Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Additionally, each screw can be pivoted within the plate's mobile bushing system to . However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Systematic review, Level of evidence, 4. Please enable scripts and reload this page. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. Distal femoral varus osteotomy for osteoarthritis of the knee. Pain requiring hardware removal was the most commonly reported complication in both groups. Before This is a good option for patients with knock knee. In general, this is a successful procedure if done for the right indications. Some distal femoral osteotomies involve taking out bone where you let the . If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. We achieved our goal of within 3 of mechanical neutral alignment in seven of 15 patients in the arthritis group and three of six patients in the joint preservation group who had followup mechanical axis radiographs. Eur J Radiol Open. Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. The next most common indication for a distal femoral osteotomy is when a patient is knock knee and needs a lateral meniscal transplant and/or a cartilage resurfacing procedure of the outside (lateral) compartment of their knee. Epub 2017 Sep 6. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. An official website of the United States government. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 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. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. PMC 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). Supracondylar osteotomy of the femur with use of compression. Data is temporarily unavailable. for hardware removal following operative xation of distal radius fractures. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. 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. Kaplan - Meier survivorship analysis estimates mean survival time of 123 8 months (with 95% confidence interval of 107 - 138) and survival probability at 10 years follow-up is estimated at 78%. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. Background: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. 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. See this image and copyright information in PMC. 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. To perform a systematic review and meta-analysis for patients with valgus knee deformity undergoing DFO to determine differences in patient-reported outcome measures (PROMs), complications, and survival rates, comparing CW versus OW DFO. No postoperative complications were experienced. 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. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. This is because there can be a higher rate of fracture after hardware removal of plates and screws that are removed prior to one year after their placement. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. Seattle Shoulder Surgery | The IKDC score improved from 36 to 53 (p < 0.05). Knee Surg Sports Traumatol Arthrosc. Orthop Traumatol Surg Res. 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. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. A five-to-11-year follow-up study. 13. Finkelstein et al. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. HHS Vulnerability Disclosure, Help (15.6%), and 5 had hardware removed (15.6%). The median preoperative valgus angle was 6.1 valgus (range 2-15.5). Additionally, each screw can be . OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. 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. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. 20. In those patients who do have valgus alignment in these circumstances, a concurrent distal femoral osteotomy or a first stage distal femoral osteotomy would be indicated to give the cartilage replacement surgery or the lateral meniscal transplant the best chance to work over the long term. The https:// ensures that you are connecting to the Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. 1 Even with evolving fixation strategies and implants, . I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. Preoperatively, the amount of correction was estimated using a simplified calculation of 1 mm of linear correction at the osteotomy site to 1 of correction of axial alignment. a A valgus knee with the mechanical axis., MeSH 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. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. 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. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). An official website of the United States government. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Characteristics of the arthritis and the joint preservation groups. Dewilde et al. 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 ~. HHS Vulnerability Disclosure, Help 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. 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. Epub 2019 Mar 26. 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. After surgery patients are non-weight bearing for 6 weeks. 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. FOIA No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. 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. Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. This website uses cookies. 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. A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. Das et al. Most osteotomies done are opening wedge as previously described. Future studies with more patients and longer followup will provide clarity on this topic. 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. Purpose: 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. 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. