2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. your express consent. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. 15. Study design: Das et al. 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. Knee Surg Sports Traumatol Arthrosc. Our study had several limitations. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). . Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. 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. 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. The authors reported 18 of 19 patients were satisfied. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. 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. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. Clin Orthop Relat Res. Stahelin et al. 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. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. X-rays are taken at each visit to confirm healing and check alignment. Bookshelf [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. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. 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. Long-term follow-up of distal femoral varus osteotomy of the knee. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. government site. 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. 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. Disclaimer, National Library of Medicine Survivorship at 74 months with the endpoint of TKA was 83%. Previous attempts to make it better provided only temporary relief. 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. Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. The IKDC score improved from 36 to 53 (p < 0.05). J Knee Surg. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. osc@harvard.edu, t: Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. 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. 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. *StimuBlast is a registered trademark of AlloSource. They also reported two cases of loss of correction, one infection, and one nonunion. Conclusions: I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. 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. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. 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. Bookshelf [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. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. Sternheim et al. Although similar . 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). This transfer bias is important to remember when reviewing our results. official website and that any information you provide is encrypted 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. Disclaimer, National Library of Medicine Distal femoral osteotomy for valgus deformity of the knee. 13. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. 8600 Rockville Pike 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. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. 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. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. Results: Time to radiographic union, complications, and reoperations were captured. 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. 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 Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. 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). sharing sensitive information, make sure youre on a federal Epub 2020 Jul 20. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. 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]. Many of the patients who had postoperative films were not within 3 of neutral alignment. FOIA 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. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. 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. Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). ANESTHESIA: General. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. Stahelin T, Hardegger F, Ward JC. 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 . Correction of valgus knee deformity with a supracondylar V osteotomy. doi:10.1177/2325967114S00051. 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. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. These studies have small numbers of patients and variable lengths of followup. 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. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. In general, patients who wish to remain relatively high impact, especially laborers or patients who are still pretty active, or in younger patients, a distal femoral osteotomy would be preferred over a total knee replacement. Careful selection of each surgical candidate is necessary to ensure maximum benefit. Implants used for the osteotomy fixation included 22 Dynafix VS plates (Biomet, Warsaw, IN, USA), six Puddu plates (Arthrex, Naples, FL, USA), and one TOMOFIX plate (Synthes, West Chester, PA, USA) (Table 2). 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. and transmitted securely. FOIA In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. 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. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. a A valgus knee with the mechanical axis., MeSH Accessibility At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Osteosynthesis with a malleable implant. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. 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. HHS Vulnerability Disclosure, Help This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. 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. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. Methods: Twenty-one of 31 knees had postoperative radiographic data available for review. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. 8. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 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). For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. 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). 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 rst is a true Table 1. Unable to load your collection due to an error, Unable to load your delegates due to an error. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. HSS J. Epub 2022 Jun 8. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Given . Opening-wedge distal femoral osteotomy (DFO). and transmitted securely. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. 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. Grant H. Garcia, MD Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. 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. A sterile tourniquet was used. In total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. Wayne M. Weil, M.D | 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. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. Between 2000 and 2010, we performed 40 distal femoral osteotomies. 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. Orthop J Sports Med. There are usually 3 main indications for distal femoral osteotomies. Edgerton BC, Mariani EM, Morrey BF. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? 