Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Epub 2017 Sep 6. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. 13. Download Citation | Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures | Background: A locking compression plate (LCP . 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. 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. An official website of the United States government. This website uses cookies. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. 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. The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). 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. In fact 2 years ago I finished climbing the top 100 peaks in CO. These are the lateral opening wedge osteotomy, whereby a bone wedge is placed into the outside portion of the femur to change the alignment or a closing wedge medial distal femoral osteotomy, whereby a bone wedge is taken out and the bone is collapsed down to change the alignment. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. 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. your express consent. 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%]). 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. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. 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. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. osc@harvard.edu, t: 2700 Vikings Circle 2021 Oct;29(10):3299-3309. doi: 10.1007/s00167-020-06166-3. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. 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. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). In a simplified technique, an opening wedge osteotomy is performed originating from the distal femoral diaphyseal-metaphyseal flare, avoiding surgical exposure to the medial side of the distal femoral region. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. Terry GC, Cimino PM. Bethesda, MD 20894, Web Policies Phil Downer, M.D | 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 ~. The site is secure. 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. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. EDINA- CROSSTOWN OFFICE This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. 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). Some distal femoral osteotomies involve taking out bone where you let the leg compress on itself, this is called a closing wedge distal femoral osteotomy. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. Our study had several limitations. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Correction of valgus knee deformity with a supracondylar V osteotomy. Broken hardware and screws were removed. Closed intramedullary osteotomies of the femur. The indications for osteotomy included symptomatic lateral compartment arthritis with clinical valgus deformity or a cartilage or meniscal defect in the lateral compartment with clinical valgus alignment. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. distal femoral osteotomy hardware removal. Wolters Kluwer Health Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Osteosynthesis with a malleable implant. Distally the coupler was mated to a DFR in the usual fashion . The most worrisome complication is that the boney cut does not heal. Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Sternheim et al. 3, 4) and was ultimately converted to a TKA. The site is secure. 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. Saithna et al. +1 (617) 495 4089. The opening-wedge plate was then placed and fixed with four screws (Fig. 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. Pain requiring hardware removal was the most common complication in both techniques, while long-term survivability was found to be a function of follow-up and not surgical technique. Stahelin T, Hardegger F, Ward JC. Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. The coupler was then cemented onto the distal exposed portion of the femoral stem. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. COMPLICATIONS: None. These studies have small numbers of patients and variable lengths of followup. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). 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. Please enable it to take advantage of the complete set of features! The patients who underwent a TKA were female (age, 26 and 40.1 years; BMI, 30.5 and 30.7, respectively) and received these procedures 2.4 and 3.2 years after their DFVO because . 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. a A valgus knee with the mechanical axis., MeSH 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 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]. sharing sensitive information, make sure youre on a federal ANESTHESIA: General. Before Concurrent with this, a plate and screws are placed on the outside of the knee and bone graft is placed into the opening wedge which is created to assist with healing of the gap. FOIA Clin Sports Med. 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. Book an appointment today! Eur J Radiol Open. Its combination with various cartilage repair procedures has been shown to further improve outcomes. 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. Knee Surg Relat Res. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. A survivorship analysis. View Profile, Grant H. Garcia, MD The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. Postoperative management included touchdown weightbearing for 6 weeks with no limits to ROM followed by 4 to 6 weeks of progressive weightbearing with the use of crutches. Twenty-one of 31 knees had postoperative radiographic data available for review. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. 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. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. 8. Pain requiring hardware removal was the most commonly reported complication in both groups. Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. Given . We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. 5. Epub 2019 Mar 26. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. 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. In total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. 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).