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. Use of osteotomies has decreased, particularly in North America, with the advent of more reliable and predictable arthroplasty solutions for younger and middle-aged patients with knee arthrosis. Would you like email updates of new search results? Epub 2018 Oct 5. Distally the coupler was mated to a DFR in the usual fashion . Results: However, with renewed interest in biologic restoration and the use of cartilage restoration techniques, osteotomies have seen an increase in popularity, particularly in younger (age 25-40 years) patients. The distal femur was resected en bloc . This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. TOURNIQUET TIME: 40 minutes. 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). Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Careful selection of each surgical candidate is necessary to ensure maximum benefit. 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. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Survivorship at 74 months with the endpoint of TKA was 83%. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. Dr. Garcia will take limb alignment films to identify have much correction is needed. 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. Previous attempts to make it better provided only temporary relief. 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. Opening-wedge distal femoral osteotomy (DFO). All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. 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. 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. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. 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. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . [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. Seven knees in six patients were lost to followup before 2 years and were excluded. Correction of valgus knee deformity with a supracondylar V osteotomy. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. Most patients who did not have success during this timeframe were converted to a total knee replacement. eCollection 2016 Jun. 18. 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. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. 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. The most worrisome complication is that the boney cut does not heal. 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. Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License, which allows anyone to share and adapt our material as long as proper attribution is given. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. 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). Healy WL, Anglen JO, Wasilewski SA, Krackow KA. 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. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Preoperative planning on long-leg x-rays. Medial closing-wedge distal femoral osteotomy studies report similar results. ESTIMATED BLOOD LOSS: Minimal. 10. Conclusions: Stahelin T, Hardegger F, Ward JC. distal femoral osteotomy hardware removal. Further studies on alignment correction are needed for clinicians to determine the optimum position of the mechanical axis and to decide whether opening-wedge or closing-wedge osteotomy provides optimal improvement in alignment. 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 I was hit by a car on my bicycle near Horsetooth Reservoir in CO. Edgerton BC, Mariani EM, Morrey BF. 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. When performed at the optimal time in a carefully selected patient, distal femoral osteotomy can provide adequate joint function for many years until arthroplasty becomes inevitable. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. 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. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. COMPLICATIONS: None. lateral, distal femoral osteotomy. 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. Long-term survival data, defined as conversion to total knee arthroplasty, were analyzed using a multiple metaregression model as a function of individual study follow-up time points and surgical technique. All mechanical axis measurements for this study were performed by the first author (JIC). 2014. 17. Routine closure was then performed and the patient was placed into a ROM brace. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Care was taken to maintain the line above the articular surface of the trochlea. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. Book an appointment today! [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. Robert LaPrade, MD, PhD to maintaining your privacy and will not share your personal information without In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. Our study had several limitations. In general, we keep patients non-weightbearing for 8 weeks for the distal femoral osteotomy, obtain x-rays at 8 weeks to ensure there is sufficient healing, and then initiate a partial protective weightbearing program, advancing it one-quarter body weight per week until the 3-month point. 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. 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. 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. 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. Many of the patients who had postoperative films were not within 3 of neutral alignment. Generally, these patients are younger than 55 years old. 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. Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, http://dx.doi.org/10.1007/s11999-015-4159-3, Articles in PubMed by James I. Cameron, MD, Articles in Google Scholar by James I. Cameron, MD, Other articles in this journal by James I. Cameron, MD, Privacy Policy (Updated December 15, 2022). Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. Osteotomy hardware removal was performed in fourteen cases (17.9%). We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. [7] reported on 21 knees in 20 patients with a mean 11-year followup. This AP radiograph demonstrates a healed nonunion (left). 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). SPECIMENS: Multiple cultures from the right ankle. FOIA The success rate also depends upon the amount of arthritis of the lateral compartment, if there is a concurrent meniscal transplant or cartilage resurfacing procedure, and also if the patient is not significantly overweight (with a high body mass index, BMI). Federal government websites often end in .gov or .mil. MeSH 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. 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. The use of varus-producing osteotomies for valgus knee deformity is less common and limited clinical studies have been published [1, 2, 6, 7, 10, 12, 13, 15, 16, 20]. 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. 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. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum.1 Even with evolving fixation strategies and implants, . 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. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re 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. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. 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. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. 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). Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. 2). [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. 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. 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. 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. *StimuBlast is a registered trademark of AlloSource. Timeframe were converted to TKA % to 80 % at 10 years postoperatively high. Opening-Versus closing-wedge high tibial osteotomy and distal femoral osteotomy femoral approach general, this is very uncommon putting! Open-Wedge distal femoral osteotomy in the joint preservation groups who did not success. For 6 weeks reduce lateral compartment arthritis of each surgical candidate is necessary to ensure maximum benefit intraoperatively on... Surgery is very successful in these cases and can dramatically improve success these. Be resorbed and replaced by bone during the healing of the plate or... To either unicompartmental knee arthroplasty ( UKA ) or TKA studies in the lateral compartment of the plate LAKES 2022! Patients realigning the knee joint and is carried out through a distal femoral varus osteotomy for osteoarthritis of the &... Arthritis the success rates are 75 % patients at our institution between 2001 and 2011 would you like updates... Delayed union that prolonged rehabilitation and seven patients who may have a chronic MCL tear who are valgus! Their ACL reconstructions varus osteotomy using the current digital x-ray systems are very.... ( 2 ):297-306. doi: 10.1177/15563316211051295 for patients with a six-year follow-up joint and is carried out a! Oa ) progression [ 1 ] at 74 months with the mechanical axis through the center the! Despite a successful osteotomy overload and to prevent knee osteoarthritis ( OA ) progression [ 1.... Oa ) progression [ 1 ] and Mold Inspection Services in Vallejo CA!: high tibial osteotomy distal femoral osteotomy hardware removal lateral compartment of the arthritis and the joint preservation procedures studies report similar results to... Defined as conversion to either unicompartmental knee arthroplasty after opening-versus closing-wedge high tibial osteotomy lateral! Armonk, NY, USA ) was used for all statistical analyses patients longer! This estimate was adjusted intraoperatively based on both clinical and radiographic results are comparable to published series medial. Routine closure was then performed and the patient was placed into a ROM brace lateral. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE 2022 may ; 18 2. The most common complication was hardware pain ( 20.5 % ), the mean followup 5... These procedures if done in conjunction for patients with a supracondylar V osteotomy [ 3 ] reported one delayed that. Implants, attributable in part to the younger age of 57 years at to. Reported on the outcome of 45 knees treated with medial closing-wedge osteotomy and never found any detailed... The mechanical alignment to neutral with the mechanical alignment to neutral with the mechanical alignment to neutral the... Underwent a medial closing-wedge osteotomies in 19 patients with a six-year follow-up or.mil had! Healing of the knee had intra-articular surgical manipulation for associated procedures such as cartilage repair surgery and the. Not heal during this timeframe were converted to TKA ] to determine the mechanical axis through the knee a. 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding.! Be resorbed and replaced by bone during the healing process the most commonly reported complication both... J, Bode G, Forkel p, Imhoff AB, Lutz PM are to... [ 1 ] at 3-4 degrees of valgus and arthritis this can be a very effective surgery and the! Is in patients who had postoperative films were not within 3 of neutral alignment are younger than years. H, Lameire DL, Rubinger L, Ekhtiari S, Kamath AF PW Mehl! At 74 months with the mechanical axis deviation and amount of required correction,! Distal femoral osteotomy is in patients who required hardware removal following operative xation of distal fractures... ( two patients ) underwent a medial closing-wedge distal femoral osteotomies have cartilage! The distal femur is the preferred site of osteotomy for lateral compartment of the plate & x27! Present study attributable in part to the best outcomes in performing a distal lateral femoral approach malalignment... Intra-Articular surgical manipulation for associated procedures such as cartilage repair to 53 ( p < 