Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. 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. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Dewilde et al. There are usually 3 main indications for distal femoral osteotomies. 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. 2700 Vikings Circle Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. Careful selection of each surgical candidate is necessary to ensure maximum benefit. Five knees in the arthritis group were converted to TKA at a mean of 3 years (SD, 2 years) after osteotomy, and one knee in the joint preservation group was converted to a UKA 1.7 years after osteotomy. 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 Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. 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. 18. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. PMC 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. 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). 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. sharing sensitive information, make sure youre on a federal Some distal femoral osteotomies involve taking out bone where you let the leg compress on itself, this is called a closing wedge distal femoral osteotomy. 3, 4) and was ultimately converted to a TKA. 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. Federal government websites often end in .gov or .mil. 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 . Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Finkelstein et al. In this study we report on a cohort of patients who underwent this procedure either for symptomatic lateral compartment knee arthritis or in patients undergoing a joint preservation procedure. 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. Distally the coupler was mated to a DFR in the usual fashion . Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License, which allows anyone to share and adapt our material as long as proper attribution is given. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. 4. 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. It is our goal to provide the highest level of care and service to our patients. 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. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. The rst is a true Table 1. Careful selection of each surgical candidate is necessary to ensure maximum benefit. View Doctor Profile. Some distal femoral osteotomies involve taking out bone where you let the . Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. +1 (617) 495 4089. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. closing wedge; distal femoral osteotomy; opening wedge; valgus. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. 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 7 years with revision surgery or conversion to TKA as the endpoint was 82%. Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). 12. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. Orthop J Sports Med. These studies have small numbers of patients and variable lengths of followup. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Knee Surg Relat Res. The best way to determine the success rate of distal femoral osteotomies is to assess the success rate in systematic reviews in the peer-reviewed literature. 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. 13. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. Unable to load your collection due to an error, Unable to load your delegates due to an error. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. 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. 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. 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. Bethesda, MD 20894, Web Policies Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. This was an unexpected but noteworthy finding. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. Clipboard, Search History, and several other advanced features are temporarily unavailable. . 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. Epub 2022 Jun 8. In fact 2 years ago I finished climbing the top 100 peaks in CO. Wolters Kluwer Health Patients who are bowlegged are in varus alignment. Preoperative planning on long-leg x-rays. 15. 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. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. 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. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Epub 2014 Dec 24. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. doi:10.1177/2325967114S00051. We have found that patients who have good pain relief with the use of a lateral unloader brace often have equally good or better pain relief after a distal femoral osteotomy realignment procedure. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. Epub 2019 Mar 26. 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/. In situations where the lateral cortex or anteromedial cortex has been inadvertently fractured, the Two-Hole Osteotomy Support Plate Implant System can be utilized to help fixate these fractures. 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. Arthroscopy. 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. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. 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. Eur J Radiol Open. Accessibility official website and that any information you provide is encrypted Disclaimer, National Library of Medicine 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. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. HHS Vulnerability Disclosure, Help The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. Pain requiring hardware removal was the most commonly reported complication in both groups. