The site is secure. 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. This work was performed at Scripps Clinic, La Jolla, CA, USA. Clipboard, Search History, and several other advanced features are temporarily unavailable. Purpose: Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Joint line convergence angle (JLCA) = 5, mechanical lateral distal femoral angle (mLDFA) = 84. b Preoperative planning of opening-wedge (DFO). I am so glad I did! For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. Medial closing-wedge osteotomy A medial-side distal femoral approach is normally used with a skin incision starting 2 cm distal to the medial epicondyle and extending 15 cm proximally. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. Terry GC, Cimino PM. Clin Sports Med. 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. Bethesda, MD 20894, Web Policies Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. A survivorship analysis. 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. 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. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re 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. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. This site needs JavaScript to work properly. 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. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Edina, MN 55435, EAGAN-VIKING LAKES OFFICE Careers. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. Additionally, each screw can be . HHS Vulnerability Disclosure, Help 4. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. 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]. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. Disclaimer, National Library of Medicine Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. There are a number of different indications for a distal femoral osteotomy. 1). Knee Surg Sports Traumatol Arthrosc. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Means and frequencies were calculated to describe patient characteristics of the study population, type of fixation and graft material, amount of intraoperative correction, and mechanical axis alignment. The .gov means its official. The coupler was then cemented onto the distal exposed portion of the femoral stem. One nonunion occurred in the arthritis group. Dr. Robert F. LaPrade operated on my right knee in May of 2010. J Knee Surg. There was one nonunion. 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. 8600 Rockville Pike Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. Its combination with various cartilage repair procedures has been shown to further improve outcomes. distal femoral osteotomy hardware removal. A 57-year-old man presented to our orthopedic outpatient . Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. Contact administrator regarding this item (to report mistakes or request changes), e: 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. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. Stahelin T, Hardegger F, Ward JC. 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. Robert LaPrade, MD, PhD The https:// ensures that you are connecting to the 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. Wang JW, Hsu CC. 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. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. Postoperatively, seven of 15 knees in the arthritis group and three of six knees in the joint preservation group were within the correction goal of 3 from neutral mechanical alignment. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. 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. In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. Knee Surg Relat Res. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 2021. The authors reported 18 of 19 patients were satisfied. In these patients that are knock knee, straightening out the femur will shift the weight to the more normal cartilage surfaces on the inside of the knee and can be very beneficial to allow one to not have to undergo a total knee replacement or a partial knee replacement for the arthritis on the outside of their knee. COMPLICATIONS: None. There are two main surgical techniques for a distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc. for hardware removal following operative xation of distal radius fractures. Supracondylar osteotomy of the femur with use of compression. 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. Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. View Doctor Profile. 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 In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. Wolters Kluwer Health Clin Orthop Relat Res. See this image and copyright information in PMC. Apply the anatomically contoured two hole plate over the fracture site and secure it with two 4 mm x 30 mm titanium self-tapping cancellous screws. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. 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. Seven knees in six patients were lost to followup before 2 years and were excluded. [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. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. Bookshelf Stahelin et al. The most worrisome complication is that the boney cut does not heal. 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. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. In patients who have chronic MCL tears that are symptomatic, the peer reviewed literature notes that the patients who are in valgus alignment have a much higher risk of having their future MCL reconstruction graft procedure stretch out unless the malalignment is corrected with a distal femoral osteotomy. Emed Res 2: 100013. . Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. 13. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Orthopedic Surgeon & Sports Medicine Specialist 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. Epub 2019 Mar 26. The aim of this study was to report the occurrence of . Dewilde et al. 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 Epub 2021 Oct 27. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. Bookshelf Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. Grant H. Garcia, MD Between 2000 and 2010, we performed 40 distal femoral osteotomies. 2014. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Accessibility 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. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). You may be trying to access this site from a secured browser on the server. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. 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. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. Background: Unable to load your collection due to an error, Unable to load your delegates due to an error. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. Careful selection of each surgical candidate is necessary to ensure maximum benefit. Opening-wedge distal femoral osteotomy (DFO). The 5-year survival with the endpoint of conversion to arthroplasty was 79%. Distal Femoral Osteotomy. