In our hands, almost all patients who benefit from the use of a lateral unloader brace do very well with a later performed distal femoral osteotomy and are able to correct the knock knee condition. This site needs JavaScript to work properly. Background: 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. Its combination with various cartilage repair procedures has been shown to further improve outcomes. 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. 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]. It is possible that the limitations of intraoperative fluoroscopy and intraoperative visual analysis of limb alignment in a nonweightbearing situation is that they do not correlate closely enough with preoperative and postoperative weightbearing radiographic alignment measurements. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? Dr. Garcia will take limb alignment films to identify have much correction is needed. Thirty-eight knees (97%) in 36 patients were lateral opening-wedge varus-producing osteotomies; of those, 31 knees (82%) in 30 patients had followup at a minimum of 2 years (mean, 5 years; SD, 2; range, 2-12 years) and comprised the study population. 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. 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. 15. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. This answers all my questions! 17. After surgery patients are non-weight bearing for 6 weeks. 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. FOIA After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. There are usually 3 main indications for distal femoral osteotomies. Would you like email updates of new search results? Saithna et al. 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. EDINA- CROSSTOWN OFFICE Epub 2019 Mar 26. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. Routine closure was then performed and the patient was placed into a ROM brace. Your message has been successfully sent to your colleague. 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 site is secure. 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). Clipboard, Search History, and several other advanced features are temporarily unavailable. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. J Knee Surg. Int J Mol Sci. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. Edgerton BC, Mariani EM, Morrey BF. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. 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. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. Careful selection of each surgical candidate is necessary to ensure maximum benefit. The remaining 31 knees (82%) in 30 patients comprised the study population. 3, 4) and was ultimately converted to a TKA. 8. Purpose: Optimizing indications and technique in osteotomies around the knee. 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) Distal femoral varus osteotomy for painful genu valgum. Epub 2022 Jun 8. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. Given . Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. Epub 2016 Jun 3. Eur J Radiol Open. White dotted line: mechanical axes of the femur. 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. 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. 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. 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. 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. Aglietti P, Menchetti PP. 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. sharing sensitive information, make sure youre on a federal Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. This site needs JavaScript to work properly. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. 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. Das et al. Distal femoral varus osteotomy. 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. Methods: 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. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. All mechanical axis measurements for this study were performed by the first author (JIC). The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). Osteotomy hardware removal was performed in fourteen cases (17.9%). View Doctor Profile. Two knees (two patients) underwent a medial closing-wedge osteotomy and were not included in the present study. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. Grant H. Garcia, MD 4010 W. 65th St. 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. Twenty-one of 31 knees had postoperative radiographic data available for review. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. This is what this term means. Most osteotomies done are opening wedge as previously described. Distally the coupler was mated to a DFR in the usual fashion . 8600 Rockville Pike 13. 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. Additionally, each screw can be pivoted within the plate's mobile bushing system to . Please enable it to take advantage of the complete set of features! Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. The site is secure. 16. Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. This website uses cookies. For more information, please refer to our Privacy Policy. Wolters Kluwer Health Federal government websites often end in .gov or .mil. Unable to load your collection due to an error, Unable to load your delegates due to an error. A distal femoral involves a surgical cut of the bone at bottom of the femur. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. eCollection 2022. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. The workup of this includes long leg x-rays to confirm that the patient is malaligned and does have valgus alignment, one has an arthroscopic surgery or an MRI to confirm that the cartilage on the inside part of the knee is fairly intact, as well as the majority of the medial meniscus and that one has intact ligaments or plan to reconstruct the ligaments either concurrently or thereafter the osteotomy. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. The https:// ensures that you are connecting to the Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. (1) Does lateral opening-wedge osteotomy lead to accurate correction? OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Epub 2016 Dec 21. Between 2000 and 2010, we performed 40 distal femoral osteotomies. This transfer bias is important to remember when reviewing our results. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. 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. Care was taken to maintain the line above the articular surface of the trochlea. Joint line convergence angle (JLCA) = 5, mechanical lateral distal femoral angle (mLDFA) = 84. b Preoperative planning of opening-wedge (DFO). Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). 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%]). 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. 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. 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. The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. Long-term survival data, defined as conversion to total knee arthroplasty, were analyzed using a multiple metaregression model as a function of individual study follow-up time points and surgical technique. 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. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Distal femoral osteotomy for valgus deformity of the knee. The correction was slowly created. 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. Additionally, each screw can be . We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. official website and that any information you provide is encrypted Clipboard, Search History, and several other advanced features are temporarily unavailable. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. ANESTHESIA: General. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. 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. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. 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. 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). Further research with larger groups in this area is needed. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. Clin Orthop Relat Res. Orthopedic Surgeon & Sports Medicine Specialist Das et al. SPECIMENS: Multiple cultures from the right ankle. The opening-wedge plate was then placed and fixed with four screws (Fig. . Careers. 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. 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 was one nonunion. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. 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. The IKDC score improved from 36 to 53 (p < 0.05). It is our goal to provide the highest level of care and service to our patients. 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. 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. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. Federal government websites often end in .gov or .mil. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. Contact administrator regarding this item (to report mistakes or request changes), e: X-rays are taken at each visit to confirm healing and check alignment. Stahelin et al. 11. Finkelstein et al. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Careers. 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. The entire limb, including the iliac crest, was prepped and draped free. By continuing to use this website you are giving consent to cookies being used. This is a good option for patients with knock knee. A 135-case series with minimum 5-year follow-up. 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. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. 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. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. The first one is in patients who may have developed arthritis either from a previous lateral meniscectomy or genetic causes and who are found to have fairly normal cartilage in the rest of their knee, but have arthritis on the outside of their knee. One nonunion occurred in the arthritis group. Arthroscopy. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. Characteristics of the arthritis and the joint preservation groups. 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. Improvements in the IKDC scores were noted postoperatively. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. 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 . 1). Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Patients who are bowlegged are in varus alignment. official website and that any information you provide is encrypted 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. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Epub 2021 Oct 27. The heights of . Epub 2018 Oct 5. 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. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. There are two main surgical techniques for a distal femoral osteotomy. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. Limb alignment was checked fluoroscopically and clinically. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. 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. Data is temporarily unavailable. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. Backstein D, Morag G, Hanna S, Safir O, Gross A. 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. See this image and copyright information in PMC. Our study had several limitations. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. Wang JW, Hsu CC. Epub 2020 Jul 20. Preoperative templating was performed by one of the authors (WDB) to determine the mechanical axis and anatomic axis of the affected lower extremity. Wayne M. Weil, M.D | These patients were either treated nonoperatively or were considered for TKA. Many of the patients who had postoperative films were not within 3 of neutral alignment. PMC An official website of the United States government. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. Study design: Of course, these are the success rates for patients who were treated for osteoarthritis, and no real publications have been performed in the long term rates after meniscus transplants, cartilage replacement surgeries, or ligament reconstructions because there are not a sufficient number of patients to have good long-term analysis in the peer-reviewed literature. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). 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). The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 2021 Oct;29(10):3299-3309. doi: 10.1007/s00167-020-06166-3. They also reported two cases of loss of correction, one infection, and one nonunion. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. .
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