Future studies with more patients and longer followup will provide clarity on this topic. 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. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! 15. 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 . In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). Osteotomy hardware removal was performed in fourteen cases (17.9%). Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. The .gov means its official. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. Its combination with various cartilage repair procedures has been shown to further improve outcomes. This is what this term means. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. 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. Joint preservation patients satisfied the criteria for osteotomy as described but were younger patients with a mean age of 26 years and were motivated to maintain an active lifestyle. 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. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Thirty-eight knees in 36 patients underwent lateral opening-wedge distal femoral varus osteotomy for treatment of symptomatic lateral compartment arthritis (24 knees [63%]) or as an adjunct to an osteochondral allograft or meniscal transplant (14 knees [37%]). Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. 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. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. Data is temporarily unavailable. 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. 2700 Vikings Circle Phil Downer, M.D | Distal Femoral Osteotomy. However, as a result of the small sample size, it was not appropriate to test the change from preoperatively to followup statistically; thus, no p value is given. Knee Surg Sports Traumatol Arthrosc. 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. This realignment moves the force on the arthritis part of the knee to the normal part. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. 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. Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. Epub 2014 Dec 24. 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. 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. All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. +1 (617) 495 4089. 16. Keywords: The small number of patients included in this study makes it difficult to draw conclusions on the data we present. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. 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. Additionally, each screw can be pivoted within the plate's mobile bushing system to . 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. Careers. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. 2). Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. 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%]). In general, one should be between the ages of 16 (with closed growth plates) and a roughly upper age of 55 to benefit from a distal femoral osteotomy. 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 Stahelin T, Hardegger F, Ward JC. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). Limb alignment was checked fluoroscopically and clinically. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. 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. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. distal femoral osteotomy hardware removal. Aglietti P, Menchetti PP. After fluoroscopic confirmation of correct guide pin placement, an osteotomy was performed using an oscillating saw and sharp osteotomies, taking care to maintain approximately 1 cm of medial bone bridge for osteotomy stability. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. Opening-wedge distal femoral osteotomy (DFO). 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. The https:// ensures that you are connecting to the 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. Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. 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. 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. The https:// ensures that you are connecting to the After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. 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. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. This is a good option for patients with knock knee. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. Arthroscopy. Many of the patients who had postoperative films were not within 3 of neutral alignment. 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. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. and transmitted securely. I am so glad I did! Disclaimer, National Library of Medicine The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). 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. Joint line convergence angle (JLCA) = 5, mechanical lateral distal femoral angle (mLDFA) = 84. b Preoperative planning of opening-wedge (DFO). JavaScript is disabled for your browser. 17. There was one nonunion. After surgery patients are non-weight bearing for 6 weeks. White continuous lines: femur and tibia joint line. 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. Indications and Contraindications Indications Moderate corrections up to 10 degrees for opening wedge Larger corrections from 12 to 27 degrees for closing wedge Lateral compartment mild to moderate osteoarthritis Lateral condyle cartilage lesions (with or without cartilage restoration) Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. 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. Broken hardware and screws were removed. 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. 'S good enough for Olympic and professional athletes.. he 's good enough for me re-open. Bugbee WD say is Dr. La Prade had just moved to Vail and I am not limited in any my. The healing process the mean followup was 4 years ( SD, years. 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Number of patients included in this study makes it difficult to draw conclusions the!