Int J Mol Sci. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. 3. Patients with a cartilage defect in the lateral compartment who also had medial knee pain were also not deemed candidates for the osteotomy. 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. A survivorship analysis. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. Care was taken to maintain the line above the articular surface of the trochlea. 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. Epub 2014 Dec 24. 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. 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. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). 11. Distal Femoral Osteotomy vlog: Hardware removal - YouTube Last vlog!My blog: https://orbite-beast.tumblr.com/ Last vlog!My blog: https://orbite-beast.tumblr.com/. The authors reported 18 of 19 patients were satisfied. a A valgus knee with the mechanical axis., MeSH Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. It is our goal to provide the highest level of care and service to our patients. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. The opening-wedge plate was then placed and fixed with four screws (Fig. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. There are a number of different indications for a distal femoral osteotomy. Systematic review, Level of evidence, 4. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. Time to radiographic union, complications, and reoperations were recorded. 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. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. Broken hardware and screws were removed. FOIA EFORT Open Rev. 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. 17. Epub 2019 Nov 27. 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. The average patient age at surgery is 33 11 years with mean BMI of 28 6. Clipboard, Search History, and several other advanced features are temporarily unavailable. I am so glad I did! The small number of patients included in this study makes it difficult to draw conclusions on the data we present. Improvements in the IKDC scores were noted postoperatively. 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. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. [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. [7] reported on 21 knees in 20 patients with a mean 11-year followup. Clipboard, Search History, and several other advanced features are temporarily unavailable. Time to radiographic union, complications, and reoperations were captured. This transfer bias is important to remember when reviewing our results. Your message has been successfully sent to your colleague. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. Late recurrence of varus deformity after proximal tibial osteotomy. 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. Otherwise, there is a risk that the hinge on the inside part of the knee could crack or the screws could break because too much weight is being placed on them from relying on the plate and screws to hold the fracture apart rather than allowing the bone to heal. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. These braces help push the weight towards the inside of the knee, and by doing so, they can help serve as an excellent screen to determine if a patient would benefit from a distal femoral osteotomy. Call Us Today (888) 260-0449 Knee Surg Sports Traumatol Arthrosc. Preoperatively, all patients underwent complete radiographic evaluation including full-length, standing AP radiographs of bilateral lower extremities (some radiographs were done at outside institutions and were not available for alignment measurements for this study). HSS J. Please enable scripts and reload this page. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. Its combination with various cartilage repair procedures has been shown to further improve outcomes. In general, patients who smoke are not candidates for a distal femoral osteotomy because bone does not heal very well in smokers and this would generally be a contraindicated surgical procedure in this circumstance. 15. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. View Doctor Profile. Sternheim et al. 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 most common type of distal femoral osteotomy is one that involves an incision on the outside of 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. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). 4. Its combination with various cartilage repair procedures has been shown to further improve outcomes. to maintaining your privacy and will not share your personal information without 16. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. The .gov means its official. 6. 19. The site is secure. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? 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. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Future studies with more patients and longer followup will provide clarity on this topic. There was one nonunion. A distal femoral involves a surgical cut of the bone at bottom of the femur. This AP radiograph demonstrates a healed nonunion (left). This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. . Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. 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. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. Please enable it to take advantage of the complete set of features! I was hit by a car on my bicycle near Horsetooth Reservoir in CO. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. 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. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. TOURNIQUET TIME: 40 minutes. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. 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