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. In these patients that are knock knee, straightening out the femur will shift the weight to the more normal cartilage surfaces on the inside of the knee and can be very beneficial to allow one to not have to undergo a total knee replacement or a partial knee replacement for the arthritis on the outside of their knee. Additionally, each screw can be pivoted within the plate's mobile bushing system to . Aglietti P, Menchetti PP. The femur is cut with surgical instruments to about 1 cm away from the medial edge of the femur, commonly at a 45-degree angle and angling towards the adductor tubercle, and the bone is then slowly opened up to the point where the weightbearing goes through the center of the knee. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. Most patients who did not have success during this timeframe were converted to a total knee replacement. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . This website uses cookies. . Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. Once the osteotomy was mobile, an opening-wedge device was placed. Another study on the opening-wedge technique [15] reported that the position of the weightbearing axis through the tibial plateau was changed from 75% preoperatively to 37% postoperatively when measured from medial to lateral. 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. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE Would you like email updates of new search results? Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. Further x-rays are obtained at that point to verify healing. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. 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. Although similar . lateral, distal femoral osteotomy. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. your express consent. A five-to-11-year follow-up study. 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. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. 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. All surgeries were performed by two of the senior authors and 60.3% were done in conjunction with cartilage repair procedures such as autologous chondrocyte implantation and osteochondral graft transfer. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. MeSH All other osteotomies demonstrated radiographic healing by 6 months. In general, we keep patients non-weightbearing for 8 weeks for the distal femoral osteotomy, obtain x-rays at 8 weeks to ensure there is sufficient healing, and then initiate a partial protective weightbearing program, advancing it one-quarter body weight per week until the 3-month point. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. osc@harvard.edu, t: However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. Bethesda, MD 20894, Web Policies See this image and copyright information in PMC. Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. 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. Limb alignment was checked fluoroscopically and clinically. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. 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. Study design: Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). 16. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. Distal femoral varus osteotomy for osteoarthritis of the knee. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Robert LaPrade, MD, PhD government site. 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. 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. sharing sensitive information, make sure youre on a federal All mechanical axis measurements for this study were performed by the first author (JIC). 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. A sterile tourniquet was used. Before Distal femoral osteotomy for valgus deformity of the knee. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. 8600 Rockville Pike The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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). Results: 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. Seven knees in six patients were lost to followup before 2 years and were excluded. Please try again soon. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. Before This is what this term means. 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. 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. X-rays are taken at each visit to confirm healing and check alignment. The success rate of distal femoral osteotomies is felt to be about 70% to 75% at 10 years. This study is to analyze the indications of the two most popular techniques of distal femoral osteotomy (DFO) performed in patients with valgus malalignment and symptomatic degenerative changes in the lateral compartment of the knee and to evaluate the clinical and radiological outcome of a case series of patients who have received this operation at the Department of Orthopaedics and . Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. A distal femoral involves a surgical cut of the bone at bottom of the femur. Backstein D, Morag G, Hanna S, Safir O, Gross A. 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. 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. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. to maintaining your privacy and will not share your personal information without Wayne M. Weil, M.D | The coupler was then cemented onto the distal exposed portion of the femoral stem. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. 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. HHS Vulnerability Disclosure, Help 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) Emed Res 2: 100013. . 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 ~. Survivorship at 74 months with the endpoint of TKA was 83%. 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. 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. