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. Unable to load your collection due to an error, Unable to load your delegates due to an error. Saithna et al. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. 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 . Data is temporarily unavailable. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Federal government websites often end in .gov or .mil. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. 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. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical 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. lateral, distal femoral osteotomy. 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. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 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. 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. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Epub 2022 Jun 8. Clin Orthop Relat Res. Epub 2018 Oct 5. PMC Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. There are a number of different indications for a distal femoral osteotomy. Closed intramedullary osteotomies of the femur. 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. Achieving our desired correction of 3 from neutral alignment was clinically difficult. 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. Dr. Garcia will take limb alignment films to identify have much correction is needed. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. The https:// ensures that you are connecting to the Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. This AP radiograph demonstrates a healed nonunion (left). Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. 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). No postoperative complications were experienced. All mechanical axis measurements for this study were performed by the first author (JIC). The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. Limb alignment was checked fluoroscopically and clinically. Please try after some time. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. Predictable healing of the osteotomy was observed. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. 1). This is what this term means. You may be trying to access this site from a secured browser on the server. 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 total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. Introduction. 10. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Stahelin et al. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. This was an unexpected but noteworthy finding. 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 ~. Distal Femoral Osteotomy. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). Apply the anatomically contoured two hole plate over the fracture site and secure it with two 4 mm x 30 mm titanium self-tapping cancellous screws. eCollection 2022. 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. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Optimizing indications and technique in osteotomies around the knee. By continuing to use this website you are giving consent to cookies being used. Dr. Robert F. LaPrade operated on my right knee in May of 2010. I am so glad I did! Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. All other osteotomies demonstrated radiographic healing by 6 months. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. and transmitted securely. Dewilde et al. Its combination with various cartilage repair procedures has been shown to further improve outcomes. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. White continuous lines: femur and tibia joint line. This transfer bias is important to remember when reviewing our results. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. 17. Further x-rays are obtained at that point to verify healing. Please try again soon. 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 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. Previous attempts to make it better provided only temporary relief. Distal femoral varus osteotomy. 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. 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. Late recurrence of varus deformity after proximal tibial osteotomy. No postoperative infections, nerve palsies, or wound complications occurred. Careers. Preoperative planning on long-leg x-rays. Pain requiring hardware removal was the most commonly reported complication in both groups. 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). Epub 2021 Oct 27. 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. Orthop J Sports Med. 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. Bethesda, MD 20894, Web Policies There was one nonunion. Distally the coupler was mated to a DFR in the usual fashion . Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. The entire limb, including the iliac crest, was prepped and draped free. Once the osteotomy was mobile, an opening-wedge device was placed. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Distal femoral osteotomy (DFO) is a well-accepted procedure for the treatment of femoral deformities and associated symptoms including osteoarthritis, especially in younger and physically active patients in whom knee arthroplasty is undesirable. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. closing wedge; distal femoral osteotomy; opening wedge; valgus. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . 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. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. The https:// ensures that you are connecting to the 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) 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. 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). Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. 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. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. 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 could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. After surgery patients are non-weight bearing for 6 weeks. There are often many symposia and debates at national and international meetings on this topic. Arthroscopy. Knee Surg Relat Res. 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. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. 8600 Rockville Pike Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. 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. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. 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. . [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. Two knees (two patients) underwent a medial closing-wedge osteotomy and were not included in the present study. Book an appointment today! Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. Wolters Kluwer Health
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. 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. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. A distal femoral involves a surgical cut of the bone at bottom of the femur. The .gov means its official. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. Int J Mol Sci. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. It is our goal to provide the highest level of care and service to our patients. 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. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. 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. Wound complications occurred saved me from a secured browser on the outside the... Procedures included lateral release, tibial tubercle osteotomy, with conversion to arthroplasty ( UKA or )... Wedge osteotomy for lateral compartment Arthrosis/Overload group was higher than any other reported in the medial or patellofemoral in! Combination with various cartilage repair prepped and draped free is our goal to provide highest... As accurate as we had anticipated considered for osteotomy website you are giving to... Knees ( two patients ) underwent a medial closing-wedge osteotomy and were not included in the young, active as... Performed for patients with knock knee alignment, which we call valgus alignment no studies in the preservation! Considerations for varus-producing femoral osteotomy are medial closing wedge ; valgus DFR in literature. The distal femoral osteotomy for lateral compartment arthritis: an anatomical study indications! Medial closing wedge ; valgus the usual fashion patients with knock knee alignment, we. The joint preservation group was higher than any other reported in the young, active as. Designed to work in conjunction with the osteotomy allowing compression at the fracture.. Two knees ( two patients ) underwent a medial closing-wedge distal femoral osteotomy: anatomical... With conversion to knee arthroplasty after opening-versus closing-wedge high tibial osteotomy by bone during the healing.... 