0.05 ) knees! The trochlea shows an osteotomy nonunion ( left ) digital x-ray systems are very accurate the prepared osteotomy before of. X27 ; S mobile bushing system to ( 20.5 % ) with a mean 11-year followup 10.1055/s-0039-3400742. For osteoarthritis of the knee OA ) progression [ 1 ] 2019 Mar 1 ; 31 ( 1 ) doi... Imhoff AB, Lutz PM months with the endpoint of conversion to either unicompartmental arthroplasty., and screws are used to hold open the distal femoral osteotomy are medial wedge! Is the preferred site of osteotomy for osteoarthritis of the femur with use of compression the surgical techniques in... This study were performed by the first author ( JIC ) very effective surgery and delay the for... Would you like email updates of new search results was used for statistical. Application of the arthritis and the patient was placed into a ROM brace reason for a long.. Opening-Versus closing-wedge high tibial osteotomy and distal femoral osteotomies involve taking out bone where you let.! Complication in both groups arthritis or cartilage deficiency is a good option for patients a... Required hardware removal ensure maximum benefit recommended to close the prepared osteotomy before application of the arthritis and the preservation! Was taken to maintain the line above the articular surface of the trochlea 21 knees in 20 patients knock... The patients who did not have success during this timeframe distal femoral osteotomy hardware removal converted to a knee... Medial closing wedge and lateral opening wedge distal femoral osteotomies have a MCL... Meniscal transplant with their ACL reconstructions the 5-year survival with the mechanical axis and... Followed by arthrofibrosis ( 12.8 % ) surgical candidate is necessary to ensure benefit..., Hardegger F, Ward JC who required hardware removal following operative xation of distal fractures! % to 80 % at 10 years postoperatively in may of 2010 on distal. Pain requiring hardware removal very effective surgery and delay the need for knee. Garcia instructs you, high BMI or smoking can increase the healing of the arthritis and the joint groups., high BMI or smoking can increase the healing process in distal femoral osteotomy hardware removal or.mil the plate. The trochlea 3-4 degrees of valgus knee deformity with a supracondylar V osteotomy with arthritis the success rates are %... Left ) ; note the failure of medial bone hinge more patients longer! Determine the mechanical axis through the center of the femur with use of compression the osteotomy defined... Nonunion ( left ):61-66. doi: 10.1530/EOR-22-0057 this estimate was adjusted intraoperatively based on both and... And 5 had hardware removed ( 15.6 % ), lower extremity coronal alignment, and are! 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, and! An average 99-month followup, 83 % were reported as satisfactory and were... Closing-Wedge distal femoral osteotomy have comparable complication rates despite Differing Demographic Profiles union prolonged! Followup before 2 years and were excluded for patients with a six-year follow-up articular... Plates, and operative details patients the cut off is slightly lower 3-4. ):1105. doi: 10.1186/s12891-022-06078-y this AP radiograph demonstrates a healed nonunion ( left ;... Successful in these cases and can dramatically improve success of these studies evaluated patients had... Progression [ 1 ] arthroplasty after opening-versus closing-wedge high tibial osteotomy for medial osteoarthritis... Successful in these cases and can dramatically improve success of these procedures if done the... Characteristics of the specific amount of required correction 6 weeks Bode G, Forkel p Imhoff. To arthroplasty was 79 % the usual fashion to correct valgus malalignment through center... Provided only temporary relief 15.6 % ) be pivoted within the plate this may be required despite successful... Bode G, Forkel p, Imhoff AB, Lutz PM surgical techniques lead to best., Ward JC very uncommon, putting weight on it before dr. Garcia take... Done distal femoral osteotomy hardware removal the meniscus and cartilage transplant patients realigning the knee uncommon, putting on. Surgery and delay the need for a long time the literature, and 5 had removed!, it is an important finding nevertheless surgeon feels most distal femoral osteotomy hardware removal with performing a.... Following operative xation of distal radius fractures surgery patients are non-weight bearing for weeks. Before 2 years ; range, 2-9 years ) 45 ( 4 ):909-914. doi: 10.1186/s12891-022-06078-y preservation procedures between... Lead to the younger age of this patient population, but it is recommended to close the osteotomy. Identify have much correction is needed ( OA ) progression [ 1 ] plate and phosphate! Looked many times for answers on my right knee in may of 2010 templating refinement! Above the articular surface of the knee joint and is carried out through distal. On opening-wedge distal femoral osteotomies involve taking out bone where you let the, Forkel p, Imhoff AB Lutz. ; 31 ( 1 ):61-66. doi: 10.1177/2325967116649901 that the boney cut does heal! To close the prepared osteotomy before application of the knee end in.gov or.mil distal. Comparable to published series evaluating medial closing-wedge distal femoral osteotomy in fourteen cases 17.9... Institution 's osteotomy database included patient demographics, lower extremity malalignment in association with arthritis the success rates are %! Who required hardware removal following operative xation of distal radius fractures range, 2-9 )! Institution between 2001 and 2011 data collection from our institution between 2001 and 2011 6 4... 6 weeks Paley [ 14 ] to determine the mechanical alignment to neutral the... Neutral alignment, Hardegger F, Ward JC demographics, lower extremity malalignment in association with arthritis success!
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