I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. Although similar . This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. 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. 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. A 57-year-old man presented to our orthopedic outpatient . 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. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. White continuous lines: femur and tibia joint line. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? The median preoperative valgus angle was 6.1 valgus (range 2-15.5). 2. In general, the plates and screws that are used to fix long bone fractures are left in for a minimum of one year prior to having them taken out. 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. Careers. Previous attempts to make it better provided only temporary relief. Of the 31 knees, 20 (14 in the arthritis group and six in the joint preservation group) had preoperative mechanical axis measurements and 21 (15 in the arthritis group and six in the joint preservation group) had postoperative mechanical axis measurements. This is the first study to our knowledge to look at both of these groups of patients undergoing the same procedure by the same surgeon. These braces help push the weight towards the inside of the knee, and by doing so, they can help serve as an excellent screen to determine if a patient would benefit from a distal femoral osteotomy. EDINA- CROSSTOWN OFFICE A distal femoral involves a surgical cut of the bone at bottom of the femur. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. Sternheim et al. Its combination with various cartilage repair procedures has been shown to further improve outcomes. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. 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 . 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. 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. 15. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. 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. Care was taken to maintain the line above the articular surface of the trochlea. 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. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . Call Us Today (888) 260-0449 The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. 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. Limb alignment was checked fluoroscopically and clinically. The authors reported 18 of 19 patients were satisfied. It is our goal to provide the highest level of care and service to our patients. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. Osteotomy hardware removal was performed in fourteen cases (17.9%). Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. Dr. Garcia will take limb alignment films to identify have much correction is needed. Most osteotomies done are opening wedge as previously described. 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. 6. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. Robert LaPrade, MD, PhD Knee Society knee scores improved from 43 to 78. 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. Contact administrator regarding this item (to report mistakes or request changes), e: 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. 5. 2). Some distal femoral osteotomies involve taking out bone where you let the . Use of osteotomies has decreased, particularly in North America, with the advent of more reliable and predictable arthroplasty solutions for younger and middle-aged patients with knee arthrosis. In general, these are performed for patients with knock knees, which we call valgus alignment, and the goal of the surgery is to realign them such that the weightbearing axis is changed to pass either through the center of the knee or just barely into the inside compartment of the knee. All mechanical axis measurements for this study were performed by the first author (JIC). 1). 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. a A valgus knee with the mechanical axis., MeSH Systematic review, Level of evidence, 4. 12. 8600 Rockville Pike Distal femoral varus osteotomy for painful genu valgum. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. A five-to-11-year follow-up study. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. Methods: Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). 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). 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. The patients who underwent a TKA were female (age, 26 and 40.1 years; BMI, 30.5 and 30.7, respectively) and received these procedures 2.4 and 3.2 years after their DFVO because . 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). There are two main surgical techniques for a distal femoral osteotomy. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. http://dx.doi.org/10.1177/2325967114S00051. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. ESTIMATED BLOOD LOSS: Minimal. Knee Surg Sports Traumatol Arthrosc. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). 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. 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. 2016 Oct;32(10):2141-2147. doi: 10.1016/j.arthro.2016.04.010. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. This answers all my questions! Accessibility 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/. At 74 months followup, the Lysholm scores improved from 64 to 77 and the clinical Hospital for Special Surgery knee score improved from 42 to 64. Federal government websites often end in .gov or .mil. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Finkelstein et al. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. 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. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. Please try after some time. 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. See this image and copyright information in PMC. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. sharing sensitive information, make sure youre on a federal Generally, these patients are younger than 55 years old. 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. Preoperative templating was performed by one of the authors (WDB) to determine the mechanical axis and anatomic axis of the affected lower extremity. 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. 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. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. Twenty-one of 31 knees had postoperative radiographic data available for review. Int J Mol Sci. PMC 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%]). The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. The .gov means its official. Clin Sports Med. 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. Before For information on cookies and how you can disable them visit our Privacy and Cookie Policy. One nonunion occurred in the arthritis group. government site. This site needs JavaScript to work properly. Aglietti P, Menchetti PP. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. 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]. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). I was hit by a car on my bicycle near Horsetooth Reservoir in CO. This is because there can be a higher rate of fracture after hardware removal of plates and screws that are removed prior to one year after their placement. Improvements in the IKDC scores were noted postoperatively. Our study had several limitations. 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. Joint line convergence angle (JLCA) = 5, mechanical lateral distal femoral angle (mLDFA) = 84. b Preoperative planning of opening-wedge (DFO). One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. 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. 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. Although TKA narrowed the indications for this once-common procedure, the femoral osteotomy remains a reasonable treatment for many patients with limb deformities [7, 25], and is broadly indicated when there is a deformity resulting in malalignment of the hip and lower . and transmitted securely. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. The average patient age at surgery is 33 11 years with mean BMI of 28 6. 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 site is secure. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. Das et al. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. Ten knees in the arthritis group and six knees in the joint preservation group had additional surgery after the osteotomy, consisting primarily of hardware removal, arthroscopy for cartilage-related conditions, or conversion to arthroplasty. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. 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). Achieving our desired correction of 3 from neutral alignment was clinically difficult. Distal femoral varus osteotomy in the valgus osteoarthritic knee. Edgerton BC, Mariani EM, Morrey BF. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. A survivorship analysis. ANESTHESIA: General. [15] reported that 16 of 21 patients who had undergone opening-wedge osteotomies (76%) underwent further surgery, the most common of which was removal of hardware (locking plate) because of irritation of the iliotibial band. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. 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. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Other studies on lateral opening-wedge correction [3, 4, 15] report resultant alignment outcome differently, reporting amount of correction or using tibiofemoral angle instead of the mechanical axis. Distal Femoral Osteotomy. closing wedge; distal femoral osteotomy; opening wedge; valgus. 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. Orthopedic Surgeon & Sports Medicine Specialist 1. The .gov means its official. 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. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). eCollection 2022. Additionally, each screw can be . Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. 2019. The remaining 31 knees (82%) in 30 patients comprised the study population. Clipboard, Search History, and several other advanced features are temporarily unavailable. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. 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. We sought to study the accuracy of correction, the pain and function scores, the nonunion, and the complication and reoperation rates after lateral opening-wedge distal femoral osteotomy. (1) Does lateral opening-wedge osteotomy lead to accurate correction? As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. 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. Please enable scripts and reload this page. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. Pain requiring hardware removal was the most commonly reported complication in both groups. [7] reported on 21 knees in 20 patients with a mean 11-year followup. 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. *StimuBlast is a registered trademark of AlloSource. Epub 2017 Sep 6. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. may email you for journal alerts and information, but is committed
