true Table 1. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. 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 . Further surgery after lateral opening-wedge distal femoral osteotomy. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. A 57-year-old man presented to our orthopedic outpatient . Seattle Shoulder Surgery | PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. This was an unexpected but noteworthy finding. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. lateral, distal femoral osteotomy. Future studies with more patients and longer followup will provide clarity on this topic. 7. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Before Results: The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. sharing sensitive information, make sure youre on a federal Grant H. Garcia, MD Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. 12. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. Purpose: (1) Does lateral opening-wedge osteotomy lead to accurate correction? The coupler was then cemented onto the distal exposed portion of the femoral stem. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. Epub 2016 Dec 21. Limb alignment was checked fluoroscopically and clinically. The site is secure. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. 3. All surgeries were performed by two of the senior authors and 60.3% were done in conjunction with cartilage repair procedures such as autologous chondrocyte implantation and osteochondral graft transfer. 2). Routine closure was then performed and the patient was placed into a ROM brace. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. 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. 3, 4) and was ultimately converted to a TKA. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. In fact 2 years ago I finished climbing the top 100 peaks in CO. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. The average patient age at surgery is 33 11 years with mean BMI of 28 6. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. 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. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. Data is temporarily unavailable. Correction of valgus knee deformity with a supracondylar V osteotomy. Characteristics of the arthritis and the joint preservation groups. Once the osteotomy was mobile, an opening-wedge device was placed. Aglietti P, Menchetti PP. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. Epub 2017 Sep 6. 16. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. Patients who are bowlegged are in varus alignment. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Thirty-eight knees in 36 patients underwent lateral opening-wedge distal femoral varus osteotomy for treatment of symptomatic lateral compartment arthritis (24 knees [63%]) or as an adjunct to an osteochondral allograft or meniscal transplant (14 knees [37%]). 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. The opening-wedge plate was then placed and fixed with four screws (Fig. 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. Many of the patients who had postoperative films were not within 3 of neutral alignment. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. A 135-case series with minimum 5-year follow-up. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. Das et al. 20. Clin Sports Med. 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). EFORT Open Rev. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. 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 meniscus allografting) has been performed. 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May of 2010. a preoperative long-leg standing X-rays ( left ) underwent opening-wedge distal femoral osteotomy with supracondylar... Or ACL tears survivorship of 64 % at 10 years, which included seven failures ( three early four.
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