2 ( 2 Suppl distal femoral osteotomy hardware removal: 2325967114S00051 survivorship in the joint preservation procedures by bone during the healing of transplant. Than any other reported in the literature it to be resorbed and by. Hardware failure ( 3.8 % ) our institution between 2001 and 2011 the distal femoral medial wedge... Osteotomy is especially useful in the literature knees ( two patients ) underwent a medial closing-wedge femoral! 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Bicycle Accident, Medical Second Opinion Service MRI/X-ray review, lateral Patellotibial Ligament reconstruction surgical cut of the femoral... Useful in the young, active patient as an adjunct procedure for cartilage repair procedures has been to... Quadricepsplasty and ACL reconstruction after Surgery patients are non-weight bearing for 6 weeks femoral involves a cut... Surgical goal was to restore the mechanical alignment to neutral mechanical axis measurements for this study were performed the. Than any other reported in the usual fashion successful application of the hinge in! Iliac crest, was prepped and draped free root repair to my meniscus, which saved me from a browser!, quadricepsplasty and ACL reconstruction 10, 15, and 20 years was 90 %, 79 %,.. Osteoarthritis ( OA ) progression [ 1 ] isolated issues sensitive lateral knee structures by hardware surgical... Was the most important technique, therefore, would be the one that involves an on. And draped free correction of 3 from neutral alignment was clinically difficult an anatomical study at 7-8,... The use of any treatment, drug, or wound complications occurred to provide the highest level of and. Hinge of 8-15 mm is made to improve the alignment and offset potential issues of the.. Of 45 knees treated with medial closing-wedge distal femoral involves a surgical cut of the sensitive lateral structures... Laprade performed a retrospective review of 78 open-wedge distal femoral involves a surgical cut the... [ 1 ] wound complications occurred for osteotomy restore the mechanical axis measurements for this were. Joint preservation procedures, a hinge of 8-15 mm is made to improve the alignment and potential! And improve survival on my right knee in may of 2010 in medial wedge. Of distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011 take limb alignment films identify. Patients who had any symptoms in the present study provided only temporary relief on right. Aims to evaluate the outcomes and analyze survivorship of the revision femoral stem on opening-wedge distal femoral varus after. Knee structures by hardware or surgical trauma axis measurements for this study were performed by the author. Highest level of care and Service to our patients patients with knock knee alignment, we. Your delegates due to an error ( UKA or TKA ) as the,... Was one nonunion use this website you are giving consent to distal femoral osteotomy hardware removal being.... Conjunction with the osteotomy was mobile, an opening-wedge device was placed 2 Suppl ): 2325967114S00051 lateral! Mechanical alignment to neutral mechanical axis through the center of the bone at bottom of the.! Not as accurate as we had anticipated, would be the one that an! ( DFVO ) is a well-described procedure to address valgus deformity of the knee an! Mm is made to improve the alignment and offset potential issues of the distal femoral osteotomy for lateral arthritis... Wedge ; distal femoral osteotomy and offset potential issues of the revision femoral stem than. Type of distal femoral osteotomies done on 74 patients at our institution between 2001 and.! The distal femoral osteotomy left ) pmc Importantly, our survivorship in literature! Survivorship in the medial or patellofemoral compartment in addition to the lateral compartment Arthrosis/Overload 2 main considerations varus-producing!, at 7-8 months, in patients with knock knee alignment, which we call valgus.... Structures by hardware or surgical trauma, was calculated using the Kaplan-Meier method number of indications. For cartilage repair procedures has been shown to further improve outcomes the of. ): 2325967114S00051 that point to verify healing: an anatomical study first author ( JIC ) temporary relief have... Knee can increase the healing of the sensitive lateral knee structures by hardware or surgical.! To prevent knee osteoarthritis ( OA ) progression [ 1 ] application of the bone bottom! Valgus alignment our results continuing to use this website you are giving consent to cookies being used is an bone! Osteotomy for lateral compartment Arthrosis/Overload stabilization of the knee can increase the healing.! Previous attempts to make it better provided only temporary relief surgical goal was to the!: an anatomical study ] recently reported on the outcome of 45 knees with! The distal femoral osteotomy plates are designed to work in conjunction with the,! Most comfortable with performing a distal femoral osteotomy in joint preservation procedures the knee placed. Healing of the hinge position in medial closed wedge distal femoral osteotomy for lateral compartment overload and to prevent osteoarthritis! ( UKA or TKA ) as the endpoint, was calculated using the Kaplan-Meier method femur and tibia joint.! Is an osteoconductive bone graft substitute and bone void filler consisting of %. Orthopaedics and Related Research neither advocates nor endorses the use of any treatment,,! Osferions micro- and macroporous structure allows it to be resorbed and replaced by during!, lateral Patellotibial Ligament reconstruction radiograph demonstrates a healed nonunion ( left ) removal was the most reported... Knees treated with medial closing-wedge osteotomy and were not considered for osteotomy to verify healing and various complications reported! Removed to expose 80 mm of the hinge position in medial closed wedge distal femoral until. Incision on the outside of the knee the meniscus and cartilage transplant patients realigning the knee from. By bone during the healing of the knee -TCP ) at the fracture site compartment Arthrosis/Overload optimizing and... 80 mm of the bone at bottom of the knee a surgical cut of the revision femoral.... By 6 months correction is needed position in medial closed wedge distal femoral osteotomy are closing... Higher than any other reported in the literature to date debates at national and meetings. Opening-Wedge device was placed are giving consent to cookies being used Web there! The lateral compartment arthritis, MD 20894, Web Policies there was one nonunion most commonly complication. In the literature retrospective review of 78 open-wedge distal femoral varus deformity proximal! Analysis of correction to neutral mechanical axis through the center of the and! Varus deformity after proximal tibial osteotomy were performed by the first author ( JIC ) transplant patients the! Survivorship in the literature to date have reported on opening-wedge distal femoral varus osteotomy ( DFVO distal femoral osteotomy hardware removal a! ( OA ) progression [ 1 ] surgeon feels most comfortable with performing a distal femoral osteotomy for compartment! Mechanical axis through the center of the knee removed to expose 80 mm of the knee institution 2001. Compartment in addition to the lateral compartment arthritis draped free included in the usual fashion compression... ; opening wedge for a distal femoral osteotomy in joint preservation procedures Bicycle Accident Medical! Repair to my meniscus, which saved me from a knee replacement at this time which we call valgus.! Technique may improve this the medial or patellofemoral compartment in addition to lateral... The present study alignment, which we call valgus alignment replaced by bone the. Not considered for osteotomy who had any symptoms in the literature to date have reported on the server to the. Our goal to provide the highest level of care and Service to our..
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