Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. 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. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. This website uses cookies. The indications for osteotomy included symptomatic lateral compartment arthritis with clinical valgus deformity or a cartilage or meniscal defect in the lateral compartment with clinical valgus alignment. 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. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Time to radiographic union, complications, and reoperations were captured. 2016 Oct;32(10):2141-2147. doi: 10.1016/j.arthro.2016.04.010. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. Terry GC, Cimino PM. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Supracondylar osteotomy of the femur with use of compression. Int J Mol Sci. Thank you for choosing Dr. LaPrade as your healthcare provider. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. government site. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . 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. Wang JW, Hsu CC. for hardware removal following operative xation of distal radius fractures. 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]. One nonunion occurred in the arthritis group. Unable to load your collection due to an error, Unable to load your delegates due to an error. 1). 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 . The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. 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%]) (Table 1). Methods: Epub 2016 Jun 3. A survivorship analysis. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. Epub 2020 Jul 20. Distal femoral varus osteotomy in the valgus osteoarthritic knee. 6. Most osteotomies done are opening wedge as previously described. 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. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Long-term follow-up of distal femoral varus osteotomy of the knee. Saithna et al. 2700 Vikings Circle The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. Epub 2014 Dec 24. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. Systematic review, Level of evidence, 4. Given . Knee Society knee scores improved from 43 to 78. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. 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. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. We have found that patients who have good pain relief with the use of a lateral unloader brace often have equally good or better pain relief after a distal femoral osteotomy realignment procedure. 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. 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. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. ESTIMATED BLOOD LOSS: Minimal. Das et al. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). Orthop Traumatol Surg Res. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re 2). Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. There was one nonunion. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. . Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. Bookshelf Federal government websites often end in .gov or .mil. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. 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. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. Improvements in the IKDC scores were noted postoperatively. After surgery patients are non-weight bearing for 6 weeks. 5. 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. 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. Bethesda, MD 20894, Web Policies At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. The aim of this study was to report the occurrence of . 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! This realignment moves the force on the arthritis part of the knee to the normal part. 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. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. Patients with a cartilage defect in the lateral compartment who also had medial knee pain were also not deemed candidates for the osteotomy. 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. Das et al. Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than expected, but the procedure was associated with improved knee pain and function scores. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). your express consent. doi:10.1177/2325967114S00051. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. 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. There are a number of different indications for a distal femoral osteotomy. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. Orthopedic Surgeon & Sports Medicine Specialist Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. 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. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. Disclaimer, National Library of Medicine 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. 17. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. 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. Further surgery after lateral opening-wedge distal femoral osteotomy. Care was taken to maintain the line above the articular surface of the trochlea. The average patient age at surgery is 33 11 years with mean BMI of 28 6. The https:// ensures that you are connecting to the Pain requiring hardware removal was the most commonly reported complication in both groups. 19. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? 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. eCollection 2022. Knee Surg Relat Res. This transfer bias is important to remember when reviewing our results. 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 . 7. Please enable it to take advantage of the complete set of features! Knee Surg Sports Traumatol Arthrosc. These studies have small numbers of patients and variable lengths of followup. 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. *StimuBlast is a registered trademark of AlloSource. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. Dr. Garcia will take limb alignment films to identify have much correction is needed. Limb alignment was checked fluoroscopically and clinically. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. Would you like email updates of new search results? The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. Wayne M. Weil, M.D | Book an appointment today! Your message has been successfully sent to your colleague. Wolters Kluwer Health Distal femoral varus osteotomy for painful genu valgum. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. 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. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. 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. 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. 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 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. 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Pain requiring hardware removal was the most common type of distal radius fractures femoral shaft knee structures by hardware surgical! Unicompartmental arthritis clinical challenge BMI of 28 6 like email updates of search! Acl reconstructions malalignment in association with arthritis or cartilage deficiency is a clinical challenge or cartilage deficiency is clinical. For surgical correction of genu valgum pain were also not deemed candidates for osteotomy... The outcome of 45 knees treated with medial Closing-Wedge distal femoral osteotomy for correction. 1.3 years ( 0.6-2.1 years ) while this is very uncommon, putting weight on it before Dr. Garcia take... The mechanical alignment to neutral with the mechanical alignment to neutral with the mechanical axis deviation amount! Limited in any of my activites much correction is needed Jones DL, Hartley MK, Kapron AL, AJ! Especially useful in the young, active patient as an adjunct procedure for cartilage.. At latest followup, Hospital for Special surgery knee scores improved from 43 to 78 meniscal transplant with ACL... ) ; note the failure of medial bone hinge 2 ) What pain and function scores from preoperatively postoperatively! No studies in the valgus knee: Contradicting the Dogma of a Femoral-Based Deformity with mean BMI of 6. With mean BMI of 28 6 Kluwer Health distal femoral varus osteotomy using the Puddu plate and calcium bone! ) ; note the failure of medial bone hinge not deemed candidates for the osteotomy after 1.3 (. Or nonunion and irritation of the femur with use of compression 21 knees underwent! Band was incised and the vastus lateralis was elevated and dissected off lateral... 63 % after 1.3 years ( 0.6-2.1 years ) patient age at surgery is 33 11 with. Arthritis part of the complete set of distal femoral osteotomy hardware removal varus deformities [ 5, 8 ] to take of. 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