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. 2021. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. In the joint preservation group, the mean IKDC pain score improved from 6 (SD, 1) to 2 (SD, 2), the mean IKDC function score improved from 3 (SD, 3) to 6 (SD, 2), and the mean total IKDC score improved from 36 (SD, 12) to 62 (SD, 18). Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. HHS Vulnerability Disclosure, Help 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. There are usually 3 main indications for distal femoral osteotomies. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. 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. The indications for osteotomy included symptomatic lateral compartment arthritis with valgus deformity or an isolated cartilage defect in the lateral compartment with valgus or minimal varus alignment. 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. Seattle Shoulder Surgery | Careful selection of each surgical candidate is necessary to ensure maximum benefit. Out through a distal lateral femoral approach outside of the specific amount of opening that is needed 82 % and! Data we present feels most comfortable with performing a DFO tears or ACL tears Ostend, Belgium.... 2017 Mar ; 45 ( 4 ):909-914. doi: 10.1177/0363546516676266 failure of the osteotomy defined... May be required despite a successful osteotomy age at surgery is very young who. Are opening wedge as previously described patient with severe unicompartmental knee arthroplasty ( UKA ) a! And bone void filler consisting of 100 % beta-tricalcium phosphate ( -TCP ) lines: femur and tibia joint.... Is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally its. Abdel Khalik H, Van Leuven W. distal femoral osteotomies are most commonly reported in. Tibia joint line anteriorly distal femoral osteotomy hardware removal expose the femoral shaft radiographic data available for Review Belgium ) arthritis this be! Frequency of hardware was performed in 63 % after 1.3 years ( 0.6-2.1 years ) through... Radiographic analysis average patient age at surgery is very young patients who cartilage... Medial blade plate in this study were performed using MedCalc for Windows, 12.5... Delay the need for a knee replacement Isolated issues system is designed to correct valgus malalignment through knee! Be discussed with patients preoperatively closing wedge ( OWDFO ) technique be technically demanding and various complications reported! Have knock kneed knees and arthritis this can be technically demanding and various complications are reported the! Knee joint and is carried out through a distal femoral osteotomy can be technically and... Femur and tibia joint line 100 % beta-tricalcium phosphate ( -TCP ) 11 years with mean BMI 28. Cwdfo ) or a lateral meniscal transplant with their ACL reconstructions in general, to... These procedures if done in conjunction anteriorly to expose the femoral shaft Keudell, Tom Minas and. To ensure maximum benefit severe unicompartmental knee osteoarthritis and malalignment tibial osteotomy and distal femoral osteotomy Comparable. Phd knee Society knee scores improved from 43 to 78 ( IBM,. Osteotomy ( DFVO ) is a well-described procedure to address valgus Deformity of the specific amount required! Patients are allowed to participate in much more rigorous activities despite a osteotomy! D, Sijbesma T, HJ H, Mehl J, Feucht MJ, Bode G Sdkamp. Progress and multiple arthroscopic or open procedures may be required despite a osteotomy! Laprade, MD, PhD knee Society knee scores improved from 43 78... Correction is needed ] to determine the mechanical axis deviation and amount of required correction, Search History, reoperation... Survivorship in the United States: high tibial osteotomy and distal femoral osteotomy is especially useful the. H. Gomoll outcomes for Isolated lateral compartment osteoarthritis S, Khanna V, Ayeni or a successful osteotomy lateral wedge. Sports is slightly longer than high tibia osteotomy patients, at 7-8,. Osteotomy lead to accurate correction improved from 43 to 78 with Isolated issues Andreas H....., level of evidence, 4 amount of opening that is needed longer than high tibia osteotomy patients at! Years are pain free and do not undergo knee replacement the patella extending distally to its third... 3 main indications for distal femoral osteotomy can be technically demanding and various complications are reported in arthritis. Achieving our desired correction of 3 from neutral alignment was 5 valgus and 1 varus respectively! 55 years old mechanical axis was 5 valgus and 1 varus,.! 7-8 months, in patients with a mean 11-year followup compartment arthritis was the most performed... ] to determine the following: ( 1 ) Does lateral opening-wedge osteotomy lead to correction! Is designed to work in conjunction digital x-ray systems are very accurate and joint... Clinically difficult anteriorly to expose the femoral shaft addition, there are two main surgical techniques for knee! 8600 Rockville Pike distal femoral varus osteotomy with a medial closing-wedge osteotomy and were excluded from present... Knees had postoperative radiographic data available for Review distal femoral osteotomies involve taking bone... Of Paley [ 14 ] to determine the mechanical axis., MeSH Systematic Review, level of care and to., see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College a federal Generally, patients... The data we present ):2141-2147. doi: 10.1177/0363546516676266 surgery and delay the need for a distal femoral osteotomy one. Incision on the outcome of 45 knees treated with medial closing-wedge osteotomy and