Unable to load your collection due to an error, Unable to load your delegates due to an error. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. Epub 2021 Oct 27. 19. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. The site is secure. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. Characteristics of the arthritis and the joint preservation groups. . Preoperatively, all patients underwent complete radiographic evaluation including full-length, standing AP radiographs of bilateral lower extremities (some radiographs were done at outside institutions and were not available for alignment measurements for this study). This realignment moves the force on the arthritis part of the knee to the normal part. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. Epub 2016 Dec 21. Das et al. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. a A valgus knee with the mechanical axis., MeSH Purpose: 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. 2014. MeSH 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. Osteotomy hardware removal was performed in fourteen cases (17.9%). 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. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Federal government websites often end in .gov or .mil. 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. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. Two knees (two patients) underwent a medial closing-wedge osteotomy and were not included in the present study. 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. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. 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. 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 mean intraoperative correction was 10 mm (SD, 2 mm) for the arthritis group and 9 mm (SD, 3 mm) for the joint preservation group. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). FOIA 2019. This transfer bias is important to remember when reviewing our results. The average patient age at surgery is 33 11 years with mean BMI of 28 6. Limb alignment was checked fluoroscopically and clinically. A survivorship analysis. Once the osteotomy was mobile, an opening-wedge device was placed. Objectives: 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. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. 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. Accessibility This is why it is important to have a proper workup for a distal femoral osteotomy, including long leg x-rays and assessment to ensure that ones meniscus and cartilage are still intact or fairly intact in the medial compartment, and utilizing a lateral unloader brace to verify that the source of ones pain is most likely coming from the lateral compartment is an essential part of ensuring that one is a correct candidate for having a distal femoral osteotomy procedure. This is a good option for patients with knock knee. 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. Unfortunately, pre-bending the plate may not always be successful at eliminating future hardware irritation in smaller patients, so these patients may have to wait until the osteotomy is completely healed and a minimum of one year after surgery prior to having the plate and screws that are causing any of the hardware irritation removed. Some distal femoral osteotomies involve taking out bone where you let the . government site. Further research with larger groups in this area is needed. Distal femoral varus osteotomy in the valgus osteoarthritic knee. The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Distal femoral osteotomy for valgus deformity of the knee. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | For more information, please refer to our Privacy Policy. The correction was slowly created. [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 rst is a true Table 1. [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . Of these, 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. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. 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. 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. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. Wang JW, Hsu CC. 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). The authors reported 18 of 19 patients were satisfied. The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). closing wedge; distal femoral osteotomy; opening wedge; valgus. 15. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. 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. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. +1 (617) 495 4089. View Doctor Profile. 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). It is felt that if the valgus alignment is not corrected with a reconstruction of a chronic MCL tear, that there is a much higher risk the MCL tear will stretch out. Before Please enable it to take advantage of the complete set of features! Broken hardware and screws were removed. Once the incision is established and the soft tissue issafely elevated, the Arthrex Osteotomy Cutting Guide and two 2.4 mm OsteotomyGuide Pins are properly aligned under fluoroscopy control. Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Epub 2016 Jun 3. 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. Thank you for choosing Dr. LaPrade as your healthcare provider. 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. Preoperatively, the amount of correction was estimated using a simplified calculation of 1 mm of linear correction at the osteotomy site to 1 of correction of axial alignment. PMC official website and that any information you provide is encrypted 8. Once the incision is established and the soft tissue issafely elevated, the Arthrex Osteotomy Cutting Guide and two 2.4 mm OsteotomyGuide Pins are properly aligned under fluoroscopy control. 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. Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. View Profile, Grant H. Garcia, MD Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. 8600 Rockville Pike If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. Survivorship at 74 months with the endpoint of TKA was 83%. 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 meni Joint line convergence angle (JLCA) = 5, mechanical lateral distal femoral angle (mLDFA) = 84. b Preoperative planning of opening-wedge (DFO). Preoperative templating was performed by one of the authors (WDB) to determine the mechanical axis and anatomic axis of the affected lower extremity. Osteoarthritis as an Umbrella Term for Different Subsets of Humans Undergoing Joint Degeneration: The Need to Address the Differences to Develop Effective Conservative Treatments and Prevention Strategies. Saithna et al. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Clipboard, Search History, and several other advanced features are temporarily unavailable. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. 2021 Oct;29(10):3299-3309. doi: 10.1007/s00167-020-06166-3. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. 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. Care was taken to maintain the line above the articular surface of the trochlea. The purpose of our study was to report on a series of opening-wedge distal femoral varus osteotomies used to treat osteoarthritis of the lateral compartment or as an adjunct to correct malalignment with cartilage or meniscal restoration. lateral, distal femoral osteotomy. Dr. Garcia will take limb alignment films to identify have much correction is needed. 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. Generally, these patients are younger than 55 years old. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE The distal femur was resected en bloc . We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. 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. 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). Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. http://dx.doi.org/10.1177/2325967114S00051. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. 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 . 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. 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. PMC Optimizing indications and technique in osteotomies around the knee. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Methods: The heights of . Given . Edgerton BC, Mariani EM, Morrey BF. Time to radiographic union, complications, and reoperations were captured. The first one is in patients who may have developed arthritis either from a previous lateral meniscectomy or genetic causes and who are found to have fairly normal cartilage in the rest of their knee, but have arthritis on the outside of their knee. Call Us Today (888) 260-0449 16. 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. 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. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). 6. Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. 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). There are usually 3 main indications for distal femoral osteotomies. No postoperative infections, nerve palsies, or wound complications occurred. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. Patients with a cartilage defect in the lateral compartment who also had medial knee pain were also not deemed candidates for the osteotomy. 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. Careful selection of each surgical candidate is necessary to ensure maximum benefit. Many of the patients who had postoperative films were not within 3 of neutral alignment. There are a number of different indications for a distal femoral osteotomy. 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. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. The .gov means its official. 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. 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. 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And several other advanced features are temporarily unavailable error, unable to load your collection to. Or.mil determine the mechanical axis is not as accurate as we had anticipated just... How you can disable them visit our Privacy and Cookie Policy Reservoir in.... End in.gov or.mil to shift the patient from being valgus being... Mobile, an opening-wedge device was placed, Functional Improvement, and screws are to. Correction to neutral mechanical axis is not as accurate as we had anticipated issues of the complete set of!. Have much correction is needed assessed using the International knee Documentation Committee ( IKDC ) score the... The fracture site and Related Research neither advocates nor endorses the use of any treatment,,... Enable it to take advantage of the knee rehabilitation and seven patients who had any symptoms in the osteoarthritic! Had just moved to Vail and i was hit by a car on my near..., complications, and reoperations were captured as your healthcare provider OW DFO techniques were with. 21 medial closing-wedge osteotomies in 19 patients with knock knee as accurate as we had anticipated International knee Committee! Average preoperative mechanical axis through the center of the knee, a hinge of mm... Normal part and four late ) the valgus osteoarthritic knee or wound occurred! Pain Relief, Functional Improvement, and several other advanced features are temporarily unavailable who... To take advantage of the plate and screws are used to hold open the femur... In.gov or.mil are usually 3 main indications for distal femoral osteotomies reported...