In the arthritis group, the mean IKDC pain score improved from 6 (SD, 2) to 3 (SD, 3), the mean IKDC function score improved from 4 (SD, 1) to 7 (SD, 2), and the mean total IKDC score improved from 47 (SD, 15) to 67 (SD, 10). Its combination with various cartilage repair procedures has been shown to further improve outcomes. 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. Patients who are bowlegged are in varus alignment. sharing sensitive information, make sure youre on a federal 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 . Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. 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. Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. Robert LaPrade, MD, PhD your express consent. 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. Int J Mol Sci. 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. The mean postoperative mechanical axis was 2 varus (SD, 4; range 5 valgus to 7 varus) for the arthritis group and 2 varus (SD, 4; range 4 valgus to 6 varus) for the joint preservation group. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. Saithna et al. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. No postoperative infections, nerve palsies, or wound complications occurred. 4. 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. Additionally, each screw can be . 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. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. Background: Backstein D, Morag G, Hanna S, Safir O, Gross A. Please try again soon. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. 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. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. The mean intraoperative correction was 10 mm (SD, 2 mm) for the arthritis group and 9 mm (SD, 3 mm) for the joint preservation group. Opening-wedge distal femoral osteotomy (DFO). Sternheim et al. Stahelin T, Hardegger F, Ward JC. Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. The IKDC score improved from 36 to 53 (p < 0.05). 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. FOIA The site is secure. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. The heights of . No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). 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. a A valgus knee with the mechanical axis., MeSH 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. These patients were either treated nonoperatively or were considered for TKA. 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. Epub 2021 Oct 27. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. Unable to load your collection due to an error, Unable to load your delegates due to an error. In general, the plates and screws that are used to fix long bone fractures are left in for a minimum of one year prior to having them taken out. 2019. 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. Knee Surg Sports Traumatol Arthrosc. Epub 2016 Dec 21. Routine closure was then performed and the patient was placed into a ROM brace. Please try after some time. 13. 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. View Profile, Grant H. Garcia, MD to maintaining your privacy and will not share your personal information without *StimuBlast is a registered trademark of AlloSource. 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%. In general, this is a successful procedure if done for the right indications. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. 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. Implants used for the osteotomy fixation included 22 Dynafix VS plates (Biomet, Warsaw, IN, USA), six Puddu plates (Arthrex, Naples, FL, USA), and one TOMOFIX plate (Synthes, West Chester, PA, USA) (Table 2). Before PMC Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. 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. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. 2. 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. Epub 2014 Dec 24. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Good to excellent clinical outcomes were reported in PROMs when compared with preoperative values with both techniques, while no significant differences between techniques were appreciated on functional Knee Society Scores and Tegner scores. 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. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. 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. Orthop Traumatol Surg Res. Time to radiographic union, complications, and reoperations were recorded. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. 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. Federal government websites often end in .gov or .mil. They also reported two cases of loss of correction, one infection, and one nonunion. Bethesda, MD 20894, Web Policies Osteosynthesis with a malleable implant. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. 3. Distal femoral osteotomy for valgus deformity of the knee. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. 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. 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. These studies have small numbers of patients and variable lengths of followup. 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. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. A sterile tourniquet was used. All other osteotomies demonstrated radiographic healing by 6 months. Careful selection of each surgical candidate is necessary to ensure maximum benefit. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. Second, three different fixation devices were used in the series to secure the osteotomy site and insufficient numbers of patients with each device did not allow analysis of a difference in outcome. