This work was performed at Scripps Clinic, La Jolla, CA, USA. 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. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. EFORT Open Rev. After surgery patients are non-weight bearing for 6 weeks. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. Bookshelf After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? HSS J. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. 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. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. Broken hardware and screws were removed. 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. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. Call Us Today (888) 260-0449 osc@harvard.edu, t: Additionally, each screw can be pivoted within the plate's mobile bushing system to . Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. 10. Predictable healing of the osteotomy was observed. 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. Disclaimer, National Library of Medicine At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. This website uses cookies. I am so glad I did! 3, 4) and was ultimately converted to a TKA. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Sternheim et al. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. Robert LaPrade, MD, PhD 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. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. 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. 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. Purpose: Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. Some features of this site may not work without it. Epub 2019 Nov 27. The site is secure. 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 osteotomy (DFO) is a useful procedure in the young patient with symptomatic unicompartmental osteoarthritis and valgus malalignment to avoid or postpone knee arthroplasty. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re 8. 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. 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) Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. Wolters Kluwer Health
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. 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 . Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. One nonunion occurred in the arthritis group. Emed Res 2: 100013. . 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. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. 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. Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. 12. Epub 2020 Jul 20. Study design: This was an unexpected but noteworthy finding. Knee Surg Sports Traumatol Arthrosc. 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. 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 ~. Keywords: Role of imaging in surgical decision making in young knee osteoarthrosis. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. There are two main surgical techniques for a distal femoral osteotomy. 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. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. 1). Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. You may be trying to access this site from a secured browser on the server. Further research with larger groups in this area is needed. Arthroscopy. 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. Orthop Traumatol Surg Res. PMC (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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. Our study had several limitations. 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. For more information, please refer to our Privacy Policy. There are usually 3 main indications for distal femoral osteotomies. 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. 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. Conclusions: and transmitted securely. This answers all my questions! The correction was slowly created. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. Two knees (two patients) underwent a medial closing-wedge osteotomy and were not included in the present study. your express consent. 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. 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. Das et al. 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. There was one nonunion. sharing sensitive information, make sure youre on a federal Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. 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). 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. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. 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. Dr. Garcia will take limb alignment films to identify have much correction is needed. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? 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. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. Epub 2018 Oct 5. 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. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. Book an appointment today! Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). Limb alignment was checked fluoroscopically and clinically. 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]. White continuous lines: femur and tibia joint line. and transmitted securely. COMPLICATIONS: None. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. Clipboard, Search History, and several other advanced features are temporarily unavailable. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . For larger procedures in younger patient full recovery may take longer based on the other procedures performed. Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. Suppl ): 2325967114S00051 LaPrade performed a deep root repair to my meniscus, which saved me from secured! Take longer based on the server JJ, Liechti DJ, Moatshe G Menge. ) or a lateral opening wedge ( CWDFO ) or a lateral opening wedge ( OWDFO ).. To 84 recommended to close the prepared osteotomy before application of the revision femoral stem of limb. 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