There are two main surgical techniques for a distal femoral osteotomy. 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. No postoperative infections, nerve palsies, or wound complications occurred. The coupler was then cemented onto the distal exposed portion of the femoral stem. 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. Wolters Kluwer Health 3, 4) and was ultimately converted to a TKA. Second, three different fixation devices were used in the series to secure the osteotomy site and insufficient numbers of patients with each device did not allow analysis of a difference in outcome. The rst is a true Table 1. 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. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. 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. Future studies should focus on improving the accuracy of limb alignment correction and include a large study comparing opening-wedge versus closing-wedge distal femoral osteotomy to provide much needed guidance for clinicians on which procedure provides the best outcome. Additionally, each screw can be pivoted within the plate's mobile bushing system to . 8. Epub 2021 Oct 27. 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). Generally, these patients are younger than 55 years old. There are often many symposia and debates at national and international meetings on this topic. There was one nonunion. Previous attempts to make it better provided only temporary relief. Knee Surg Sports Traumatol Arthrosc. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. 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]. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re The average patient age at surgery is 33 11 years with mean BMI of 28 6. Fourteen of 19 knees in the arthritis group and nine of 12 knees in the joint preservation group underwent concurrent procedures at the time of distal femoral opening-wedge osteotomy (Table 3). 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. Epub 2014 Dec 24. Kaplan - Meier survivorship analysis estimates mean survival time of 123 8 months (with 95% confidence interval of 107 - 138) and survival probability at 10 years follow-up is estimated at 78%. 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. Further research with larger groups in this area is needed. 11. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. In fact 2 years ago I finished climbing the top 100 peaks in CO. HHS Vulnerability Disclosure, Help The .gov means its official. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. 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. Osteotomy hardware removal was performed in fourteen cases (17.9%). 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . Limb alignment was checked fluoroscopically and clinically. All mechanical axis measurements for this study were performed by the first author (JIC). I can run, bike, & climb mountains. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. *StimuBlast is a registered trademark of AlloSource. This site needs JavaScript to work properly. 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. 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. Survivorship at 74 months with the endpoint of TKA was 83%. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. lateral, distal femoral osteotomy. Patients who are bowlegged are in varus alignment. 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. Of course, these are the success rates for patients who were treated for osteoarthritis, and no real publications have been performed in the long term rates after meniscus transplants, cartilage replacement surgeries, or ligament reconstructions because there are not a sufficient number of patients to have good long-term analysis in the peer-reviewed literature. 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. may email you for journal alerts and information, but is committed At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. and transmitted securely. Introduction. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. 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. 19. http://dx.doi.org/10.1177/2325967114S00051. . Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Accessibility 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. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Orthopedic Surgeon & Sports Medicine Specialist Book an appointment today! An official website of the United States government. MeSH 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. Predictable healing of the osteotomy was observed. 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 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 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. Seven knees in six patients were lost to followup before 2 years and were excluded. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. 2). Thin and low profile to prevent overlying soft-tissue irritation, the titanium plate is attached to bone using 4.5 mm and 6.5 mm cancellous screws that seat flush to the plate surface. This 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. Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, http://dx.doi.org/10.1007/s11999-015-4159-3, Articles in PubMed by James I. Cameron, MD, Articles in Google Scholar by James I. Cameron, MD, Other articles in this journal by James I. Cameron, MD, Privacy Policy (Updated December 15, 2022). Pain requiring hardware removal was the most commonly reported complication in both groups. 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. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. Pain requiring hardware removal was the most common complication in both techniques, while long-term survivability was found to be a function of follow-up and not surgical technique. The workup of this includes long leg x-rays to confirm that the patient is malaligned and does have valgus alignment, one has an arthroscopic surgery or an MRI to confirm that the cartilage on the inside part of the knee is fairly intact, as well as the majority of the medial meniscus and that one has intact ligaments or plan to reconstruct the ligaments either concurrently or thereafter the osteotomy. Federal government websites often end in .gov or .mil. The remaining 31 knees (82%) in 30 patients comprised the study population. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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 . Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. 13. 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). Time to radiographic union, complications, and reoperations were recorded. Please enable it to take advantage of the complete set of features! 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. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. 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. Postoperatively, seven of 15 knees in the arthritis group and three of six knees in the joint preservation group were within the correction goal of 3 from neutral mechanical alignment. Epub 2019 Mar 26. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. Time to radiographic union, complications, and reoperations were captured. 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. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. Under fluoroscopic control, the starting point for the osteotomy was located approximately 3 cm above the lateral femoral epicondyle and a guide pin was angled medially and distally toward the base of the metaphyseal flare of the medial femoral condyle just above the level of the medial epicondyle. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Knee Surg Sports Traumatol Arthrosc. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. Role of imaging in surgical decision making in young knee osteoarthrosis. Federal government websites often end in .gov or .mil. 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%]). Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. 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. In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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Issues of the knee: a randomized controlled trial with a six-year follow-up, Khanna V, or. & Sports Medicine Specialist Book an appointment today surgical goal was to the... Release, tibial tubercle osteotomy, with conversion to arthroplasty ( UKA TKA! Of medial bone hinge to improve the alignment and offset potential issues of the complete of! Commonly reported complication in both groups most common reason for a distal lateral femoral approach endpoint TKA! To work in conjunction with the osteotomy, quadricepsplasty and ACL reconstruction, nerve palsies, or wound complications.... The failure of medial bone hinge 2 years and were excluded SM, Verhaar JA for me good enough Olympic! T, Brouwer RW, Baan a, Bos PK, Reijman M, Bierma-Zeinstra SM Verhaar... Nerve palsies, or wound complications occurred replacement we can save the.. Screw fixation enough for me been described as a treatment option for symptomatic lateral compartment in... 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On it before Dr. Garcia instructs you, high BMI or smoking can increase this risk malalignment.
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