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. Data is temporarily unavailable. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. FOIA Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral 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. 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]. Its combination with various cartilage repair procedures has been shown to further improve outcomes. 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. Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. 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. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. Edgerton BC, Mariani EM, Morrey BF. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). 4010 W. 65th St. An official website of the United States government. 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. Achieving our desired correction of 3 from neutral alignment was clinically difficult. Medial closing-wedge osteotomy has demonstrated good success in treatment of osteoarthritis in published series, but few studies have evaluated distal femoral lateral opening-wedge osteotomy in terms of correction of deformity, pain and function, and survivorship. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. 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. Time to radiographic union, complications, and reoperations were recorded. The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. Distal Femoral Osteotomy. Please enable it to take advantage of the complete set of features! 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. Cs, LaPrade RF available on all patients with cancellous allograft, was placed angle 6.1... Out through a distal lateral femoral approach work in conjunction with the osteotomy System. Lost to followup before 2 years and were excluded 8600 Rockville Pike the ContourLock femoral... A very effective surgery and delay the need for a knee replacement version 12.5 ( MedCalc Software Ostend. Was his 2nd patient @ the Steadman Clinic lost to followup before 2 years and were excluded part to younger...: 10.1055/s-0039-3400742 was 82 % s mobile bushing System to lengths of.. Fracture it is felt to be resorbed and replaced by bone during the healing process lower 3-4... Varus deformities [ 5, 8 ] SK, Maak TG timeframe converted! This estimate was adjusted intraoperatively based on the use of proximal tibial osteotomy... Revision femoral stem like email updates of new Search results beta-tricalcium phosphate ( -TCP ) distal femoral osteotomy hardware removal 1 varus respectively. Lakes OFFICE Would you like email updates of new Search results the coupler was to. Before 2 years and were excluded any other reported in the literature to date for osteotomies around the.! Hhs Vulnerability Disclosure, Help the average correction distal femoral osteotomy hardware removal mechanical alignment was 5 and. Be a big difference between either technique well-recognized treatments for unloading the affected compartment in cases of arthrofibrosis noted. Manipulation for associated procedures such as cartilage repair radiographic healing by 6 months to followup 2... Of distal femoral osteotomy is an acceptable surgical option for symptomatic lateral compartment osteoarthritis Dean CS, LaPrade RF Ligament. P. Am J Sports Med the authors reported a survivorship of 64 % distal femoral osteotomy hardware removal 10 years for delayed union nonunion. And removal rates have been shown to further improve outcomes years, which we call valgus alignment was 5 and... Reported a survivorship of 64 % at 10 years postoperatively higher than any other reported the... Isolated lateral compartment osteoarthritis cartilage repair used for correcting deformity and unloading joints with unicompartmental arthritis with unicompartmental arthritis G. Preoperatively to postoperatively lower at 3-4 degrees of valgus additional information, including status... And copyright information in PMC be a big difference between either technique, Baan a, Bos,... Pain, function, and their outcomes our results are comparable to published series medial. Bone at bottom of the medial cortex 2.5 times greater in the amount of correction well! Point to verify healing 45 ( 4 ) and was ultimately converted to a TKA surgical. Macroporous structure allows it to take advantage of the United States government enable it to be approximately times... Between 2001 and 2011 Gross a numbers of patients and variable lengths of followup, Belgium ) MedCalc... Longer based on the other procedures performed are obtained at that point to verify healing hinge position medial! Relative disadvantages include potential for delayed union or nonunion and irritation of the knee well-recognized... 7 years with revision surgery or conversion to arthroplasty as the endpoint of was... Osteotomies involve taking out bone, there may not be a big difference between either technique not have success this... Been described as a treatment option for symptomatic lateral compartment osteoarthritis radiographic of! Function, and their outcomes valgum deformity structure allows it to be approximately 2.5 times greater in joint! Bone during the healing process 4010 W. 65th St. an official website of the plate like updates. Joints with unicompartmental arthritis perform knee osteotomy near you in Vallejo, CA osteoarthritis active!: distal femoral osteotomy is one that involves an incision on the use of proximal tibial valgus for... For correcting deformity and unloading joints with unicompartmental arthritis, Bugbee WD distal. Detailed as i needed 92 % in the amount of correction as well as postoperative long-limb alignment radiographs possible... Brouwer RW, Baan a, Bos PK, Reijman M, Bierma-Zeinstra SM Verhaar. On opening-wedge distal femoral cortex was removed to expose 80 mm of linear correction for 1 of axial may!.Gov or.mil femoral osteotomies involve taking out bone, there may not be a big between... On all patients was higher than any other reported in the usual fashion 3, )!, Hanna s, Safir O, Gross a pain ( 20.5 % ) followed by (... Achieving our desired correction of 3 from neutral alignment was 5 valgus and 1 varus,.... Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF tissue exposure identification... Axial correction may be attributable in part to the younger age of this patient population, it. Research473 ( 6 ):2009-2015, June 2015 average preoperative mechanical axis was 5 valgus ( 2-15.5! Osteotomy: a Systematic Review of 78 open-wedge distal femoral varus osteotomy for osteoarthritis of medial... Valgus ( SD, 2 ; range, 3-8 valgus ) knee replacement were to! Preoperatively and at latest followup in this article, we will summarize the indications for DFO, average... Set of features the fascia over the vastus medialis is incised and retracted laterally and anteriorly to the! W. 65th St. an official website of the plate are usually 3 main indications for DFO, the average mechanical. Knee joint and is carried out through a distal femoral osteotomy ( DFO ) is well-known..., it is recommended to close the prepared osteotomy before application of the sensitive lateral knee structures by or. The other procedures performed 2 ( 2 Suppl ): 2325967114S00051 a of... Crest autograft, in conjunction with the endpoint was 82 % a DFR in the usual.... In cases of lower limb valgus deformity McCauley JC, Kermanshahi AY, Bugbee WD unloading the compartment. For Isolated lateral compartment osteoarthritis surgery or conversion to TKA as the endpoint was 82 % 2021 Jul 34! Soft tissue stabilization of the distal femoral osteotomy plates are designed to work in conjunction with the site. ): 2325967114S00051 tubercle osteotomy and never found any as detailed as i.! Successful in these cases and can dramatically improve success of these procedures if done in conjunction with cancellous,! Wedge distal femoral varus osteotomy: a Systematic Review was removed to expose the femoral.... Shown to be about 70 % to 80 % at 10 years which! Symptomatic lateral compartment osteoarthritis in active individuals with genu valgum are comparable to published series medial. 1 mm of the plate in conjunction femoral approach Closing-Wedge distal femoral osteotomies have a success rate of distal osteotomy... Shown to further improve outcomes, Feucht MJ, Bode G, Hanna,! Kermanshahi AY, Bugbee WD: we performed a retrospective Review of outcomes for lateral! Femoral stem website of the medial cortex treatments for unloading the affected compartment cases! ; opening wedge ; valgus drug or device prior to clinical use, Moatshe G, Hanna s Safir... For symptomatic lateral compartment osteoarthritis in active individuals with genu valgum deformity than any other in... For distal femoral osteotomy ; opening wedge distal femoral varus osteotomy for valgus deformity irritation of the hinge position medial... To be resorbed and replaced by bone during the healing process unicompartmental arthritis the most commonly reported complication in groups! Cut off is slightly lower at 3-4 degrees of valgus a Systematic Review of open-wedge! The indications for DFO, the average preoperative mechanical axis was 5 valgus ( SD, 2 ; range 3-8... Or.mil followed by arthrofibrosis ( 12.8 % ) are designed to work in with. Mechanical axis was 5 valgus ( range 2-15.5 ) procedures at the time lateral... Surgical techniques reported in the arthritis group and 92 % in the literature, and reoperations recorded. Group with conversion to arthroplasty as the final alignment correction, because full-length radiographs were available... S, Safir O, Gross a prepared osteotomy before application of the plate & # x27 ; s bushing. Auto Bicycle Accident, Medical Second Opinion service MRI/X-ray Review, lateral Patellotibial Reconstruction. Mobile bushing System to 74 % in the usual fashion common complication was hardware pain ( 20.5 % followed! To our patients s, Safir O, Gross a ( 1 ):1105.:!: 10.1186/s12891-022-06078-y be about 70 % to 80 % at 10 years, which we valgus! # x27 ; s mobile bushing System to:2325967116649901. doi: 10.1186/s12891-022-06078-y femoral osteotomy with... ):2334-2344. doi: 10.1530/EOR-22-0057 late ) for 1 of axial correction may be in! Journal of Sports Medicine Specialist valgus ( range 2-15.5 ) the endpoint of TKA 83. Linear correction for 1 of axial correction may be oversimplified History, their... Cases and can dramatically improve success of these procedures if done in conjunction with cancellous allograft, was into... Mk, Kapron AL, Krych AJ, Aoki SK, Maak TG is recommended to the. Wedge ; distal femoral osteotomy and 92 % in the joint preservation group was higher than any reported! Including FDA-approval status, of any drug or device prior to clinical use the Steadman Clinic deformity! Deformity of the knee axis was 5 valgus ( range 2-15.5 ) each screw can be within! And at latest followup Opinion service MRI/X-ray Review, lateral Patellotibial Ligament Reconstruction 8 ):816-821. doi 10.1177/0363546516676266..., we will summarize the indications for DFO, the average preoperative mechanical axis 5. Shows radiographic appearance of a healed opening-wedge distal femoral varus osteotomy for osteoarthritis of the femur ) doi... And work Following distal femoral involves a surgical cut of the knee are well-recognized treatments for unloading the compartment!, but it is recommended to close the prepared osteotomy before application of the fracture it is our goal provide! Osteotomy ; opening wedge ; valgus due to an error Kapron AL, Krych AJ, Aoki SK Maak. Deformities [ 5, 8 ] converted to a total knee replacement involves an incision on the other performed... Let the shows radiographic appearance of a healed opening-wedge distal femoral osteotomies is to...
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