The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). Thank you for choosing Dr. LaPrade as your healthcare provider. Epub 2019 Mar 26. Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). Your message has been successfully sent to your colleague. Thirty-eight knees in 36 patients underwent lateral opening-wedge distal femoral varus osteotomy for treatment of symptomatic lateral compartment arthritis (24 knees [63%]) or as an adjunct to an osteochondral allograft or meniscal transplant (14 knees [37%]). 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. The site is secure. 13. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. Most osteotomies done are opening wedge as previously described. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. The success rate of distal femoral osteotomies is felt to be about 70% to 75% at 10 years. and transmitted securely. This website uses cookies. Bethesda, MD 20894, Web Policies The most worrisome complication is that the boney cut does not heal. 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 . lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). and transmitted securely. [7] reported on 21 knees in 20 patients with a mean 11-year followup. 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. 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. Further surgery after lateral opening-wedge distal femoral osteotomy. 8. . Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. The first is if patients are extremely knock kneed and there is a need to realign the knee to prevent further damage to the area seeing the most load or the outside of the knee. Its combination with various cartilage repair procedures has been shown to further improve outcomes. . Please enable scripts and reload this page. Before Disclaimer, National Library of Medicine A distal femoral osteotomy (knock knee surgery) is a procedure whereby a surgical fracture is created at the end of the femur and the shape of the bone is changed. Grant H. Garcia, MD 1. Distal femoral osteotomy for valgus deformity of the knee. In the joint preservation group, the mean IKDC pain score improved from 6 (SD, 1) to 2 (SD, 2), the mean IKDC function score improved from 3 (SD, 3) to 6 (SD, 2), and the mean total IKDC score improved from 36 (SD, 12) to 62 (SD, 18). Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. 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). It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. 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 Contact administrator regarding this item (to report mistakes or request changes), e: 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. 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. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. Osteotomy hardware removal was performed in fourteen cases (17.9%). Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. In this case, the medial-proximal tibial angle is 89 (average normal angle, 87) and the mechanical lateral-distal femoral angle is 84 (average normal angle, 87), thus showing that the larger valgus deformity originates from the distal femur and a distal femoral osteotomy should be performed to correct this malalignment. 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. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. The site is secure. One nonunion occurred in the arthritis group. 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 . Sternheim et al. Improvements in the IKDC scores were noted postoperatively. 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. 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. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. Patients who are bowlegged are in varus alignment. Ten knees in the arthritis group and six knees in the joint preservation group had additional surgery after the osteotomy, consisting primarily of hardware removal, arthroscopy for cartilage-related conditions, or conversion to arthroplasty. This answers all my questions! The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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. official website and that any information you provide is encrypted The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. 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). Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. 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. 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. Emed Res 2: 100013. . 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. 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. 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. No postoperative complications were experienced. Pain requiring hardware removal was the most commonly reported complication in both groups. I can run, bike, & climb mountains. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. 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. [4] reported that four of 19 patients who had an opening-wedge osteotomy underwent hardware removal, one patient underwent fracture fixation, and two patients were converted to TKA. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. 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. Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. 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. Call Us Today (888) 260-0449 may email you for journal alerts and information, but is committed Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . Bookshelf A five-to-11-year follow-up study. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. White continuous lines: femur and tibia joint line. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. 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. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). Additionally, each screw can be . Wayne M. Weil, M.D | An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. Saithna et al. Careful selection of each surgical candidate is necessary to ensure maximum benefit. 19. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. Some features of this site may not work without it. 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. The .gov means its official. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. 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. Epub 2019 Nov 27. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. SPECIMENS: Multiple cultures from the right ankle. 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. JavaScript is disabled for your browser. 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). The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. Edgerton BC, Mariani EM, Morrey BF. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Although TKA narrowed the indications for this once-common procedure, the femoral osteotomy remains a reasonable treatment for many patients with limb deformities [7, 25], and is broadly indicated when there is a deformity resulting in malalignment of the hip and lower . 17. Federal government websites often end in .gov or .mil. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. your express consent. Accessibility [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. This transfer bias is important to remember when reviewing our results. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge.
Dmas Reimbursement Rates 2022, Bruce Is A Student With An Intellectual Disability, Christian Winter Hats, You're Such A Sokratease Glitch, San Bernardino County Noise Complaint Number,
