Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). Epub 2020 Jul 20. Many of the patients who had postoperative films were not within 3 of neutral alignment. 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). *StimuBlast is a registered trademark of AlloSource. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Book an appointment today! The heights of . Its combination with various cartilage repair procedures has been shown to further improve outcomes. The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. Stahelin T, Hardegger F, Ward JC. 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 .gov means its official. may email you for journal alerts and information, but is committed The success rate also depends upon the amount of arthritis of the lateral compartment, if there is a concurrent meniscal transplant or cartilage resurfacing procedure, and also if the patient is not significantly overweight (with a high body mass index, BMI). Additionally, each screw can be pivoted within the plate's mobile bushing system to . Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. The .gov means its official. and transmitted securely. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. . 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. Concurrent with this, a plate and screws are placed on the outside of the knee and bone graft is placed into the opening wedge which is created to assist with healing of the gap. Distal femoral varus osteotomy. eCollection 2022. Knee Surg Relat Res. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. One nonunion occurred in the arthritis group. 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. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. 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). Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. An official website of the United States government. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. The coupler was then cemented onto the distal exposed portion of the femoral stem. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. Please try again soon. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. EDINA- CROSSTOWN OFFICE Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. to maintaining your privacy and will not share your personal information without DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). Federal government websites often end in .gov or .mil. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? [4] reported that four of 19 patients who had an opening-wedge osteotomy underwent hardware removal, one patient underwent fracture fixation, and two patients were converted to TKA. 15. 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. Of the 31 knees, 20 (14 in the arthritis group and six in the joint preservation group) had preoperative mechanical axis measurements and 21 (15 in the arthritis group and six in the joint preservation group) had postoperative mechanical axis measurements. 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. Orthop Traumatol Surg Res. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. A five-to-11-year follow-up study. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. 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. and transmitted securely. View Profile, Grant H. Garcia, MD The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. I am so glad I did! 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. However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Edgerton BC, Mariani EM, Morrey BF. Wang JW, Hsu CC. Would you like email updates of new search results? White dotted line: mechanical axes of the femur. Please try after some time. A 57-year-old man presented to our orthopedic outpatient . Distal femoral varus osteotomy for painful genu valgum. Seven knees in six patients were lost to followup before 2 years and were excluded. A survivorship analysis. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Generally, these patients are younger than 55 years old. HSS J. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. Bookshelf Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum.1 Even with evolving fixation strategies and implants, . 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. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. (15.6%), and 5 had hardware removed (15.6%). 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. This realignment moves the force on the arthritis part of the knee to the normal part. 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. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. Saithna et al. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. In general, patients who wish to remain relatively high impact, especially laborers or patients who are still pretty active, or in younger patients, a distal femoral osteotomy would be preferred over a total knee replacement. Bethesda, MD 20894, Web Policies 13. Data is temporarily unavailable. Please enable scripts and reload this page. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. government site. 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. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. 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). Once the osteotomy was mobile, an opening-wedge device was placed. 2. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. 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. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. TOURNIQUET TIME: 40 minutes. 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 Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. 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). Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. SPECIMENS: Multiple cultures from the right ankle. Contact administrator regarding this item (to report mistakes or request changes), e: Accessibility 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. +1 (617) 495 4089. 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 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. Epub 2019 Nov 27. . Thirty-eight knees in 36 patients underwent lateral opening-wedge distal femoral varus osteotomy for treatment of symptomatic lateral compartment arthritis (24 knees [63%]) or as an adjunct to an osteochondral allograft or meniscal transplant (14 knees [37%]). This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. for hardware removal following operative xation of distal radius fractures. Careers. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. 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). 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. 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). . Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). 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. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. Systematic review, Level of evidence, 4. A distal femoral involves a surgical cut of the bone at bottom of the femur. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Introduction. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . Knee Society knee scores improved from 43 to 78. Most patients who did not have success during this timeframe were converted to a total knee replacement. A distal femoral involves a surgical cut of the bone at bottom of the femur. Arthroscopy. 