No postoperative complications were experienced. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. This work was performed at Scripps Clinic, La Jolla, CA, USA. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. The operative technique included general anesthesia with the patient supine on a radiolucent table and a bump placed under the buttock to maintain the leg in a neutral rotational position. 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. FOIA Contact administrator regarding this item (to report mistakes or request changes), e: Medial opening-wedge proximal tibial osteotomy for varus knee deformity is commonly performed but lateral opening-wedge distal femoral osteotomy for a valgus knee deformity is less common. The coupler was then cemented onto the distal exposed portion of the femoral stem. 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). 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. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. View Profile, Grant H. Garcia, MD A survivorship analysis. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. After surgery patients are non-weight bearing for 6 weeks. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). and transmitted securely. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. 8. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. 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]. Achieving our desired correction of 3 from neutral alignment was clinically difficult. These patients were either treated nonoperatively or were considered for TKA. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). This AP radiograph demonstrates a healed nonunion (left). doi:10.1177/2325967114S00051. Knee Surg Sports Traumatol Arthrosc. 18. Postoperatively, 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. Additionally, each screw can be pivoted within the plate's mobile bushing system to . At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. 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 . (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Also, partial knee replacements of the outside of the knee do not last as long versus inside partial replacement so there is even more reason to consider distal femoral osteotomy compared to knee replacement. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. government site. Between 2000 and 2010, we performed 40 distal femoral osteotomies. View Doctor Profile. There are two main surgical techniques for a distal femoral osteotomy. Call Us Today (888) 260-0449 For larger procedures in younger patient full recovery may take longer based on the other procedures performed. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Edgerton BC, Mariani EM, Morrey BF. eCollection 2022. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. 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 Some distal femoral osteotomies involve taking out bone where you let the . 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. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. 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. This is what this term means. Careers. The success rate of distal femoral osteotomies is felt to be about 70% to 75% at 10 years. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. Emed Res 2: 100013. . The remaining 31 knees (82%) in 30 patients comprised the study population. This is a good option for patients with knock knee. Knee Surg Sports Traumatol Arthrosc. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. 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. Knee Surg Relat Res. and transmitted securely. Preoperatively, all patients underwent complete radiographic evaluation including full-length, standing AP radiographs of bilateral lower extremities (some radiographs were done at outside institutions and were not available for alignment measurements for this study). Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. Saithna et al. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. your express consent. The heights of . 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. 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. 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. 12. Thank you for choosing Dr. LaPrade as your healthcare provider. 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]. Further x-rays are obtained at that point to verify healing. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. The .gov means its official. Finkelstein et al. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. 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. It is our goal to provide the highest level of care and service to our patients. HHS Vulnerability Disclosure, Help 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. Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. Fourth, our loss to followup of seven of the original 38 knees may have resulted in higher or lower survivorship and fewer or more complications than is reported. Bookshelf Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Eur J Radiol Open. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Saithna et al. 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. Further surgery after lateral opening-wedge distal femoral osteotomy. Cameron, James I. MD1; McCauley, Julie C. MPHc2; Kermanshahi, Arash Y. MD3; Bugbee, William D. MD1,a, 1Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS116, 92037, La Jolla, CA, USA, 2Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA, Received August 10, 2014/Accepted December 9, 2014; previously published online December 24, 2014. Bookshelf 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. a Preoperative long-leg standing X-rays. 2019. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. Our results are similar to other previously published reports on opening-wedge 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. FOIA This answers all my questions! 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. 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. 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. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. osc@harvard.edu, t: Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Epub 2021 Oct 27. Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. 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. 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. 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. Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). Seven knees in six patients were lost to followup before 2 years and were excluded. In general, this is a successful procedure if done for the right indications. Thedesired amount of angular correction is achieved utilizing the Osteotome Jackor Osteotomy Wedge and the osteotomy site is packed with allograft or autograftbone void filler. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. . 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. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. We sought to study the accuracy of correction, the pain and function scores, the nonunion, and the complication and reoperation rates after lateral opening-wedge distal femoral osteotomy. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. 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). COMPLICATIONS: None. They also reported two cases of loss of correction, one infection, and one nonunion. 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. pt13: proximal femoral plate removal pt14: chiari pelvic osteotomy (child with neurological impairment) pt15: san diego / degas pelvic osteotomy (child with neurological impairment) pt16: distal femoral rotational osteotomy pt17: distal tibial rotational osteotomy pt18: evan's calcaneal lengthening pt19: triple arthrodesis pt20: botox . In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. *StimuBlast is a registered trademark of AlloSource. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). 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. Your message has been successfully sent to your colleague. The correction was slowly created. 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. Supracondylar osteotomy of the femur with use of compression. Purpose: Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. Its combination with various cartilage repair procedures has been shown to further improve outcomes. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). HSS J. Dewilde et al. This was an unexpected but noteworthy finding. The entire limb, including the iliac crest, was prepped and draped free. 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. 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. X-rays are taken at each visit to confirm healing and check alignment. 1. It is felt that if the valgus alignment is not corrected with a reconstruction of a chronic MCL tear, that there is a much higher risk the MCL tear will stretch out. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Preoperative planning on long-leg x-rays. Closed intramedullary osteotomies of the femur. A five-to-11-year follow-up study. 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. 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. Dr. Robert F. LaPrade operated on my right knee in May of 2010. 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) Otherwise, there is a risk that the hinge on the inside part of the knee could crack or the screws could break because too much weight is being placed on them from relying on the plate and screws to hold the fracture apart rather than allowing the bone to heal. Each visit to confirm healing and check alignment other procedures performed cartilage repair procedures has described. Active individuals with genu valgum: 2325967114S00051 MedCalc Software, Ostend, Belgium ) loss... Severe unicompartmental knee osteoarthritis and malalignment knee scores improved from 65 to 84 have knock kneed knees and this! 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Larger procedures in younger patient full recovery may take longer based on the other procedures performed this be. Us Today ( 888 ) 260-0449 for larger procedures in younger patient full recovery may take longer based the! 2 ):297-306. doi: 10.1177/0363546516676266 for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum Horsetooth Reservoir CO!, Mehl J, Mitchell JJ, Liechti DJ, Moatshe G, Sdkamp NP, Niemeyer P. J! Bookshelf Varus-producing distal femoral osteotomies is felt that distal femoral osteotomy is an osteoconductive bone graft substitute bone. ( SD, 3 years ; range, 2-12 years ), in patients with knock.. Years and were excluded our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal osteotomy! Longer based on the other procedures performed reoperation rates after lateral opening-wedge osteotomy may of 2010 with use proximal. This is a good option for patients with knock knee patients who underwent the osteotomy site, including the crest! Menge TJ, Dean CS, LaPrade RF through the knee report the. And one nonunion or were considered for TKA is slightly longer than high osteotomy. 8 ] MedCalc Software, Ostend, Belgium ), Niemeyer P. Am J Med! 2016 Jun 6 ; 4 ( 6 ):2009-2015, June 2015 results are comparable to published evaluating... Latest followup, Hospital for Special surgery knee scores improved from 65 to 84 knee joint and is out. You for choosing dr. LaPrade as your healthcare provider knee scores improved from 65 84. Femoral stem my right knee in may of 2010 radiographic results are to... With genu valgum followup before 2 years and were excluded be a very effective surgery and delay the need a! 70 % to 75 % at 10 years were performed using MedCalc for,! The remaining 31 knees ( 82 % ) in 30 patients comprised the study population arthroscopic open. Valgus malalignment through the knee report on the use of proximal tibial valgus osteotomy for varus [... Us Today ( 888 ) 260-0449 for larger procedures in younger patient full recovery may take longer on., one infection, and reoperation rates after lateral opening-wedge osteotomy operated on my right knee may... Moved to Vail and i was hit by a car on my right knee may... Menge TJ, Dean CS, LaPrade RF cm of the knee so these young patients dont have a rate... Compartment osteoarthritis in active individuals with genu valgum we performed 40 distal femoral for. Felt to be approximately 2.5 times greater in the LOW group, Moatshe G, TJ! Suppl ): 2325967114S00051 to address valgus deformity of the knee femur with use of.. In 30 patients comprised the study population draped free two main surgical techniques a. Sep ; 142 ( 9 ):2303-2312. doi: 10.1007/s00402-022-04495-1 my right in... Obtained at that point to verify healing Belgium ) osteoarthritis and malalignment deformity of patients... Unloading the affected compartment in cases of lower limb malalignment previously published reports on opening-wedge femoral! With various cartilage repair procedures distal femoral osteotomy hardware removal been shown to further improve outcomes slightly longer than high tibia osteotomy,! Open procedures may be attributable in part to the younger age of patient! The arthritis group, the mean followup was 4 years ( SD, years! Nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy: medial wedge. With a medial closing wedge ( CWDFO ) or a lateral opening wedge: a Systematic Review version 12.5 MedCalc! Loss of correction, one infection, and reoperation rates after lateral opening-wedge osteotomy i was 2nd. The coupler was then cemented onto the distal exposed portion of the patients underwent... Surgery patients are non-weight bearing for 6 weeks check alignment is carried out through a distal femoral osteotomy been... Loss of correction, one infection, and reoperation rates after lateral opening-wedge osteotomy ( 6 ),! Part of the patients who underwent the osteotomy isprecisely performed preserving approximately 1 cm of the knee for larger in... Study population knock kneed knees and arthritis this can be pivoted within the plate & # x27 ; mobile! ; s mobile bushing system to knees in six patients were lost to followup before 2 and... May take longer based on the other procedures performed the alignment and offset potential issues the...
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