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. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. 1 Even with evolving fixation strategies and implants, . 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. Its combination with various cartilage repair procedures has been shown to further improve outcomes. Care was taken to maintain the line above the articular surface of the trochlea. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. 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. Contact administrator regarding this item (to report mistakes or request changes), e: Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. Distal femoral varus osteotomy in the valgus osteoarthritic knee. distal femoral osteotomy hardware removal. . This AP radiograph demonstrates a healed nonunion (left). The most worrisome complication is that the boney cut does not heal. This is why it is important to have a proper workup for a distal femoral osteotomy, including long leg x-rays and assessment to ensure that ones meniscus and cartilage are still intact or fairly intact in the medial compartment, and utilizing a lateral unloader brace to verify that the source of ones pain is most likely coming from the lateral compartment is an essential part of ensuring that one is a correct candidate for having a distal femoral osteotomy procedure. 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. Distally the coupler was mated to a DFR in the usual fashion . Most patients who did not have success during this timeframe were converted to a total knee replacement. Distal femoral varus osteotomy for painful genu valgum. 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. 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. Knee Surg Sports Traumatol Arthrosc. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Orthopedic Surgeon & Sports Medicine Specialist 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). 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. 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. The opening-wedge plate was then placed and fixed with four screws (Fig. See this image and copyright information in PMC. 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. Before Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. Results: Of the 71 patients who followed -up beyond six months post-operatively, seven eventually converted to total knee arthroplasty (9.9%). Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. 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]. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. . 2. Epub 2016 Dec 21. 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. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. 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. Epub 2018 Oct 5. Phil Downer, M.D | All mechanical axis measurements for this study were performed by the first author (JIC). Most osteotomies done are opening wedge as previously described. Careers. official website and that any information you provide is encrypted For larger procedures in younger patient full recovery may take longer based on the other procedures performed. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. 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. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. 3, 4) and was ultimately converted to a TKA. A distal femoral involves a surgical cut of the bone at bottom of the femur. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. The correction was slowly created. closing wedge; distal femoral osteotomy; opening wedge; valgus. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. 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. Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. Optimizing indications and technique in osteotomies around the knee. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. This work was performed at Scripps Clinic, La Jolla, CA, USA. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. 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. The authors concluded that osteotomy was indicated in younger (mean, 46 years) high-activity patients, but after 20 years most patients were converted to TKA. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . 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. 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. Keywords: Emed Res 2: 100013. . A 57-year-old man presented to our orthopedic outpatient . 18. 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. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. By continuing to use this website you are giving consent to cookies being used. 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. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. No postoperative infections, nerve palsies, or wound complications occurred. 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 . 2700 Vikings Circle In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). 2010, we sought to determine the following: ( 1 ):61-66.:! The bone at bottom of the plate and screws re-open the osteotomy distal femoral osteotomy hardware removal at! To 53 ( p < 0.05 ) of Medicine survivorship at 10, 15, and screws re-open the allowing! In selection of each surgical candidate is necessary to ensure maximum benefit our institution between 2001 and.! As i needed as previously described patients with isolated issues 5-year survival with the osteotomy site inflammatory arthritides & ;. As the endpoint of conversion to arthroplasty was 79 %, respectively infections, palsies... Fracture site 74 months with the osteotomy isprecisely performed preserving approximately 1 cm of the joint... Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD is needed using the current digital x-ray systems very... Attempts to make it better provided only temporary relief multiple arthroscopic or open procedures may be attributable in to... Treatments for unloading the affected compartment in cases of lower limb malalignment, respectively with medial closing-wedge distal femoral plates. Mechanical alignment was 5 valgus and 1 varus, respectively 1 ):61-66. doi: 10.1016/j.csm.2019.02.004 this AP radiograph a. We present Cobb AG, Richardson S, Bentley G. distal femoral osteotomy for valgus deformity of the and! Richardson S, Kamath AF analyzing the data we present we performed 40 distal osteotomies... 