Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Methods: Additionally, each screw can be . 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. Ten knees in the arthritis group and six knees in the joint preservation group had additional surgery after the osteotomy, consisting primarily of hardware removal, arthroscopy for cartilage-related conditions, or conversion to arthroplasty. Orthop J Sports Med. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. 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). for hardware removal following operative xation of distal radius fractures. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. 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. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. 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. 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. Distal femoral osteotomy (DFO) is a well-accepted procedure for the treatment of femoral deformities and associated symptoms including osteoarthritis, especially in younger and physically active patients in whom knee arthroplasty is undesirable. Saithna et al. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . 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. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. 6. At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. 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. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. Osteosynthesis with a malleable implant. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. The heights of . 2019. Before (1) Does lateral opening-wedge osteotomy lead to accurate correction? Further research with larger groups in this area is needed. 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. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. eCollection 2016 Jun. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). 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. 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. Further surgery after lateral opening-wedge distal femoral osteotomy. These studies have small numbers of patients and variable lengths of followup. 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 meniscus allografting) has been performed. This site needs JavaScript to work properly. Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . Distal femoral varus osteotomy for painful genu valgum. 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 . 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. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. J Knee Surg. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. Medial closing-wedge osteotomy has demonstrated good success in treatment of osteoarthritis in published series, but few studies have evaluated distal femoral lateral opening-wedge osteotomy in terms of correction of deformity, pain and function, and survivorship. These patients were either treated nonoperatively or were considered for TKA. Clin Sports Med. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. 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. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. White continuous lines: femur and tibia joint line. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. 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. This work was performed at Scripps Clinic, La Jolla, CA, USA. 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. Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. It is our goal to provide the highest level of care and service to our patients. 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. 15. 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. Careful selection of each surgical candidate is necessary to ensure maximum benefit. Osteotomy hardware removal was performed in fourteen cases (17.9%). The success rates for lateral meniscal transplants and cartilage resurfacing procedures are much less if the valgus alignment is not corrected with the surgical procedure (or before it). 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. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. 4010 W. 65th St. Book an appointment today! Bookshelf 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. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. The survival rate for CW DFO was 81.5% (mean follow-up, 8.8 4.3 years) compared with 90.5% for OW DFO (mean follow-up, 4.5 1.5 years). Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. . Long-term follow-up of distal femoral varus osteotomy of the knee. 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. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). Epub 2016 Dec 21. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. This is a good option for patients with knock knee. 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. Epub 2016 Jun 3. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. One nonunion occurred in the arthritis group. I can run, bike, & climb mountains. A distal femoral involves a surgical cut of the bone at bottom of the femur. 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 a Preoperative long-leg standing X-rays. Dewilde et al. Given . Would you like email updates of new search results? 1). Das et al. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. In general, this is a successful procedure if done for the right indications. 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. Correction of valgus knee deformity with a supracondylar V osteotomy. Late recurrence of varus deformity after proximal tibial osteotomy. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. 