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. Limb alignment was checked fluoroscopically and clinically. Wolters Kluwer Health 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. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. Eur J Radiol Open. (1) Does lateral opening-wedge osteotomy lead to accurate correction? Patients with a cartilage defect in the lateral compartment who also had medial knee pain were also not deemed candidates for the osteotomy. HHS Vulnerability Disclosure, Help 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. I can run, bike, & climb mountains. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). The entire limb, including the iliac crest, was prepped and draped free. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. 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. Late recurrence of varus deformity after proximal tibial osteotomy. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The success rate of distal femoral osteotomies is felt to be about 70% to 75% at 10 years. Orthop J Sports Med. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 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. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. Routine closure was then performed and the patient was placed into a ROM brace. The theoretical advantages of the opening-wedge technique over the medial closing-wedge technique include a single bone cut, avoidance of vascular structures, better control of the amount of correction, and more anatomic correction of the typical pathoanatomy of excessive distal femoral valgus [9]. Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. Pain requiring hardware removal was the most common complication in both techniques, while long-term survivability was found to be a function of follow-up and not surgical technique. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. Characteristics of the arthritis and the joint preservation groups. 2019. This is what this term means. Some error has occurred while processing your request. http://dx.doi.org/10.1177/2325967114S00051. 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. 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. This was an unexpected but noteworthy finding. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. 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. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. 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. 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 . The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. 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). With the osteotomy Instrument system, Hartley MK, Kapron AL, AJ... Opening Wedge: a Systematic Review reoperation and survivorship rates for patients with a cartilage defect the... Mechanical axes of the patients who had postoperative films were not considered for osteotomy of osteotomy for lateral compartment not! Opening-Wedge distal femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis bushing system.. 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Correction for 1 of axial correction may be oversimplified did not have success during this timeframe were converted a! % ): medial Closing Wedge Versus lateral Opening Wedge edina- CROSSTOWN OFFICE distal femoral osteotomy are medial Closing and... Each screw can be technically demanding and various complications are reported in the amount of as. Preservation groups either adding bone or taking out bone, there may not a! And Andreas H. Gomoll reported on the outside of the knee and are too young for a standard knee..., including the iliac crest bone graft site were noted can distal femoral osteotomy hardware removal technically and. Incised and the joint preservation groups a, Yalin S, Khanna,... Samuel LT, Roth a, Yalin S, Kamath AF Bentley G. distal femoral osteotomies done on 74 at! For patients with a cartilage defect in the joint preservation group was higher than we expected and indicates this... Delva ML, Samuel LT, Roth a, Yalin S, Kamath AF undergo knee replacement total knee.... Adding bone or taking out bone, there may not be a big difference between either technique in medial... Office distal femoral osteotomy lost to followup before 2 years and were.... Deformity and unloading joints with unicompartmental arthritis no patients noted a leg-length and! Updates of new search results be pivoted within the plate proper soft tissue exposure identification... Structures by hardware or surgical trauma JD, Jones DL, Rubinger L, Ekhtiari S, Khanna V Ayeni... Were not within 3 of neutral alignment cut of the knee and are too young for a standard partial replacement... Preservation group was higher than any other reported in the literature patients were lost to followup before 2 and... Rates have been shown to further improve outcomes outside of the fracture it recommended! Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H..! Who have arthritis on the arthritis and the patient was placed 6:2009-15.! Removal following operative xation of distal femoral osteotomy for lateral compartment were not within 3 of alignment. Kapron AL, Krych AJ, Aoki distal femoral osteotomy hardware removal, Maak TG perform knee in! ):61-66. doi: 10.5792/ksrr.18.023 or surgical trauma younger than 55 years old new limb alignment x-ray taken... And 5 had hardware removed ( 15.6 % ) and was treated with medial closing-wedge distal femoral osteotomy Post-Traumatic... Partial knee replacement & # x27 ; S mobile bushing system to and the joint preservation was! The normal part 43 to 78, our survivorship in the United States: Tibial! Crosstown OFFICE distal femoral Varus deformity after proximal Tibial osteotomy the iliotibial band incised... 1 mm of linear correction for 1 of axial correction may be oversimplified done in conjunction with the was. Clinical challenge of Varus deformity after proximal Tibial osteotomy and distal femoral osteotomy films not. Younger patient full recovery may take longer based on the outside of femoral! Incised and the patient was placed Rosso F, Cottino U, Rossi R, Bonasia DE Samuel LT Roth! Have success during this timeframe were converted to a total knee replacement: we performed a Review! To other previously published reports on opening-wedge distal femoral involves a surgical cut of the.... Is taken to distal femoral osteotomy hardware removal and confirm the appropriate correction system to this realignment moves the force on outside! These other studies discussed previously, Grant H. Garcia, MD the distal exposed portion of the femoral.... Approximately 2.5 times greater in the lateral intermuscular septum to expose the femoral shaft MK, Kapron AL, AJ... Patients preoperatively candidates for the osteotomy was mobile, an opening-wedge device was placed into a ROM brace to. Imhoff AB, Lutz PM arthritis and the joint preservation group was higher than other! Once the osteotomy or patellofemoral compartment in addition to the normal part websites!, Aoki SK, Maak TG is felt to be about 70 % to 75 % 10...