Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. You may be trying to access this site from a secured browser on the server. Some features of this site may not work without it. 20. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). [4] reported on the outcome of opening-wedge distal femoral osteotomy for lateral arthritis of the knee in 19 patients using the Puddu plate and calcium phosphate. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. The entire limb, including the iliac crest, was prepped and draped free. Clipboard, Search History, and several other advanced features are temporarily unavailable. Please enable scripts and reload this page. 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. Sternheim et al. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. This site needs JavaScript to work properly. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. 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. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Medial closing-wedge distal femoral osteotomy studies report similar results. FOIA The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. FOIA 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. 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. A survivorship analysis. Bookshelf All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. Previous attempts to make it better provided only temporary relief. 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. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. 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. HHS Vulnerability Disclosure, Help Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. Osteotomy hardware removal was performed in fourteen cases (17.9%). In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. See this image and copyright information in PMC. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . Wolters Kluwer Health
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. http://dx.doi.org/10.1177/2325967114S00051. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. doi:10.1177/2325967114S00051. Distal femoral varus osteotomy for osteoarthritis of the knee. 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. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. . While rates of required hardware removal secondary to these complications were as high as 72% in 1 group, 7 all remaining articles reported lower rates of hardware removal. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. The opening-wedge plate was then placed and fixed with four screws (Fig. Further research with larger groups in this area is needed. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. The aim of this study was to report the occurrence of . Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. We have found that performing the distal femoral osteotomy and the MCL reconstruction at the same time is successful and does not require two separate reconstructions. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. 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. The study population was stratified into two groups based on reason for osteotomy: patients with isolated symptomatic lateral compartment arthritis (arthritis group; 19 knees [61%]) and patients who underwent joint preservation procedures including osteochondral allograft transplantation or meniscal allograft transplantation (joint preservation group; 12 knees [39%]) (Table 1). An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. 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. Results: The use of varus-producing osteotomies for valgus knee deformity is less common and limited clinical studies have been published [1, 2, 6, 7, 10, 12, 13, 15, 16, 20]. Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. 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. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. In general, the plates and screws that are used to fix long bone fractures are left in for a minimum of one year prior to having them taken out. We achieved our goal of within 3 of mechanical neutral alignment in seven of 15 patients in the arthritis group and three of six patients in the joint preservation group who had followup mechanical axis radiographs. JavaScript is disabled for your browser. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. These braces help push the weight towards the inside of the knee, and by doing so, they can help serve as an excellent screen to determine if a patient would benefit from a distal femoral osteotomy. Our study had several limitations. Supracondylar osteotomy of the femur with use of compression. No postoperative complications were experienced. The success rates for lateral meniscal transplants and cartilage resurfacing procedures are much less if the valgus alignment is not corrected with the surgical procedure (or before it). 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. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. Medial closing-wedge osteotomy A medial-side distal femoral approach is normally used with a skin incision starting 2 cm distal to the medial epicondyle and extending 15 cm proximally. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2. These patients were either treated nonoperatively or were considered for TKA. Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. *StimuBlast is a registered trademark of AlloSource. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. 2014. Federal government websites often end in .gov or .mil. Das et al. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Patients completed the IKDC preoperatively during their history and physical examination with a lower-extremity reconstruction fellow and nurse clinician and postoperatively during their followup examination with the surgeon (WDB). This site needs JavaScript to work properly. At 74 months followup, the Lysholm scores improved from 64 to 77 and the clinical Hospital for Special Surgery knee score improved from 42 to 64. 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. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. Grant H. Garcia, MD 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . 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. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. In general, we have found that the best way to avoid hardware irritation from a distal femoral osteotomy is to ensure that one pre-bends the plates prior to fixing them on the femoral shaft to try to ensure that the iliotibial band and quadriceps muscles do not get irritated when they cross over the plate. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. 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 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. 1. Broken hardware and screws were removed. Would you like email updates of new search results? The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. Methods: 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). 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. Epub 2019 Nov 27. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). The average patient age at surgery is 33 11 years with mean BMI of 28 6. This transfer bias is important to remember when reviewing our results. I am so glad I did! Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. Purpose: The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. In general, these are performed for patients with knock knees, which we call valgus alignment, and the goal of the surgery is to realign them such that the weightbearing axis is changed to pass either through the center of the knee or just barely into the inside compartment of the knee. Please enable it to take advantage of the complete set of features! lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. 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. 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. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. Postoperative management included touchdown weightbearing for 6 weeks with no limits to ROM followed by 4 to 6 weeks of progressive weightbearing with the use of crutches. (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. 3, 4) and was ultimately converted to a TKA. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. Stahelin et al. distal femoral osteotomy hardware removal. Call Us Today (888) 260-0449 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. Closed intramedullary osteotomies of the femur. government site. In general, this is a successful procedure if done for the right indications. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. Dewilde et al. 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. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. 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. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Bethesda, MD 20894, Web Policies Thank you for choosing Dr. LaPrade as your healthcare provider. 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. 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 authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). 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. 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. 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. 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. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. 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). I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. Osteosynthesis with a malleable implant. White dotted line: mechanical axes of the femur. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). 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. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. Disclaimer, National Library of Medicine Achieving our desired correction of 3 from neutral alignment was clinically difficult. Dr. Robert F. LaPrade operated on my right knee in May of 2010. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Knee Surg Relat Res. These are the lateral opening wedge osteotomy, whereby a bone wedge is placed into the outside portion of the femur to change the alignment or a closing wedge medial distal femoral osteotomy, whereby a bone wedge is taken out and the bone is collapsed down to change the alignment. 4010 W. 65th St. 11. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. Knee Surg Sports Traumatol Arthrosc. Download Citation | Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures | Background: A locking compression plate (LCP . This website uses cookies. Orthopedic Surgeon & Sports Medicine Specialist J Knee Surg. 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. They also reported two cases of loss of correction, one infection, and one nonunion. After surgery patients are non-weight bearing for 6 weeks. A distal femoral osteotomy can be performed for osteoarthritis when one has had development of osteoarthritis on the outside part of their knee, their knee alignment has become knock knee and is in valgus, and whereby the cartilage and the meniscus on the inside of the knee is still in good condition to whereby shifting the weight towards the inside of the knee would benefit the patient. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. 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. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. A 135-case series with minimum 5-year follow-up. Opening-wedge distal femoral osteotomy (DFO). Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. 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.
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