In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Most patients who did not have success during this timeframe were converted to a total knee replacement. 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. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. For younger patients with ligament and cartilage surgeries the success rate is much high as 90% at 10 years and these procedures in young patients can last upwards of 20 years. Distal femoral osteotomy for valgus deformity of the knee. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re The coupler was then cemented onto the distal exposed portion of the femoral stem. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. The .gov means its official. 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. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. 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. This AP radiograph demonstrates a healed nonunion (left). At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. Wolters Kluwer Health Careful selection of each surgical candidate is necessary to ensure maximum benefit. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. Unable to load your collection due to an error, Unable to load your delegates due to an error. for hardware removal following operative xation of distal radius fractures. After surgery patients are non-weight bearing for 6 weeks. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Epub 2019 Mar 26. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. 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. 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. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). 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 . . Dewilde et al. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. 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 inside of the knee would benefit the patient. The most worrisome complication is that the boney cut does not heal. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. There are two main surgical techniques for a distal femoral osteotomy. 17. Disclaimer, National Library of Medicine 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. Background: 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]. http://dx.doi.org/10.1177/2325967114S00051. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. 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. PMC These patients were either treated nonoperatively or were considered for TKA. 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%]). Stahelin et al. sharing sensitive information, make sure youre on a federal [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Epub 2016 Dec 21. Our institutional review board-approved osteotomy database was used to identify a case series of 40 knees in 38 patients undergoing distal femoral osteotomy from January 2000 to August 2010. Late recurrence of varus deformity after proximal tibial osteotomy. a A valgus knee with the mechanical axis., MeSH 19. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Orthopedic Surgeon & Sports Medicine Specialist 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). This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. Objectives: 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. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. Study design: After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. In general, this is a successful procedure if done for the right indications. Eur J Radiol Open. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. Robert LaPrade, MD, PhD Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. 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. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. The entire limb, including the iliac crest, was prepped and draped free. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. 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. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. Methods: The median preoperative valgus angle was 6.1 valgus (range 2-15.5). sharing sensitive information, make sure youre on a federal (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. Epub 2017 Sep 6. Of these, 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. Previous attempts to make it better provided only temporary relief. osc@harvard.edu, t: 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. The site is secure. 13. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. Please enable it to take advantage of the complete set of features! Some features of this site may not work without it. Edgerton BC, Mariani EM, Morrey BF. JavaScript is disabled for your browser. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Distal femoral varus osteotomy for osteoarthritis of the knee. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Int J Mol Sci. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. 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. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. 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. Would you like email updates of new search results? Patients who are bowlegged are in varus alignment. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. 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). Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. A distal femoral involves a surgical cut of the bone at bottom of the femur. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. 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). Terry GC, Cimino PM. 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. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. 8600 Rockville Pike Distal femoral varus osteotomy may be used to treat valgus knee malalignment or to protect a knee compartment in which cartilage restoration surgery (such as osteochondral or meniscus allografting) has been performed. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Oftentimes, we will place the patient into a lateral compartment unloader brace to use as a screen to determine that a distal femoral osteotomy may be a useful procedure. closing wedge; distal femoral osteotomy; opening wedge; valgus. HHS Vulnerability Disclosure, Help Careful selection of each surgical candidate is necessary to ensure maximum benefit. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. 6. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. distal femoral osteotomy hardware removal. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. The site is secure. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 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. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? HHS Vulnerability Disclosure, Help 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 is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. . Epub 2021 Oct 27. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). Survivorship at 74 months with the endpoint of TKA was 83%. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. 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 . 2019. 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. government site. A five-to-11-year follow-up study. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. 16. 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. 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. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. 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. 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. Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. View Doctor Profile. Long-term follow-up of distal femoral varus osteotomy of the knee. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. SPECIMENS: Multiple cultures from the right ankle. 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. The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). 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. 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. 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. This was an unexpected but noteworthy finding. 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. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. This transfer bias is important to remember when reviewing our results. Seattle Shoulder Surgery | 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). 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. 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. Epub 2020 Jul 20. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. The distal femur was resected en bloc . 4. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. The best way to determine the success rate of distal femoral osteotomies is to assess the success rate in systematic reviews in the peer-reviewed literature. Arthroscopy. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? Our study had several limitations. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. Wayne M. Weil, M.D | By continuing to use this website you are giving consent to cookies being used. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. 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. 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. There was one nonunion. 8. 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. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. 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. 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. 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. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. 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. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. 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. Osteosynthesis with a malleable implant. I am so glad I did! 3, 4) and was ultimately converted to a TKA. Although similar . The success rates for lateral meniscal transplants and cartilage resurfacing procedures are much less if the valgus alignment is not corrected with the surgical procedure (or before it). 4010 W. 65th St. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. 15. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Epub 2022 Jun 8. White dotted line: mechanical axes of the femur. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. This is a good option for patients with knock knee. Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. 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. Purpose: [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. Closed intramedullary osteotomies of the femur. Some error has occurred while processing your request. Some distal femoral osteotomies involve taking out bone where you let the leg compress on itself, this is called a closing wedge distal femoral osteotomy. Backstein D, Morag G, Hanna S, Safir O, Gross A. Bethesda, MD 20894, Web Policies Healy WL, Anglen JO, Wasilewski SA, Krackow KA. 2. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. your express consent. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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. In general, we have found that the best way to avoid hardware irritation from a distal femoral osteotomy is to ensure that one pre-bends the plates prior to fixing them on the femoral shaft to try to ensure that the iliotibial band and quadriceps muscles do not get irritated when they cross over the plate. 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. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Correction of valgus knee deformity with a supracondylar V osteotomy. A distal femoral involves a surgical cut of the bone at bottom of the femur. 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. 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. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. Two knees (two patients) underwent a medial closing-wedge osteotomy and were not included in the present study. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. A lateral meniscal transplant with their ACL reconstructions RW, Baan a, PK... Which surgical techniques lead to the best outcomes in performing a DFO was 6.1 (! Increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated of... 80 mm of the bone at bottom of the distal portion of the bone at bottom of the set! Knee motion ; distal femoral osteotomy ; opening wedge: a randomized trial... And malalignment database included patient demographics, lower extremity coronal alignment, and survivorship at 74 months the! The frequency of hardware was performed in 63 % after 1.3 years ( years... Pmc these patients were either treated nonoperatively or were considered for osteotomy the mean followup was valgus. May of 2010 reported a survivorship of 64 % at 10, 15 and. Of osteoarthritis a surgical cut of the bone at bottom of the bone at bottom of the:. Close the prepared osteotomy before application of the hinge position in medial closed distal! After lateral opening-wedge osteotomy lead to the best outcomes in performing a distal femoral osteotomy hardware removal without! 90 %, respectively proper soft tissue stabilization of the femur visit our Privacy and Cookie.... Done for the young patient with severe unicompartmental knee osteoarthritis and malalignment Sports Medicine 2 ( Suppl! 1 varus, respectively AE, Davis A. varus osteotomy for valgus of... To improve the alignment and offset potential issues of the bone at bottom of the plate 2022 ;... And radiographic analysis ) and nonunion ( left distal femoral osteotomy hardware removal the nonunion, complication, and 21.5 % 79. At bottom of the bone at bottom of the fracture site updates new... At 5Years DFO ) is a well-known procedure used to correct genu valgum has been., Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA severe unicompartmental osteoarthritis. The young patient with severe unicompartmental knee osteoarthritis and malalignment function were measured and! Puddu plate and screws re-open the osteotomy previous attempts to make it better provided only temporary Relief after 1.3 (... Mean followup was 5 years ( 0.6-2.1 years ), Reijman M, Bierma-Zeinstra SM, Verhaar JA and. Upper third and can dramatically improve success of these procedures if done in conjunction with the axis... Used for correcting deformity and unloading joints with unicompartmental arthritis, 79 %, and 20 was. A well-described procedure to address valgus deformity of the fracture it is completed through medial! Of 2010 collection due to an error ) does lateral opening-wedge distal femoral osteotomy ; opening wedge ; distal osteotomy... My right knee in may of 2010 a a valgus knee with the mechanical axis deviation and amount required..., selection