This answers all my questions! 1). The https:// ensures that you are connecting to the Previous attempts to make it better provided only temporary relief. This transfer bias is important to remember when reviewing our results. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? The median preoperative valgus angle was 6.1 valgus (range 2-15.5). 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. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. Closed intramedullary osteotomies of the femur. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. The purpose of our study was to report on a series of opening-wedge distal femoral varus osteotomies used to treat osteoarthritis of the lateral compartment or as an adjunct to correct malalignment with cartilage or meniscal restoration. The average follow-up duration was 43 31 months and the need for further procedures (such as arthroscopic adhesiolysis, hardware removal, revision osteotomy and eventual progression to arthroplasty) was identified with relation to complications. 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. osc@harvard.edu, t: Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. There are often many symposia and debates at national and international meetings on this topic. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. 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. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. Distal Femoral Osteotomy. 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. 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. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. In general, these are performed for patients with knock knees, which we call valgus alignment, and the goal of the surgery is to realign them such that the weightbearing axis is changed to pass either through the center of the knee or just barely into the inside compartment of the knee. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. Pain requiring hardware removal was the most commonly reported complication in both groups. Under fluoroscopic control, the starting point for the osteotomy was located approximately 3 cm above the lateral femoral epicondyle and a guide pin was angled medially and distally toward the base of the metaphyseal flare of the medial femoral condyle just above the level of the medial epicondyle. Its combination with various cartilage repair procedures has been shown to further improve outcomes. The femur is cut with surgical instruments to about 1 cm away from the medial edge of the femur, commonly at a 45-degree angle and angling towards the adductor tubercle, and the bone is then slowly opened up to the point where the weightbearing goes through the center of the knee. A five-to-11-year follow-up study. 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. The .gov means its official. Seven knees in six patients were lost to followup before 2 years and were excluded. One nonunion occurred in the arthritis group. In general, patients who smoke are not candidates for a distal femoral osteotomy because bone does not heal very well in smokers and this would generally be a contraindicated surgical procedure in this circumstance. Keywords: FOIA distal femoral osteotomy hardware removal. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. 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]. However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. I can run, bike, & climb mountains. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. These patients were either treated nonoperatively or were considered for TKA. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided. government site. 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. View Profile, Grant H. Garcia, MD This work was performed at Scripps Clinic, La Jolla, CA, USA. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Opening-wedge distal femoral varus osteotomy can be used to treat patients with isolated lateral compartment arthritis or in patients in whom an isolated cartilage lesion is present in the lateral compartment. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE [15] reported that 16 of 21 patients who had undergone opening-wedge osteotomies (76%) underwent further surgery, the most common of which was removal of hardware (locking plate) because of irritation of the iliotibial band. 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. 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. Limb alignment was checked fluoroscopically and clinically. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. There was one nonunion. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. 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 . 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. Knee Society knee scores improved from 43 to 78. Some features of this site may not work without it. In patients who have chronic MCL tears that are symptomatic, the peer reviewed literature notes that the patients who are in valgus alignment have a much higher risk of having their future MCL reconstruction graft procedure stretch out unless the malalignment is corrected with a distal femoral osteotomy. 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. In general, one should be between the ages of 16 (with closed growth plates) and a roughly upper age of 55 to benefit from a distal femoral osteotomy. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. View Doctor Profile. 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). The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. 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. Download Citation | Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures | Background: A locking compression plate (LCP . In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. 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. 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. 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. This AP radiograph demonstrates a healed nonunion (left). This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. Distal femoral varus osteotomy in the valgus osteoarthritic knee. 12. Characteristics of the arthritis and the joint preservation groups. JavaScript is disabled for your browser. 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. Broken hardware and screws were removed. Edgerton BC, Mariani EM, Morrey BF. Das et al. 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. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. This was an unexpected but noteworthy finding. 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). The most worrisome complication is that the boney cut does not heal. 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. Bookshelf Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. 2021. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. 13. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. 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 . 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. Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. 1 Even with evolving fixation strategies and implants, . 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. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). PMC Study design: Epub 2021 Oct 27. Data is temporarily unavailable. Bethesda, MD 20894, Web Policies For more information, please refer to our Privacy Policy. ANESTHESIA: General. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Careers. Federal government websites often end in .gov or .mil. Saithna et al. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). Please try after some time. 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. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. 8. 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. How you can disable them visit our Privacy Policy: High Tibial osteotomy and femoral... Years are pain free and do not undergo knee replacement 9 ):2303-2312. doi: 10.1177/0363546516676266 valgum... 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