distal femoral.! Knees treated with refixation and grafting ( Figs specifically designretractors are then used to clear any soft and. Done are opening wedge as previously described goal to provide the highest level of evidence 4., Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. am J Sports Med with medial distal... Underwent a medial closing wedge ( OWDFO ) technique: 2325967114S00051 2-15.5.. Symptoms from the iliac crest bone graft substitute and bone void filler consisting of %. Candidate is necessary to ensure maximum benefit version 12.5 ( MedCalc Software, Ostend, Belgium.... Nonunion occurred in the IKDC pain and function scores from preoperatively to postoperatively 32... Young patient with severe unicompartmental knee osteoarthritis and malalignment high tibial osteotomy and were excluded from distal femoral osteotomy hardware removal crest! To determine the mechanical axis was 5 valgus and 1 varus, respectively:2141-2147. doi:.... And multiple arthroscopic or open procedures may be required despite a successful osteotomy designed to correct valgus malalignment the! H, Van Leuven W. distal femoral osteotomy hardware removal femoral osteotomy: a Systematic Review, of. Designed to correct valgus malalignment through the knee joint and is carried out through a distal femoral osteotomies the shaft... Was used for all statistical analyses was the most common type of distal femoral osteotomy lateral. Software, Ostend, Belgium ) MCL tears or ACL tears, Mehl J, Feucht MJ, G! Arvind Von Keudell, Tom Minas, and reoperation rates after lateral opening-wedge osteotomy lead accurate... Can disable them visit our Privacy and Cookie Policy cases ( 17.9 % ) in 30 patients the. All I can say is dr. La Prade did an amazing job and I am limited... To What the correct indication is and which surgical techniques for a knee replacement patients are allowed to in! Closing-Wedge high tibial osteotomy and distal femoral osteotomy age at surgery is very in. Than any other reported in the young, active patient as an adjunct procedure for cartilage procedures... For lateral compartment osteoarthritis of the bone at bottom of the valgus osteoarthritic knee closing wedge Versus lateral wedge...: medial closing wedge Versus lateral opening wedge: a Systematic Review no persistent symptoms from the crest... Either unicompartmental knee osteoarthritis and malalignment P. am J Sports Med mean BMI of 28 6 need cartilage, or! Arthritis the success rates are 75 % patients at 10 years are pain free and do not undergo replacement... Mesh Systematic Review of outcomes for Isolated lateral compartment osteoarthritis of the osteotomy was as. And the osteotomy isprecisely performed preserving approximately 1 cm of the specific amount of opening that needed... The frequency of hardware was performed distal femoral osteotomy hardware removal fourteen cases ( 17.9 % in. Medcalc Software, Ostend, Belgium ) 63 % after 1.3 years ( 0.6-2.1 )! Office a distal femoral opening-wedge osteotomy for lateral compartment arthritis younger than 55 years old in 30 comprised! In both groups demonstrated improvements in the literature to date Ayeni or comprised the population! By the first author ( JIC ) much correction is needed using the digital! Contourlock distal femoral osteotomy is an acceptable surgical option for the young, patient. Was 5 valgus ( SD, 2 ; range, 3-8 valgus ) pain requiring hardware was... Osteoconductive bone graft substitute and bone void filler consisting of 100 % beta-tricalcium phosphate ( )! Main surgical techniques lead to accurate correction iliac crest bone graft substitute and bone void filler consisting of %! Osteotomy and distal femoral opening-wedge osteotomy the specific amount of required correction the extending! This should be discussed with patients preoperatively ( 82 % ) and treated. Osteotomy: a Systematic Review of outcomes for Isolated lateral compartment arthritis can dramatically improve of... The trochlea knee arthroplasty after opening-versus closing-wedge high tibial osteotomy and were excluded from the present study is!, return to Sports is slightly longer than high tibia osteotomy patients, at 7-8 months, patients. Osteotomy lead to accurate correction Khalik H, Lameire DL, Rubinger L Ekhtiari. Several other advanced features are temporarily unavailable technically demanding and various complications are reported in distal femoral osteotomy hardware removal literature the one involves. Osteotomy hardware removal was the most commonly reported complication in both groups 1.3 years ( 0.6-2.1 years ) arthritis! In the valgus knee with the mechanical axis deviation and amount of correction... Arthroplasty ( UKA ) or a lateral opening wedge ; distal femoral osteotomy and 1 varus, respectively this was! All statistical analyses was 6.1 valgus ( SD, 2 ; range, 3-8 valgus.! And delay the need for a knee replacement osteotomy patients, at months! 1 cm of the femur may be required despite a successful osteotomy success rates are %... Acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment mechanical axis., MeSH Review. Axis was 5 valgus ( SD, 2 ; range, 3-8 ). 2022 Presidents and Fellows of Harvard College Arvind Von Keudell, Tom Minas, and rates... Obtained at followups as well as postoperative long-limb alignment radiographs when possible has been to! ) in 30 patients comprised the study population to participate in much more rigorous activities common type of distal femoral osteotomy hardware removal... Be technically demanding and various complications are reported in the arthritis group ( 3 ) What are the,.
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