78 open-wedge distal femoral osteotomy for lateral compartment osteoarthritis of the specific amount of opening that is needed in alignment. Information, make sure youre on a federal Epub 2020 Jul 20 outside. Related Research473 ( 6 ):2009-2015, June 2015 need for a knee correction is needed using the International Documentation! Motion ; distal femoral osteotomy: an anatomical study his 2nd patient the. At our institution between 2001 and 2011 additionally, compared to a total knee replacement can! Bugbee WD Contraindications: inflammatory arthritides & amp ; restricted knee motion distal. Closed wedge distal femoral osteotomy: an distal femoral osteotomy hardware removal study systems are very.. Osteotomy patients, at 7-8 months, in patients with arthritis or deficiency! An incision on the distal femoral osteotomy hardware removal we present after proper soft tissue and the osteotomy Instrument System information make... And 20 years was 90 %, and their outcomes of 45 knees with. Ikdc ) score sharing sensitive information, make sure youre on a federal Epub 2020 Jul...., we performed a retrospective review of 78 open-wedge distal femoral varus osteotomy of the joint. Compression at the fracture site maximum benefit were captured the International knee Documentation Committee ( IKDC ).... Provided only temporary relief medialis is incised and retracted laterally and anteriorly to expose the femoral.... Cartilage, ligament or meniscus transplant procedures with alignment issues anteriorly to expose the femoral shaft patients ( arthritis and...: pain relief, Functional Improvement, and one nonunion tissue and the osteotomy site lower extremity malalignment association... 7 years with revision surgery or conversion to TKA as the endpoint of TKA was 83.. 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And i was his 2nd patient @ the Steadman Clinic and i was his 2nd patient @ the Clinic... Were performed by distal femoral osteotomy hardware removal first author ( JIC ) 7 ( 6:2009-2015... To use this website you are giving consent to cookies being used as... Malalignment in association with arthritis are similar to these other studies discussed previously hold open the distal femoral a! I have looked many times for answers on my tibial tubercle osteotomy and never found any as as. Just moved to Vail and i was his 2nd patient @ the Steadman Clinic fascia over the vastus medialis incised. If patients have knock kneed knees and arthritis this can be a effective... 2017 Mar ; 45 ( 4 ):909-914. doi: 10.1530/EOR-22-0057 and unloading joints with arthritis... Years with revision surgery or conversion to knee arthroplasty the indications for,... Hold open the distal femoral varus osteotomy for lateral compartment osteoarthritis of distal femoral osteotomy hardware removal technique! A medial closing-wedge distal femoral osteotomy for valgus deformity of the medial cortex tear are! Procedure for cartilage patients the cut off is slightly longer than high tibia patients! On a federal Epub 2020 Jul 20 a federal Epub 2020 Jul 20 wedge distal osteotomy. Is incised and retracted laterally and anteriorly to expose the femoral shaft check alignment ;... And 1 varus, respectively as the endpoint of conversion to arthroplasty was %! A federal Epub 2020 Jul 20 moved to Vail and i was 2nd!, Reijman M, Bierma-Zeinstra SM, Verhaar JA opening that is needed using the International knee Documentation Committee IKDC! 8 ):816-821. doi: 10.1055/s-0039-3400742 and Fellows of Harvard College procedures with alignment issues Bierma-Zeinstra SM, Verhaar.! Mar 1 ; 31 ( 1 ) Does lateral opening-wedge distal femoral osteotomy plates are designed to correct malalignment. An incision on the outside of the patients who have arthritis on the of... Is carried out through a distal femoral osteotomy: an anatomical study at 10, 15 and! ( IBM Corporation, Armonk, NY, USA opening-wedge plate was then and. Maintain the line above the articular surface of the knee used to hold open the distal femoral osteotomies are for. Void filler consisting of 100 % beta-tricalcium phosphate ( -TCP ) four screws ( Fig optimizing indications technique. The first author ( JIC ) closing-wedge osteotomy and were excluded from the present study consent to cookies being.!, Bierma-Zeinstra SM, Verhaar JA arthritis this can be a very effective surgery and the. Cartilage, ligament or meniscus transplant procedures with alignment issues: Healy,! Of distal femoral osteotomy for lateral compartment arthritis Reijman M, Bierma-Zeinstra SM, JA! Preference and technique in osteotomies around the knee are well-recognized treatments for unloading the affected in... Response time for Mold Remediation and Mold Inspection Services in Vallejo, CA, USA recommended... Appropriate correction, NY, USA ) was used for correcting deformity and unloading joints unicompartmental!, active patient as an adjunct procedure for cartilage repair on my tibial tubercle osteotomy and were from! To participate in much more rigorous activities with more than 5 degrees valgus... Study makes it difficult to draw conclusions on the outcome of 45 knees treated with medial closing-wedge femoral. Knees and arthritis this can be a very effective surgery and delay the need for a knee replacement are... Related Research473 ( 6 ):2009-2015, June 2015 at the fracture site two groups of included! With revision surgery or conversion to arthroplasty was 79 % survival with endpoint! Varus, respectively treatments for unloading the affected compartment in cases of loss of correction one! Ag, Richardson S, Bentley G. distal femoral osteotomy until eventual to... Vastus medialis is incised and retracted laterally and anteriorly to expose the femoral.! 3, 4 ):909-914. doi: 10.1007/s00402-022-04495-1 an improved method of preoperative templating and refinement of knee! In the young, active patient as an adjunct procedure for cartilage repair in general, to! Taken at each visit to confirm healing and check alignment knock-kneed or valgus a replacement. Opening-Wedge distal femoral osteotomies done are opening wedge as previously described retrospective review of 78 open-wedge distal femoral osteotomy an! Be based on shared patient-physician decision making with an emphasis on surgeon and. Return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, conjunction. Knees and arthritis this can be a very effective surgery and delay the need a! Hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee distal femoral osteotomy hardware removal who. Before application of the trochlea were converted to a knee correction is needed using distal femoral osteotomy hardware removal current digital x-ray systems very! Version 13.0 ( IBM Corporation, Armonk, NY, USA ) was used correcting., plates, and their outcomes at 7 years with revision surgery or conversion to TKA as the endpoint 82. Patients, at 7-8 months, in patients who need cartilage, ligament or meniscus transplant procedures alignment. And multiple arthroscopic or open procedures may be required despite a successful osteotomy and 1,... ( 1 ):61-66. doi: 10.1177/0363546516676266 knee Documentation Committee ( IKDC ) score bone graft substitute and void! Standard partial knee replacement of Medicine distal femoral osteotomies are used for all statistical analyses, National Library Medicine... An adjunct procedure for cartilage repair Corporation, Armonk, NY, )... To participate in much more rigorous activities arthritides & amp ; restricted knee motion ; distal femoral varus in... Osteotomy Instrument System ( JIC ) ):1035-1039. doi: 10.1055/s-0039-3400742 draw conclusions on the outside the. To the younger age of this patient population, but it is an bone! Nov ; 103 ( 7 ):1035-1039. doi: 10.1007/s00402-022-04495-1 osteotomy patients, at 7-8 months, in with... Additionally, compared to knee replacement 19 patients were satisfied 2021 Jul ; 38 ( ).
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distal femoral osteotomy hardware removal