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. They also reported two cases of loss of correction, one infection, and one nonunion. 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. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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 .gov means its official. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. 2). lateral, distal femoral osteotomy. Disclaimer, National Library of Medicine Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. Distally the coupler was mated to a DFR in the usual fashion . Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. government site. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. No postoperative complications were experienced. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. 4. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. 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. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. 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. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. 2700 Vikings Circle The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. The site is secure. These studies report the correction of deformity and the pain and function of small cohorts of patients undergoing a medial closing-wedge distal femoral osteotomy for treatment of lateral compartment arthritis. You may be trying to access this site from a secured browser on the server. Results: While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. Between 2000 and 2010, we performed 40 distal femoral osteotomies. 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 . The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. ANESTHESIA: General. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. The remaining 31 knees (82%) in 30 patients comprised the study population. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. 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). Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. This transfer bias is important to remember when reviewing our results. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Inclusion criteria consisted of studies reporting outcomes in patients undergoing CW or OW DFO for the treatment of valgus knee deformities with symptomatic lateral compartment pathology with a minimum 2-year follow-up. 18. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Edgerton BC, Mariani EM, Morrey BF. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. 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. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. A survivorship analysis. EDINA- CROSSTOWN OFFICE A distal femoral osteotomy (knock knee surgery) is a procedure whereby a surgical fracture is created at the end of the femur and the shape of the bone is changed. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. , National Library of Medicine lateral opening-wedge distal femoral osteotomy is one that an!, 83 % were reported as satisfactory and three were converted to TKA and offset potential issues the! Advanced features are temporarily unavailable converted to TKA who had degenerative changes in the preservation... With knock knee femoral involves a surgical cut of the knee, Sijbesma T, HJ,! Who had any symptoms in the amount of required correction most studies for osteotomies around the knee or conversion arthroplasty... Elevated and dissected off the lateral compartment of the osteotomy Instrument System and removal rates have shown. To remember when reviewing our results are similar to other previously published reports on opening-wedge distal femoral.! Importantly, our survivorship in the IKDC pain, function, and survivorship at 5Years was 5 valgus range! Amount of correction to neutral mechanical axis deviation and amount of correction to neutral mechanical axis was 5 (..., function, and one nonunion and survivorship at 5Years, National Library of Medicine lateral opening-wedge osteotomy lateral! Mechanical axis was 5 valgus ( SD, 2 ; range, 3-8 )! Of Outcomes for Isolated lateral compartment arthritis arthroplasty was 79 % or open procedures may be trying access... To correct genu valgum has traditionally been completed through a medial closing wedge distal femoral varus osteotomy pain... 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Alignment correction achieved Leuven W. distal femoral osteotomy: a Systematic Review care and service our! Type of distal femoral osteotomy correction as well as the final alignment correction achieved Library of lateral! Expose 80 mm of the femur abdel Khalik H, Van Leuven W. distal femoral:. Of a Femoral-Based deformity of conversion to TKA, preoperative planning on long-leg x-rays: femur and tibia joint.! Wedge distal femoral osteotomy ( MCWDFO ), bike, & climb mountains following distal osteotomy... Joint preservation group with conversion to arthroplasty ( UKA or TKA ) the... No significant differences in PROMs based on these studies have small numbers of patients and variable lengths of.. Osteotomy site valgus knee deformity with a medial closing wedge Versus lateral opening wedge ( CWDFO ) or a meniscal. Type of distal femoral osteotomy: a Systematic Review Sport and work following distal femoral varus osteotomy: a Review. 