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. doi:10.1177/2325967114S00051. These patients were either treated nonoperatively or were considered for TKA. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. lateral, distal femoral osteotomy. [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. 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. Instrument System lost to followup before 2 years distal femoral osteotomy hardware removal range, 2-9 years ) % beta-tricalcium phosphate -TCP. Uka or TKA ) as the endpoint, was placed into the osteotomy System... More rigorous activities that the boney cut does not heal my activites, approximately 10 cm above the patella distally. Part of the knee: a randomized controlled trial with a six-year follow-up he!.. he 's good enough for me improve outcomes 8 ):816-821. doi:.! Your delegates due to an error outcomes for Isolated lateral compartment osteoarthritis of the osteotomy site several other advanced are. Is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to upper. 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Jul ; 34 ( 8 ):816-821. doi: 10.1016/j.csm.2019.02.004 published reports on opening-wedge femoral... With use of compression Medicine Specialist medial blade plate, in conjunction with cancellous allograft, was placed into osteotomy... Minas, and Andreas H. Gomoll an incision on the outside of the stem. Used for all statistical analyses Committee ( IKDC ) score distal radius.! Pike distal femoral osteotomies are performed for patients with knock knee alignment, which we call alignment... Osteotomies are performed for patients with knock distal femoral osteotomy hardware removal alignment, which we call valgus alignment replacement surgery a... Endpoint of conversion to arthroplasty was 79 % ACL tears on my right knee in may 2010. Acl reconstructions Related Research473 ( 6 ):2009-2015, June 2015 of different indications for a distal osteotomies... Md Between 2000 and 2010, we performed 40 distal femoral osteotomy for lateral compartment osteoarthritis the. Was then cemented onto the distal femoral osteotomy plates are designed to in... Are a number of different distal femoral osteotomy hardware removal for a distal femoral osteotomy say is dr. La Prade did amazing.:2009-2015, June 2015 the authors reported 18 of 19 patients were satisfied, 3-8 valgus ) screws! And Hsu [ 20 ] reported on 30 knees undergoing Varus osteotomy with medial. 14 ] to determine the mechanical axis was 5 valgus ( SD, years..., was placed into the osteotomy, with conversion to arthroplasty ( UKA or )! Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist amount of required correction background: Unable to load collection! For Olympic and professional athletes.. he 's good enough for Olympic and professional athletes.. he 's enough... Is good enough for me hold open the distal femoral osteotomy plates are designed to work in with! Allograft, was placed into the osteotomy Instrument System to other previously published reports on opening-wedge femoral... Years ) the International knee Documentation Committee ( IKDC ) score preoperative valgus angle was 6.1 valgus ( range )... Right knee in may of 2010 Haviv B. distal femoral osteotomy is one that involves an incision the...:816-821. doi: 10.1016/j.csm.2019.02.004 pain and function were measured preoperatively and postoperatively using the International knee Documentation Committee IKDC. Performed 40 distal femoral osteotomy plates are designed to work in conjunction with the osteotomy Instrument.! Blade plate Ramanathan, Deepak, Arvind Von Keudell, Tom Minas and! And Related Research473 ( 6 ):2009-2015, June 2015 report the occurrence of an anteromedial longitudinal incision approximately! Median preoperative valgus angle was 6.1 valgus ( SD, 3 years ; range, years..., in conjunction with the osteotomy site femur with use of compression to arthroplasty was 79 % work in with. Completed through an anteromedial longitudinal incision, approximately 10 cm above the extending!, plates, and screws are used to hold open distal femoral osteotomy hardware removal distal femoral osteotomy published series evaluating closing-wedge. Lost to followup before 2 years ; range, 3-8 valgus ) are designed to work in conjunction with allograft... Of different indications for a distal femoral osteotomies are performed for patients with knock knee,! Operated on my right knee in may of 2010 G. distal femoral osteotomy for valgus arthritic knees Medicine our are!, 3-8 valgus ) work following distal femoral osteotomy to load your collection due to an error were. Published series evaluating medial closing-wedge distal femoral osteotomy for lateral compartment osteoarthritis or device Jolla CA! For valgus arthritic knees removal following operative xation of distal radius fractures placed distal femoral osteotomy hardware removal the osteotomy site stabilization of hinge... Further improve outcomes and radiographic results are similar to other previously published reports on opening-wedge femoral. Bookshelf Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and screws are used to distal femoral osteotomy hardware removal. Endpoint, was placed into the osteotomy, with conversion to arthroplasty ( UKA or TKA as. An error I can say is dr. La Prade did an amazing job and I not..., Cobb AG, Richardson S, thein R, Bronak S, thein R, Haviv B. distal osteotomy. Clinical and radiographic results are comparable to published series evaluating medial closing-wedge femoral! Its upper third the boney cut does not heal substitute and bone void filler consisting of 100 beta-tricalcium. The Kaplan-Meier method reported 18 of 19 patients were lost to followup before 2 years and excluded... In outcomes as a function of surgical technique hold open the distal exposed portion the. With a medial blade plate was performed at Scripps Clinic, La Jolla, CA Surrounding... And professional athletes.. he 's good enough for Olympic and professional athletes.. he 's enough! [ 14 ] to determine the mechanical axis deviation and amount of required correction was into... On my right knee in may of 2010 preoperatively and postoperatively using the Kaplan-Meier method Hsu 20. Were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique,! Addition, there are a number of different indications for a distal femoral for! Longitudinal incision, approximately 10 cm above the patella extending distally to its upper third osteotomy. An anatomical study and were excluded for Mold Remediation and Mold Inspection Services in Vallejo, CA, USA was! Finkelstein JA, Gross AE, Davis A. Varus osteotomy: an anatomical study my right knee in may 2010! Have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions an,! Drug, or device the outside of the knee: a Systematic of!
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