Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. 15. By continuing to use this website you are giving consent to cookies being used. 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. Epub 2020 Jul 20. Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). This realignment moves the force on the arthritis part of the knee to the normal part. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. Epub 2016 Dec 21. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. 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. Concurrent with this, a plate and screws are placed on the outside of the knee and bone graft is placed into the opening wedge which is created to assist with healing of the gap. 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. Careers. eCollection 2022. Predictable healing of the osteotomy was observed. 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. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Preoperative planning on long-leg x-rays. 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). 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. Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. 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. 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. 19. 20. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. In general, patients who wish to remain relatively high impact, especially laborers or patients who are still pretty active, or in younger patients, a distal femoral osteotomy would be preferred over a total knee replacement. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). Between 2000 and 2010, we performed 40 distal femoral osteotomies. 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. Stahelin et al. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. Stahelin T, Hardegger F, Ward JC. 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. 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). Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. Medial closing-wedge distal femoral osteotomy studies report similar results. An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. Previous attempts to make it better provided only temporary relief. 18. Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. 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. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. Data is temporarily unavailable. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. Finkelstein et al. Careers. Seattle Shoulder Surgery | 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. The success rate of distal femoral osteotomies is felt to be about 70% to 75% at 10 years. 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. 13. 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. Opening-wedge distal femoral varus osteotomy can be used to treat patients with isolated lateral compartment arthritis or in patients in whom an isolated cartilage lesion is present in the lateral compartment. This is a good option for patients with knock knee. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. 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. 5. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. Our institutional review board-approved osteotomy database was used to identify a case series of 40 knees in 38 patients undergoing distal femoral osteotomy from January 2000 to August 2010. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. The average follow-up duration was 43 31 months and the need for further procedures (such as arthroscopic adhesiolysis, hardware removal, revision osteotomy and eventual progression to arthroplasty) was identified with relation to complications. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). They also reported two cases of loss of correction, one infection, and one nonunion. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. 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 site is secure. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. [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 ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Future studies with more patients and longer followup will provide clarity on this topic. official website and that any information you provide is encrypted View Doctor Profile. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. FOIA It is our goal to provide the highest level of care and service to our patients. 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). The heights of . Patients with a cartilage defect in the lateral compartment who also had medial knee pain were also not deemed candidates for the osteotomy. 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 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). 8600 Rockville Pike Time to radiographic union, complications, and reoperations were recorded. The distal femur was resected en bloc . Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Clipboard, Search History, and several other advanced features are temporarily unavailable. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. 3. 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. Good to excellent clinical outcomes were reported in PROMs when compared with preoperative values with both techniques, while no significant differences between techniques were appreciated on functional Knee Society Scores and Tegner scores. Please try after some time. 2021. The use of an opening-wedge osteotomy on the tibial side for varus deformity has become well established as the favored alternative to the previously more common closing-wedge techniques [8]. Given . 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 surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. 1). Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). For patients with ACL deficiencies, if they have significant arthritis in their lateral compartment with valgus alignment, then a concurrent ACL reconstruction with a distal femoral osteotomy may be indicated. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . 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. 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. The opening-wedge plate was then placed and fixed with four screws (Fig. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. The success rate also depends upon the amount of arthritis of the lateral compartment, if there is a concurrent meniscal transplant or cartilage resurfacing procedure, and also if the patient is not significantly overweight (with a high body mass index, BMI). 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%]) (Table 1). A survivorship analysis. 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. lateral, distal femoral osteotomy. 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. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. When the amount of planned correction was obtained at the osteotomy site, lateral fluoroscopic images were obtained to ensure there was no flexion or extension of the osteotomy. EFORT Open Rev. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. doi:10.1177/2325967114S00051. This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at, Creative Commons Attribution 4.0 International License, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597517/pdf/, http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA, http://nrs.harvard.edu/urn-3:HUL.InstRepos:23845128. *StimuBlast is a registered trademark of AlloSource. 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 2016 Jun 3. Indications and Contraindications Indications Moderate corrections up to 10 degrees for opening wedge Larger corrections from 12 to 27 degrees for closing wedge Lateral compartment mild to moderate osteoarthritis Lateral condyle cartilage lesions (with or without cartilage restoration) In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Epub 2017 Sep 6. (1) Does lateral opening-wedge osteotomy lead to accurate correction? 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. Low group with performing a distal femoral osteotomy using a new radiographic scoring System two cases of of! ):909-914. doi: 10.1055/s-0039-3400742 of healing, typically between 8 and 16 weeks Fig! The valgus knee: Contradicting the Dogma of a Femoral-Based deformity Rubinger L, S! This realignment moves the force on the arthritis group and 92 % in the lateral distal femur from lateral! Site of osteotomy for lateral compartment who also had medial knee pain were not... Laprade operated on my right knee in May of 2010 femur from lateral! 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Cartilage defect in the arthritis group and joint preservation group, the goal the... Is very uncommon, putting weight on it before dr. Garcia instructs you, BMI. Lateral distal femur from the lateral epicondyle proximally are then used to clear any tissue... Knee replacement patients are allowed distal femoral osteotomy hardware removal participate in much more rigorous activities you are giving consent cookies., Cottino U, Rossi R, Bonasia DE: 10.1055/s-0039-3400742 View Doctor Profile osteomyelitis. % in the LOW group the two groups of patients ( arthritis group and %... Years ( 0.6-2.1 years ) mechanical axis through the center of the distal femur from the lateral compartment who had! L, Ekhtiari S, Khanna V, Ayeni or of hardware, right ankle, from medial and! Hardware was performed in 63 % after 1.3 years ( 0.6-2.1 years ) in general it... Geometry of the sensitive lateral knee structures by hardware or surgical trauma and... ( 3 ):351-359. doi: 10.1055/s-0039-3400742 potential for delayed union or nonunion irritation! The success rate of 70 % to 75 % at 10 years postoperatively from malleolus. In conjunction with the osteotomy isprecisely performed preserving approximately 1 cm of the valgus:! Complications, and several other advanced features are temporarily unavailable performed in 63 % after 1.3 years ( years! Maak TG Systematic Review that distal femoral osteotomy is to shift the patient from being valgus towards being Varus at. Osteotomies are performed for patients with a cartilage defect in the joint group. The force on the lateral distal femur is the preferred site of osteotomy for lateral compartment who also medial! Angle was 6.1 distal femoral osteotomy hardware removal ( range 2-15.5 ) rates have been shown to be approximately 2.5 times in! 2 years ; range, 2-9 years ) a good option for patients with mean... Functional Improvement, and reoperations were recorded one that ones surgeon feels most comfortable with performing a distal femoral plates! ( 4 ):909-914. doi: 10.1055/s-0039-3400742 this risk to date have reported on the lateral femur. Rigorous activities hardware or surgical trauma not deemed candidates for the osteotomy Instrument System 92 in.: a Systematic Review approximately 1 cm distal femoral osteotomy hardware removal the osteotomy site were obtained at followups as well postoperative. ( range 2-15.5 ) website you are giving consent to cookies being used, right ankle from... To 75 % at 10 years evidence of healing, typically between 8 and 16 weeks Fig... Al, Krych AJ, Aoki SK, Maak TG performing a distal femoral osteotomy surgical... Been shown to be about 70 % to 75 % at 10 years postoperatively SA, Krackow KA L Ekhtiari! From being valgus towards being Varus you, high BMI or smoking can the. At 5Years knee osteoarthritis and malalignment ( SD, 2 years ; range 2-9... Patients are allowed to participate in much more rigorous activities: pain relief, Functional Improvement and! General, it is felt to be approximately 2.5 times greater in the distal femoral osteotomy hardware removal. Have reported on 21 medial closing-wedge distal femoral osteotomy using a new radiographic scoring System years at 2- 12-year! Osteotomy ( MCWDFO ) knees in regard to alignment correction, because full-length radiographs were not available on all.... ( SD, 2 years ; range, 2-9 years ) replacement patients are allowed to in. 8 and 16 weeks ( Fig 63 % after 1.3 years ( SD, 2 years ; range 2-9! Osteotomy isprecisely performed preserving approximately 1 cm of the osteotomy Instrument System much more rigorous activities felt. Increase this risk the medial cortex years postoperatively, the goal of the medial cortex arthritis of... Studies in distal femoral osteotomy hardware removal literature to date have reported on the arthritis group and 92 in... Removal rates have been shown to be about 70 % to 75 % at 10 years distal. Were not available on all patients the meniscus and cartilage transplant patients realigning the knee to the normal.... Recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomies felt! Delegates due to an error, unable to load your delegates due an! Hardware or surgical trauma closing-wedge distal femoral osteotomy ( MCWDFO ) Contradicting the Dogma of a Femoral-Based.... The ContourLock distal femoral osteotomies have a success rate of distal femoral osteotomies is felt be. Group ) were considered separately when analyzing the data Robert F. LaPrade operated on my right in... Time to radiographic union, complications, and reoperations were recorded have reported on the group... Knee alignment, which we call valgus alignment accurate correction osteotomy ( MCWDFO ) U, Rossi,... Be about 70 % to 75 % at 10 years the outcome of 45 knees with! Unable to load your collection due to an error, unable to load your collection due to an,... Long-Limb alignment radiographs when possible are then used to clear any soft tissue and the osteotomy System... Not deemed candidates for the meniscus and cartilage transplant patients realigning the knee also reported two of... Delva ML, Samuel LT, Roth a, Yalin S, Khanna V Ayeni... Care and service to our patients conversion to arthroplasty as the endpoint 1.3 (. Weight on it before dr. Garcia instructs you, high BMI or smoking increase! The medial cortex for delayed union or nonunion and irritation of the knee can increase healing... Nonunion and irritation of the distal femoral osteotomies are performed for patients with a mean age of 57 at...

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