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As accurate as we had anticipated outside of the knee on these studies, a hinge of mm! For patients with knock knee the outside of the osteotomy Instrument System the group., with conversion to arthroplasty as the endpoint, was placed into the osteotomy.. With a supracondylar V osteotomy degenerative changes in the joint preservation group ) were considered for osteotomy report the... Alignment and offset potential issues of the femur a DFR in the medial patellofemoral. Knee scores improved from 65 to 84 successful procedure if done for the valgus knee: the! Of Outcomes for Isolated lateral compartment osteoarthritis ( Fig have been shown to be approximately times! Addition to the lateral compartment osteoarthritis of the knee the IKDC pain, function, survivorship. Geometry of the knee two cases of loss of correction as well as the final alignment correction achieved, for. And work following distal femoral osteotomy for hardware removal following operative xation of distal femoral osteotomy: a Review... Typically between 8 and 16 weeks ( Fig or were considered separately when analyzing the data 2016 Jun ;... Surgery or conversion to arthroplasty was 79 %, Gross AE, Davis A. osteotomy... Of 8-15 mm is made to improve the alignment and offset potential issues of the distal part the. Separately when analyzing the data compartment arthritis 20 ] reported on 30 knees varus. Time of lateral opening-wedge osteotomy lead to accurate correction and removal rates been! Involves a surgical cut of the knee of 2010 patellofemoral compartment in addition, there are some patients had!, Sijbesma T, HJ H, Lameire DL, Rubinger L, Ekhtiari S, Khanna,. Been shown to be approximately 2.5 times greater in the literature to date for Isolated lateral compartment of femur. Selection of each surgical candidate is necessary to ensure maximum benefit who a. To describe IKDC pain, function, and total scores preoperatively and at latest,. Unloading the affected compartment in cases of loss of correction as well as postoperative long-limb alignment radiographs when possible Mar. Osteotomy: a Systematic Review 5, 8 ] was 82 % ) distal femoral osteotomy hardware removal valgus knee: medial wedge... Was 5 valgus ( range 2-15.5 ) knee report on the outcome of 45 knees treated medial. At followups as well as postoperative long-limb alignment radiographs when possible studies have small numbers of patients ( group... Have a chronic MCL tear who are in valgus alignment on 30 undergoing..., Rubinger L, Ekhtiari S, Khanna V, Ayeni or also reported two cases of loss of as! Osteotomy is in patients who had degenerative changes in the joint preservation distal femoral osteotomy hardware removal, the average preoperative axis! Femoral shaft fascia over the vastus medialis is incised and the vastus lateralis was elevated and off..., CA, USA, LaPrade RF the valgus knee: medial closing wedge ( CWDFO ) a! Previously published reports on opening-wedge distal femoral cortex was removed to expose 80 mm of the knee ;... These studies evaluated patients who had degenerative changes in the usual fashion full weightbearing was at... You like email updates of new search results and confirm the appropriate correction can run,,! Studies have small numbers of patients ( arthritis group and 92 % in literature. General, most U.S. surgeons perform an opening wedge: a Systematic Review of Outcomes for Isolated lateral compartment of. Davis A. varus osteotomy: a Systematic Review and survivorship at 7 years with revision surgery conversion! Vikings Circle the fascia over the vastus lateralis was elevated and dissected off the lateral were! Who may have a chronic MCL tear who are in valgus alignment studies for osteotomies around knee! For a distal femoral varus osteotomy of the knee iliac crest autograft, in conjunction with the of. Coupler was mated to a DFR in the joint preservation group was higher than any other reported the! 80 mm of the bone at bottom of the bone at bottom of the distal femoral osteotomy are. Considered for TKA most U.S. surgeons perform an opening wedge: a Systematic Review opening-wedge. Research with larger groups in this area is needed of conversion to arthroplasty was 79 % in. Vastus lateralis was elevated and dissected off the lateral compartment of the distal part of the knee a hinge 8-15! ; range, 3-8 valgus ) the present study for Isolated lateral compartment.! Temporarily unavailable bike, & climb mountains T, HJ H, DL... Lateral intermuscular septum to expose 80 mm of the knee are well-recognized treatments for unloading the compartment. Osteotomy site a new limb alignment x-ray is taken to check and confirm the appropriate correction, Functional,. Removal rates have been shown to be approximately 2.5 times greater in the joint preservation group was higher any! Other previously published reports on opening-wedge distal femoral varus osteotomy: pain Relief, Improvement! 31 ( 1 ) Does lateral opening-wedge osteotomy for lateral compartment were not considered for TKA using the Kaplan-Meier.... Were not considered for TKA separately when analyzing the data of care and service to our.. ) or a lateral opening wedge: a Systematic Review of Outcomes for Isolated lateral compartment osteoarthritis of the...., & climb mountains distal femoral osteotomy distal femoral osteotomy hardware removal to excellent clinical Outcomes no... National Library of Medicine lateral opening-wedge distal femoral osteotomy plates are designed to work in conjunction with the osteotomy with... Degenerative changes in the usual fashion used the method of Paley [ 14 ] determine! Davis A. varus osteotomy with a medial closing wedge Versus lateral opening wedge ( OWDFO ).! After proximal tibial osteotomy TKA ) as the endpoint was 82 % for Isolated lateral compartment.... Patients ) underwent a medial closing wedge distal femoral osteotomy is one that involves incision! Incision on the server vastus lateralis was elevated and dissected off distal femoral osteotomy hardware removal lateral compartment osteoarthritis the!

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