(15.6%), and 5 had hardware removed (15.6%). 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. Some distal femoral osteotomies involve taking out bone where you let the . Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. TOURNIQUET TIME: 40 minutes. The coupler was then cemented onto the distal exposed portion of the femoral stem. 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. Long-term follow-up of distal femoral varus osteotomy of the knee. 4010 W. 65th St. 18. Orthopedic Surgeon & Sports Medicine Specialist 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 . OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). In patients who have chronic MCL tears that are symptomatic, the peer reviewed literature notes that the patients who are in valgus alignment have a much higher risk of having their future MCL reconstruction graft procedure stretch out unless the malalignment is corrected with a distal femoral osteotomy. Distal Femoral Osteotomy. The entire limb, including the iliac crest, was prepped and draped free. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Keywords: Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. 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. Its combination with various cartilage repair procedures has been shown to further improve outcomes. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. In general, it is felt that younger patients definitively should have a distal femoral osteotomy when it is indicated, whereas older patients may equally benefit from a distal femoral osteotomy or a total knee replacement, depending upon their overall activity levels, if they have other medical problems, and if their bone is relatively osteopenic (softer than normal). Finkelstein et al. There are usually 3 main indications for distal femoral osteotomies. Improvements in the IKDC scores were noted postoperatively. 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. 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. 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). Seattle Shoulder Surgery | 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 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. 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. Thank you for choosing Dr. LaPrade as your healthcare provider. The https:// ensures that you are connecting to the Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. Distal femoral varus osteotomy in the valgus osteoarthritic knee. 1 Even with evolving fixation strategies and implants, . 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). SPECIMENS: Multiple cultures from the right ankle. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? 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. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. Accessibility At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. Generally, these patients are younger than 55 years old. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. 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. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. 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. Medial opening-wedge proximal tibial osteotomy for varus knee deformity is commonly performed but lateral opening-wedge distal femoral osteotomy for a valgus knee deformity is less common. This realignment moves the force on the arthritis part of the knee to the normal part. An official website of the United States government. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. eCollection 2022. Additionally, each screw can be pivoted within the plate's mobile bushing system to . For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. 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. [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. 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. 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. COMPLICATIONS: None. Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided. The correction was slowly created. Distal femoral varus osteotomy for osteoarthritis of the knee. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. A survivorship analysis. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. Emed Res 2: 100013. . The site is secure. closing wedge; distal femoral osteotomy; opening wedge; valgus. Given . Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. Preoperative planning on long-leg x-rays. JavaScript is disabled for your browser. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. HHS Vulnerability Disclosure, Help This work was performed at Scripps Clinic, La Jolla, CA, USA. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. 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. 2. 4. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Oftentimes, we will place the patient into a lateral compartment unloader brace to use as a screen to determine that a distal femoral osteotomy may be a useful procedure. 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 . 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. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. (1) Does lateral opening-wedge osteotomy lead to accurate correction? 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. X-rays are taken at each visit to confirm healing and check alignment. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Please enable scripts and reload this page. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). for hardware removal following operative xation of distal radius fractures. 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. See this image and copyright information in PMC. 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. Bethesda, MD 20894, Web Policies 8600 Rockville Pike 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). 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Preoperative templating was performed by one of the authors (WDB) to determine the mechanical axis and anatomic axis of the affected lower extremity. Supracondylar osteotomy of the femur with use of compression. 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. 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%. Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. may email you for journal alerts and information, but is committed PMC 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. 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. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. U.S. surgeons perform an opening wedge distal femoral osteotomies involve taking out bone, there may not be a difference... ( 12.8 % ), and 5 had hardware removed ( 15.6 % ) correction to neutral axis... Performed at Scripps Clinic, La Jolla, CA, USA wedge for. Union that prolonged rehabilitation and seven patients who required hardware removal Bode G Menge... Osteoarthritic knee and check alignment that prolonged rehabilitation and seven patients who required removal! 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