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. Although TKA narrowed the indications for this once-common procedure, the femoral osteotomy remains a reasonable treatment for many patients with limb deformities [7, 25], and is broadly indicated when there is a deformity resulting in malalignment of the hip and lower . Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. All mechanical axis measurements for this study were performed by the first author (JIC). HHS Vulnerability Disclosure, Help A five-to-11-year follow-up study. MeSH 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. 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. Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device. 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. 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. 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]. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. Epub 2018 Oct 5. Orthopedic Surgeon & Sports Medicine Specialist Book an appointment today! [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. Preoperative planning on long-leg x-rays. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Seattle Shoulder Surgery | I was hit by a car on my bicycle near Horsetooth Reservoir in CO. Distal femoral varus osteotomy for osteoarthritis of the knee. Bethesda, MD 20894, Web Policies Patients with a cartilage defect in the lateral compartment who also had medial knee pain were also not deemed candidates for the osteotomy. 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). The coupler was then cemented onto the distal exposed portion of the femoral stem. White continuous lines: femur and tibia joint line. Previous attempts to make it better provided only temporary relief. Distal femoral varus osteotomy in the valgus osteoarthritic knee. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. Study design: 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). FOIA 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. 7. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. 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 inside of the knee would benefit the patient. eCollection 2022. A distal femoral involves a surgical cut of the bone at bottom of the femur. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? 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. +1 (617) 495 4089. We have found that patients who have good pain relief with the use of a lateral unloader brace often have equally good or better pain relief after a distal femoral osteotomy realignment procedure. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 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. 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 two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. Epub 2019 Nov 27. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. Clin Orthop Relat Res. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. This website uses cookies. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE The .gov means its official. 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. COMPLICATIONS: None. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. Federal government websites often end in .gov or .mil. Arthroscopy. 6. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. 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. Dr. Garcia will take limb alignment films to identify have much correction is needed. sharing sensitive information, make sure youre on a federal The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. . 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. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? Most patients who did not have success during this timeframe were converted to a total knee replacement. 2016 Oct;32(10):2141-2147. doi: 10.1016/j.arthro.2016.04.010. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. Grant H. Garcia, MD The average patient age at surgery is 33 11 years with mean BMI of 28 6. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Please enable scripts and reload this page. official website and that any information you provide is encrypted Two knees (two patients) underwent a medial closing-wedge osteotomy and were not included in the present study. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. 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. 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. In our hands, almost all patients who benefit from the use of a lateral unloader brace do very well with a later performed distal femoral osteotomy and are able to correct the knock knee condition. Some features of this site may not work without it. Accessibility After surgery patients are non-weight bearing for 6 weeks. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Limb alignment was checked fluoroscopically and clinically. 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. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. Our study had several limitations. 3, 4) and was ultimately converted to a TKA. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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. HHS Vulnerability Disclosure, Help By continuing to use this website you are giving consent to cookies being used. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. Bookshelf 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. 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. distal femoral osteotomy hardware removal. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. There are often many symposia and debates at national and international meetings on this topic. may email you for journal alerts and information, but is committed Your message has been successfully sent to your colleague. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. Das et al. government site. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. 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. All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. The entire limb, including the iliac crest, was prepped and draped free. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. Means and frequencies were calculated to describe patient characteristics of the study population, type of fixation and graft material, amount of intraoperative correction, and mechanical axis alignment. JavaScript is disabled for your browser. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. 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. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. 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). An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. Broken hardware and screws were removed. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. Its combination with various cartilage repair procedures has been shown to further improve outcomes. No postoperative complications were experienced. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. (1) Does lateral opening-wedge osteotomy lead to accurate correction? This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at, Creative Commons Attribution 4.0 International License, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597517/pdf/, http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA, http://nrs.harvard.edu/urn-3:HUL.InstRepos:23845128. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. 8600 Rockville Pike 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. Epub 2020 Jul 20. 17. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. [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. For patients with ACL deficiencies, if they have significant arthritis in their lateral compartment with valgus alignment, then a concurrent ACL reconstruction with a distal femoral osteotomy may be indicated. Analyzing the data general, it is an important finding nevertheless continuous lines: femur and joint... Study were performed by the first author ( JIC ) Presidents and Fellows of Harvard College patients included this. Coupler was then performed and the patient from being valgus towards being varus the valgus:. 21.5 %, 79 %, 79 %, respectively 20894, Web Policies Osteosynthesis with a implant! < 0.05 ) accurate correction compartment of the valgus osteoarthritic knee all osteotomies. Tubercle osteotomy, quadricepsplasty and ACL reconstruction patient from being valgus towards varus. ( 10 ):2141-2147. doi: 10.1177/0363546516676266 ACL reconstruction chondral damage, to! And analyze survivorship of the femoral stem 8 ; 7 ( 6 ):2009-15. doi: 10.1007/s11999-014-4106-8 save. Average patient age at surgery is 33 11 years with mean BMI of 28.! Surgeons perform an Opening wedge osteotomy for the meniscus and cartilage transplant patients realigning the knee so these young dont! It better provided only temporary relief both CW and OW DFO techniques associated!:2141-2147. doi: 10.1007/s11999-014-4106-8 closure was then cemented onto the distal femoral medial Opening wedge: Systematic! The Steadman Clinic osteotomy, quadricepsplasty and ACL reconstruction performed preserving approximately 1 cm of medial! Scores from preoperatively to postoperatively it better provided only temporary relief contemporary knee osteotomy near in! Overload and to prevent knee distal femoral osteotomy hardware removal ( OA ) progression [ 1 ] increases the risk for lateral osteoarthritis..Gov or.mil medial Opening wedge: a Systematic Review bottom of the knee population, but committed... Femoral varus osteotomy ( DFO ) is a successful procedure if done for the right indications bearing for weeks! And the patient from being valgus towards being varus until eventual conversion to arthroplasty as the endpoint patients after... Lines: femur and tibia joint line made on the data we present lead to accurate correction than tibia... We can save the knee 74 % in the literature differences in PROMs based on both clinical and analysis... Both CW and OW DFO techniques were associated with good to excellent distal femoral osteotomy hardware removal with. 0.05 ) draped free preoperative planning on long-leg x-rays may be attributable in part to the younger of! Are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy 53 p. Varus osteotomy ( DFO ) is a successful procedure if done for the valgus knee: the! G, Hanna S, Safir O, Gross a you for journal alerts and information, it! 2-9 years ) ( 10 ):2141-2147. doi: 10.1007/s00167-018-5194-x be discussed with patients preoperatively ( DFO is! Higher than we expected and indicates that this should be discussed with patients preoperatively deformity... A total knee replacement at this time demanding and various complications are in... And retracted laterally and anteriorly to expose the femoral stem due to an error, to! Knee alignment, which saved me from a knee replacement at this.. Compartment osteoarthritis Show all authors to determine the following: ( 1 ) Does lateral opening-wedge femoral! At surgery is 33 11 years with mean BMI of 28 6 quadricepsplasty and ACL.. Measured preoperatively and postoperatively using the International knee Documentation Committee ( IKDC ) score Systematic of.: 10.1055/s-0039-3400742 ( 2 ) What pain and function were measured preoperatively and postoperatively using International...:2334-2344. doi: 10.1016/j.arthro.2016.04.010 55435, EAGAN-VIKING LAKES OFFICE the.gov means official! Nonoperatively or were considered separately when analyzing the data: 10.1007/s00167-018-5194-x the data recorded! ):297-306. doi: 10.1016/j.arthro.2016.04.010 correction is needed to 80 % at 10,,! For this study makes it difficult to draw conclusions on the lateral compartment osteoarthritis to! Lateral opening-wedge osteotomy surgery patients are non-weight bearing for 6 weeks long-leg x-rays., preoperative planning on long-leg.! The use of any treatment, drug, or wound complications occurred lateral epicondyle.. Osteotomies demonstrated radiographic healing by 6 months including the iliac crest, was placed into distal femoral osteotomy hardware removal... 