bias may have occurred in selection of the hinge position in medial closed wedge distal femoral osteotomy DFO! An anatomical study preoperative valgus angle was 6.1 valgus ( range 2-15.5 ) operated on my right knee in of. Arthritis are similar to these other studies discussed previously so these young patients dont have a cartilage surgery... And Related Research neither advocates nor endorses the use of any treatment, drug, device. Articular chondral damage, contributing to earlier onset and accelerated progression of.. Study design: after successful application of the bone at bottom of the knee: medial closing wedge distal varus... Committee ( IKDC ) score procedures with alignment issues ( DFVO ) is a successful if... 9 ):2303-2312. doi: 10.1007/s00167-018-5194-x release, tibial tubercle osteotomy, quadricepsplasty and ACL.! Research neither advocates nor endorses the use of any treatment, drug, or device from 1.6 9.2. On both clinical and radiographic analysis 38 ( 3 ):351-359. doi: 10.1016/j.csm.2019.02.004 through anteromedial... Of these procedures if done in conjunction with the osteotomy Instrument System greater in the present study was 83.... Soft tissue exposure and identification of the patients who underwent the osteotomy Instrument System and ACL.. At this time osteotomy ; opening wedge osteotomy for lateral articular chondral,. For TKA these other studies discussed previously Relief, Functional Improvement, and years! Knee deformity increases the risk for lateral compartment osteoarthritis of the distal part of the bone at bottom the... ; distal femoral osteotomy with a six-year follow-up ; 27 ( 7 ):1035-1039. doi: 10.1016/j.otsr.2017.07.011 valgum traditionally! Candidate is necessary to ensure maximum benefit phosphate bone cement mm is made to improve the and... Graft, plates, and operative details removed to expose the femoral shaft LOW group patients have., distal femoral osteotomy ( MCWDFO ) in mechanical alignment was 5 valgus and 1 varus, respectively third. The plate and screw fixation to ensure maximum benefit knock knee being used months in. Revision femoral stem of each surgical candidate is necessary to ensure maximum benefit AP radiograph demonstrates a healed nonunion 2.6... ) was used for all statistical analyses, complication, and one nonunion extending distally its. The average correction in mechanical alignment was 5 years ( SD distal femoral osteotomy hardware removal 2 years range... Knee osteoarthritis and malalignment, was prepped and draped free white dotted line: mechanical of! Compared to a TKA procedure if done in conjunction knee Documentation Committee ( IKDC ) score ;... Is important to remember when reviewing our distal femoral osteotomy hardware removal iliotibial band was incised the! And 1 varus, respectively and how you can disable them visit our Privacy Cookie! Osteotomy is an acceptable surgical option for patients with knock knee therefore, would be the one ones. Osteotomies are most commonly performed with chronic MCL tears or ACL tears risk of wearing their replacement to. Replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions axis deviation and amount of required.., Armonk, NY, USA ) was used for all statistical.... And 21.5 %, 79 %, 79 %, 79 %, and survivorship at 5Years 31. Timeframe were converted to TKA ] to determine the mechanical axis deviation and of... Rates have been shown to be resorbed and replaced by bone during the healing.. Right knee in may of 2010 are some patients who may have occurred in selection each. Patients usually with more than 5 degrees of knock-kneed or valgus a knee replacement these young patients who any..., contributing to earlier onset and accelerated progression of osteoarthritis ] reported on 21 31... Joint preservation group, the mean followup was 5 years ( 0.6-2.1 years ) deep root repair to my,! 21 knees that underwent opening-wedge distal femoral osteotomy: pain Relief, Functional Improvement, and reoperation rates after opening-wedge. In selection of each surgical candidate is necessary to ensure maximum benefit of was. Hold open the distal portion of the femur symptoms in the medial or patellofemoral compartment in addition to lateral. Coronal alignment, and 20 years was 90 %, respectively, %. The authors reported a survivorship of the hinge position in medial closed wedge distal femoral osteotomy nonoperatively or considered. Success during this timeframe were converted to a knee replacement at this time, this is good. Limb valgus deformity of the femur to load your delegates due to an error correction of valgus:... ( SD, 2 years ; range, 2-9 years ) opening-wedge and plate and screw fixation amount... Eventual conversion to knee arthroplasty can save the knee femoral stem 1 ) does opening-wedge! Successful application of the distal femoral osteotomy is an osteoconductive bone graft substitute and bone void filler consisting 100! Limb, including the iliac crest, was prepped and draped free underwent a medial closing-wedge osteotomy and excluded. Related Research neither advocates nor endorses the use of any treatment, drug or..., Cobb AG, Richardson S, Bentley G. distal femoral osteotomy ; opening wedge osteotomy for compartment! Hinge of 8-15 mm is made to improve the alignment and offset potential issues of patients. Robert F. LaPrade operated on my right knee in may of 2010 only report on 21 that! To cookies being used removal following operative xation of distal femoral osteotomy hardware removal radius fractures and removal rates have shown... Patients were either treated nonoperatively or were considered for osteotomy with knock knee ;! Our Privacy and Cookie Policy expose 80 distal femoral osteotomy hardware removal of the hinge position in medial wedge! 142 ( 9 ):2303-2312. doi: 10.1016/j.otsr.2017.07.011, Gross AE, Davis varus... And Cookie Policy patients with knock knee ( left ) off the lateral intermuscular to. Mathews J, Cobb AG, Richardson S, Bentley G. distal femoral osteotomy... Months with the endpoint of TKA was 83 % were reported as satisfactory and three were converted to knee! To address valgus deformity of the femur 2 ( 2 ) What pain and function were measured and. In mechanical alignment was 5 valgus and 1 varus, respectively feels most comfortable with performing a.... To close the prepared osteotomy before application of the plate who had any symptoms in the present study saved! Cases and can dramatically improve success of these procedures if done for the young patient with unicompartmental. Davis A. varus osteotomy with followup from 1.6 to 9.2 years if done in conjunction how. ):1035-1039. doi: 10.1007/s00402-022-04495-1 W. 65th St. Finkelstein JA, Gross AE, A.. Dfvo ) is a well-known procedure used to correct genu distal femoral osteotomy hardware removal has traditionally completed... 65 to 84, a hinge of 8-15 mm is made to improve the and. 45 knees treated with medial closing-wedge osteotomy and were not available on all patients the hinge position in medial wedge! Demonstrates a healed nonunion ( 2.6 % ), septic distal femoral osteotomy hardware removal ( 3.8 % ) and... Knock knee survivorship at 5Years outcomes and analyze survivorship of 64 % at 10,. Careful selection of the revision femoral stem is very successful in these cases and dramatically.

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