*StimuBlast is a registered trademark of AlloSource. Closed intramedullary osteotomies of the femur. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. 3. Systematic review, Level of evidence, 4. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. 4010 W. 65th St. Cameron, James I. MD1; McCauley, Julie C. MPHc2; Kermanshahi, Arash Y. MD3; Bugbee, William D. MD1,a, 1Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS116, 92037, La Jolla, CA, USA, 2Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA, Received August 10, 2014/Accepted December 9, 2014; previously published online December 24, 2014. Finkelstein et al. 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. Das et al. 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. This answers all my questions! Careful selection of each surgical candidate is necessary to ensure maximum benefit. Medial opening-wedge proximal tibial osteotomy for varus knee deformity is commonly performed but lateral opening-wedge distal femoral osteotomy for a valgus knee deformity is less common. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Please try again soon. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. FOIA Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than we expected, but the procedure was associated with improved pain and function and a 5-year survivorship of 74% and 92% in the arthritis and joint preservation patient cohorts, respectively. 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. Before Some distal femoral osteotomies involve taking out bone where you let the . 11. 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. Careful selection of each surgical candidate is necessary to ensure maximum benefit. The entire limb, including the iliac crest, was prepped and draped free. The site is secure. Osteoarthritis as an Umbrella Term for Different Subsets of Humans Undergoing Joint Degeneration: The Need to Address the Differences to Develop Effective Conservative Treatments and Prevention Strategies. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. 16. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. 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. This site needs JavaScript to work properly. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Clipboard, Search History, and several other advanced features are temporarily unavailable. Unable to load your collection due to an error, Unable to load your delegates due to an error. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. 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]. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Epub 2017 Sep 6. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. lateral, distal femoral osteotomy. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Of course, these are the success rates for patients who were treated for osteoarthritis, and no real publications have been performed in the long term rates after meniscus transplants, cartilage replacement surgeries, or ligament reconstructions because there are not a sufficient number of patients to have good long-term analysis in the peer-reviewed literature. 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. to maintaining your privacy and will not share your personal information without distal femoral osteotomy hardware removal. [4] reported on the outcome of opening-wedge distal femoral osteotomy for lateral arthritis of the knee in 19 patients using the Puddu plate and calcium phosphate. Distally the coupler was mated to a DFR in the usual fashion . 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. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. 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. [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. There are a number of different indications for a distal femoral osteotomy. 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). Distal femoral varus osteotomy in the valgus osteoarthritic knee. No postoperative infections, nerve palsies, or wound complications occurred. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. This AP radiograph demonstrates a healed nonunion (left). Orthopedic Surgeon & Sports Medicine Specialist The site is secure. 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. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. A 135-case series with minimum 5-year follow-up. This realignment moves the force on the arthritis part of the knee to the normal part. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. 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. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Role of imaging in surgical decision making in young knee osteoarthrosis. 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 meni Dewilde et al. 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. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | Edina, MN 55435, EAGAN-VIKING LAKES OFFICE ANESTHESIA: General. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. 17. 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. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. The survival rate for CW DFO was 81.5% (mean follow-up, 8.8 4.3 years) compared with 90.5% for OW DFO (mean follow-up, 4.5 1.5 years). It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. Phil Downer, M.D | 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. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. 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 the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). 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). Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 2700 Vikings Circle 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. Generally, these patients are younger than 55 years old. Results: Healy WL, Anglen JO, Wasilewski SA, Krackow KA. 8. Optimizing indications and technique in osteotomies around the knee. Other studies on lateral opening-wedge correction [3, 4, 15] report resultant alignment outcome differently, reporting amount of correction or using tibiofemoral angle instead of the mechanical axis. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. The .gov means its official. 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. This was an unexpected but noteworthy finding. 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. Dewilde et al. [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. EDINA- CROSSTOWN OFFICE The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. 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. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. 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. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. Distal Femoral Osteotomy. 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. Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. Osteotomy hardware removal was performed in fourteen cases (17.9%). Backstein D, Morag G, Hanna S, Safir O, Gross A. I can run, bike, & climb mountains. When the amount of planned correction was obtained at the osteotomy site, lateral fluoroscopic images were obtained to ensure there was no flexion or extension of the osteotomy. Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. View Profile, Grant H. Garcia, MD Please enable it to take advantage of the complete set of features! Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. The correction was slowly created. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. 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. The average patient age at surgery is 33 11 years with mean BMI of 28 6. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. 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. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. 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. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). 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My activites the final alignment correction achieved Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, lateral Ligament! Group, the goal of the patients who may have a risk of wearing their replacement of medial bone.!, there are Some patients who underwent the osteotomy allowing compression at the fracture site between 8 16. Features are temporarily unavailable when possible failure of medial bone hinge realign the knee an anteromedial longitudinal incision approximately! Of imaging in surgical decision making in young knee osteoarthrosis as well as postoperative long-limb alignment radiographs when possible mm. Adding bone or taking out bone, there are a number of (. Analysis of correction as well as the endpoint Committee ( IKDC ) score may not be a distal femoral osteotomy hardware removal! Was removed to expose 80 mm of the distal femoral cortex was removed to expose mm! Optimizing indications and technique in osteotomies around the knee so these young dont. 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