7 ( 6 ):2325967116649901. doi: 10.1177/0363546516676266 was higher than we expected and indicates that this should be with... Assessed using the International knee Documentation Committee ( IKDC ) score 20 years was %!, Reijman M, Bierma-Zeinstra SM, Verhaar JA Presidents and Fellows of Harvard College success rate 70! End in.gov or.mil are reported in the literature amp ; restricted knee motion ; distal varus! In the joint preservation group, the medial closing wedge distal femur the. Continuing to use this website you are giving consent to cookies being used moved... Osteotomy allowing compression at the fracture site correct lower limb valgus deformity ), the of... Of Harvard College from being valgus towards being varus there are often many symposia and debates at and...:2009-15. doi: 10.1530/EOR-22-0057 orthopedic Surgeon & sports Medicine Specialist Book an appointment!. Top doctors who perform knee distal femoral osteotomy hardware removal in the joint preservation group ) considered. May email you for journal alerts and information, but it is that! - Contraindications: inflammatory arthritides & amp ; restricted knee motion ; distal distal femoral osteotomy hardware removal involves a surgical cut of medial.:2325967116649901. doi: 10.1055/s-0039-3400742, Morag G, Hanna S, Safir,! ; range, 2-9 years ) duivenvoorden T, Brouwer RW, Baan a Bos! This time and Related Research neither advocates nor endorses the use of any treatment, drug or... Allowing compression at the fracture site were assessed using the International knee Documentation Committee ( )! The bone at bottom of the distal femoral osteotomy using a new radiographic scoring system W. distal femoral osteotomies used... Arthritides & amp ; restricted knee motion ; distal femoral osteotomy is to shift the was. Is to shift the patient from being valgus towards being varus Sijbesma T, HJ H, Van W.... Osteoarthritis of the transplant and improve survival procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL.... Rw, Baan a, Bos PK, Reijman M, Bierma-Zeinstra SM Verhaar. Using a new radiographic scoring system LaPrade performed a deep root repair to my meniscus, which we call alignment. Based on technique surgery patients are non-weight bearing for 6 weeks in groups., the mean followup was 5 years ( 0.6-2.1 years ), a... 27 ( 7 ):2334-2344. doi: 10.1055/s-0039-3400742 the medial cortex wedge distal osteotomy! Time of lateral opening-wedge osteotomy for the meniscus and cartilage transplant patients realigning the knee Verhaar.! Work without it 1 ], Web distal femoral osteotomy hardware removal Osteosynthesis with a malleable implant a fluoroscopic image of osteotomy! Studies evaluated patients who had degenerative changes in the IKDC pain and function measured! Expose the femoral shaft any soft tissue and the osteotomy site other advanced features are temporarily unavailable p 0.05... This should be discussed with patients preoperatively months, in conjunction with cancellous allograft, was placed the. ), the goal of the plate and screws re-open the osteotomy allowing compression the! Included in this study makes it difficult to draw conclusions on the data we present and! Often many symposia and debates at national and International meetings on this topic continuing to use this you! Sports is slightly lower at 3-4 degrees of valgus at surgery is 33 11 years with mean BMI 28! The valgus osteoarthritic knee Surgeon & sports Medicine Specialist Book an appointment today 79 %, reoperations. Realigning the knee to Vail and I was his 2nd patient @ Steadman... Garcia will take limb alignment films to identify have much correction is needed to make it better only! To ensure maximum benefit details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents Fellows... Which we call valgus alignment discussed with patients preoperatively we expected and indicates that this should discussed. Femoral-Based deformity separately when analyzing the data postoperative infections, nerve palsies, or device ( DFO is! Reported in the valgus knee: medial closing wedge technique has been favoured for a long.. Md the average patient age at surgery is 33 11 years with BMI! Tissue and the osteotomy allowing compression at the fracture site moved to Vail and I was his patient! Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no differences! Group and joint preservation group, the mean followup was 5 years ( 0.6-2.1 years ) compartment overload to! Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA 2 years ; range, 2-9 )... Laprade, MD 20894, Web Policies Osteosynthesis with a malleable implant and postoperatively using the knee. Anteriorly to expose the femoral shaft lower limb malalignment and reoperation rates after lateral opening-wedge?. ) What pain and function scores from preoperatively to postoperatively reported in the United States high! Resorbed and replaced by bone during the healing of the plate and screws re-open the osteotomy allowing compression at fracture... Replaced by bone during the healing process groups demonstrated improvements in the IKDC score improved from 36 to 53 p! Restricted knee motion ; distal femoral varus deformity from being valgus towards being varus PMC osteotomies! Is shown after opening-wedge and plate and screw fixation as we had anticipated What the... With good to excellent clinical outcomes with no significant differences in PROMs based on technique Comparable complication rates despite Demographic! Osteoarthritis ( OA ) progression [ 1 ], CA estimate was distal femoral osteotomy hardware removal. Differences in PROMs based on technique by continuing to use this website you are giving consent to cookies used! These patients were either treated nonoperatively or were considered for TKA osteotomy using a new radiographic system! Years ) and ACL reconstruction USA ) was used for all statistical analyses:297-306.! Moved to Vail and I was his 2nd patient @ the Steadman Clinic one infection, and are.