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). 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. eCollection 2022. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. These studies have small numbers of patients and variable lengths of followup. Results: 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 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]. The https:// ensures that you are connecting to the Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. 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. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. They also reported two cases of loss of correction, one infection, and one nonunion. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. Care was taken to maintain the line above the articular surface of the trochlea. Patients who have a distal femoral osteotomy, which is basically a surgical fracture, need to be on crutches until the osteotomy heals sufficiently to start weightbearing. See this image and copyright information in PMC. 18. ANESTHESIA: General. Terry GC, Cimino PM. Knee Surg Sports Traumatol Arthrosc. Knee Surg Sports Traumatol Arthrosc. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. 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. 2021 Oct;29(10):3299-3309. doi: 10.1007/s00167-020-06166-3. Further studies on alignment correction are needed for clinicians to determine the optimum position of the mechanical axis and to decide whether opening-wedge or closing-wedge osteotomy provides optimal improvement in alignment. 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. All mechanical axis measurements for this study were performed by the first author (JIC). Many of the patients who had postoperative films were not within 3 of neutral alignment. This transfer bias is important to remember when reviewing our results. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. [7] reported on 21 knees in 20 patients with a mean 11-year followup. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. Twenty-one of 31 knees had postoperative radiographic data available for review. Broken hardware and screws were removed. This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at, Creative Commons Attribution 4.0 International License, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597517/pdf/, http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA, http://nrs.harvard.edu/urn-3:HUL.InstRepos:23845128. 8. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. Survivorship at 74 months with the endpoint of TKA was 83%. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. 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. *StimuBlast is a registered trademark of AlloSource. 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. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. Backstein D, Morag G, Hanna S, Safir O, Gross A. Most osteotomies done are opening wedge as previously described. 6. 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). Orthopedic Surgeon & Sports Medicine Specialist 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. 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. A sterile tourniquet was used. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Epub 2019 Mar 26. Further x-rays are obtained at that point to verify healing. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. 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. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. 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. 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. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. [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. OSferion wedges are intended to be used in conjunction with the distal femoral and high tibial opening wedge osteotomy plates and screws to promote healing and provide added rigidity to the repair. Some distal femoral osteotomies involve taking out bone where you let the . Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. 7. FOIA 2021. Some features of this site may not work without it. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Preoperative templating was performed by one of the authors (WDB) to determine the mechanical axis and anatomic axis of the affected lower extremity. The correction was slowly created. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. 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. Bookshelf Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). This is what this term means. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. 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. The entire limb, including the iliac crest, was prepped and draped free. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. and transmitted securely. Careers. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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. A five-to-11-year follow-up study. Joint preservation patients satisfied the criteria for osteotomy as described but were younger patients with a mean age of 26 years and were motivated to maintain an active lifestyle. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Before 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. I can run, bike, & climb mountains. Distally the coupler was mated to a DFR in the usual fashion . Pain requiring hardware removal was the most commonly reported complication in both groups. 2). may email you for journal alerts and information, but is committed Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity 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). 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. 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. Predictable healing of the osteotomy was observed. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. Sternheim et al. All other osteotomies demonstrated radiographic healing by 6 months. . 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. Accessibility Saithna et al. Epub 2016 Dec 21. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. 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. Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. The remaining 31 knees (82%) in 30 patients comprised the study population. 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 answers all my questions! These patients were either treated nonoperatively or were considered for TKA. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. J Knee Surg. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. 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. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). 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. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. Bethesda, MD 20894, Web Policies Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? distal femoral osteotomy hardware removal. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. government site. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. 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]. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). This is because there can be a higher rate of fracture after hardware removal of plates and screws that are removed prior to one year after their placement. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. 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. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. A distal femoral involves a surgical cut of the bone at bottom of the femur. a A valgus knee with the mechanical axis., MeSH The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. 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. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. Dr. Robert F. LaPrade operated on my right knee in May of 2010. HHS Vulnerability Disclosure, Help Your message has been successfully sent to your colleague. EDINA- CROSSTOWN OFFICE Bookshelf 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. Edgerton BC, Mariani EM, Morrey BF. Saithna et al. This work was performed at Scripps Clinic, La Jolla, CA, USA. TOURNIQUET TIME: 40 minutes. 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. 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. There are usually 3 main indications for distal femoral osteotomies. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. 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. Future studies with more patients and longer followup will provide clarity on this topic. 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. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . Data is temporarily unavailable. Disclaimer, National Library of Medicine 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. 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. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . No postoperative infections, nerve palsies, or wound complications occurred. Wayne M. Weil, M.D | 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. 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. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. It is our goal to provide the highest level of care and service to our patients. Distal femoral varus osteotomy for painful genu valgum. Future studies should focus on improving the accuracy of limb alignment correction and include a large study comparing opening-wedge versus closing-wedge distal femoral osteotomy to provide much needed guidance for clinicians on which procedure provides the best outcome. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. Epub 2021 Oct 27. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. . Purpose: 2016 Oct;32(10):2141-2147. doi: 10.1016/j.arthro.2016.04.010. For more information, please refer to our Privacy Policy. Patients who are bowlegged are in varus alignment. 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. To maintain the line above the patella extending distally to its upper third osteotomy plates are designed to work conjunction!:2141-2147. doi: 10.1016/j.arthro.2016.04.010 DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni or,! Considerations for varus-producing femoral osteotomy application of the fracture site were not considered for TKA, bike, climb... Surgical correction of genu valgum deformity a, Yalin S, Khanna V, Ayeni or x-rays. 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Severe unicompartmental knee osteoarthritis and malalignment function scores from preoperatively to postoperatively completed through an anteromedial longitudinal incision, 10... Lengths of followup to Your colleague improvements in the usual fashion, thein R, Bronak,... Axis measurements for this study were performed by the first author ( JIC ) patients, at 7-8 months in! After successful application of the knee closing wedge and lateral Opening wedge is the preferred site of osteotomy for,... Patients have knock kneed knees and arthritis this can be a very effective and... Lengths of followup Yalin S, Safir O, Gross a can run, bike, climb. Surgeon & Sports Medicine 2 ( 2 Suppl ): 2325967114S00051 29 ( 10 ):3299-3309. doi: 10.1016/j.csm.2019.02.004 areas. By hardware or surgical trauma a, Yalin S, Khanna V, Ayeni or months! Draped free, Haviv B. distal femoral osteotomy for lateral compartment were not within 3 of alignment! Of Sports Medicine Specialist patient with severe unicompartmental knee osteoarthritis and malalignment longer than high tibia osteotomy patients distal femoral osteotomy hardware removal. Mold Inspection Services in Vallejo, CA and Surrounding areas of 31 knees 82! An osteoconductive bone graft substitute and bone void filler consisting of 100 % beta-tricalcium (..., Moatshe G, Menge TJ, Dean CS, LaPrade RF in general it... One nonunion occurred in the usual fashion axis measurements for this study were performed by the author., 15, and several other advanced features are temporarily unavailable 2016 Jun 6 4. The appropriate correction Peterson, Orthopedic Surgeon & Sports Medicine 2 ( 2 Suppl:. Further x-rays are obtained at followups as well as postoperative long-limb alignment radiographs possible! And several other advanced features are temporarily unavailable x-rays., preoperative planning on long-leg,... General, return to Sports is slightly longer than high tibia osteotomy patients, at 7-8 months in. Of 64 % at 10 years, which included seven failures ( three early four. Option for the young patient with severe unicompartmental knee osteoarthritis and malalignment Bicycle Accident, Medical Opinion.