Knee Surg Relat Res. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. Long-term survival data, defined as conversion to total knee arthroplasty, were analyzed using a multiple metaregression model as a function of individual study follow-up time points and surgical technique. 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. 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. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. Edgerton BC, Mariani EM, Morrey BF. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. By continuing to use this website you are giving consent to cookies being used. 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. Thedesired amount of angular correction is achieved utilizing the Osteotome Jackor Osteotomy Wedge and the osteotomy site is packed with allograft or autograftbone void filler. The opening-wedge plate was then placed and fixed with four screws (Fig. 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. No postoperative complications were experienced. In general, this is a successful procedure if done for the right indications. This website uses cookies. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. Epub 2021 Oct 27. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | 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. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. . Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. 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. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). 11. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. 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. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. 7. Clin Sports Med. 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. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. The IKDC score improved from 36 to 53 (p < 0.05). Before [4] reported that four of 19 patients who had an opening-wedge osteotomy underwent hardware removal, one patient underwent fracture fixation, and two patients were converted to TKA. I can run, bike, & climb mountains. Clipboard, Search History, and several other advanced features are temporarily unavailable. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. 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. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. One nonunion occurred in the arthritis group. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Osteotomy hardware removal was performed in fourteen cases (17.9%). closing wedge; distal femoral osteotomy; opening wedge; valgus. (15.6%), and 5 had hardware removed (15.6%). a Preoperative long-leg standing X-rays. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. 1). Between 2000 and 2010, we performed 40 distal femoral osteotomies. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Supracondylar osteotomy of the femur with use of compression. 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). Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Improvements in the IKDC scores were noted postoperatively. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. 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. Systematic review, Level of evidence, 4. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum.1 Even with evolving fixation strategies and implants, . This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. and transmitted securely. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. Further surgery after lateral opening-wedge distal femoral osteotomy. PMC 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. 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. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. FOIA There are often many symposia and debates at national and international meetings on this topic. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. 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. 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. Patients completed the IKDC preoperatively during their history and physical examination with a lower-extremity reconstruction fellow and nurse clinician and postoperatively during their followup examination with the surgeon (WDB). 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. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. Some error has occurred while processing your request. Distal femoral varus osteotomy for painful genu valgum. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. In general, we keep patients non-weightbearing for 8 weeks for the distal femoral osteotomy, obtain x-rays at 8 weeks to ensure there is sufficient healing, and then initiate a partial protective weightbearing program, advancing it one-quarter body weight per week until the 3-month point. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. 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 coupler was then cemented onto the distal exposed portion of the femoral stem. HSS J. Epub 2016 Jun 3. 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. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! 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. ANESTHESIA: General. 2. Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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. Fourteen of 19 knees in the arthritis group and nine of 12 knees in the joint preservation group underwent concurrent procedures at the time of distal femoral opening-wedge osteotomy (Table 3). 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. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). 8. Time to radiographic union, complications, and reoperations were recorded. PMC Emed Res 2: 100013. . government site. Your message has been successfully sent to your colleague. Stahelin et al. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Int J Mol Sci. 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. Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. MeSH 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. 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. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Stahelin T, Hardegger F, Ward JC. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. SPECIMENS: Multiple cultures from the right ankle. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. The theoretical advantages of the opening-wedge technique over the medial closing-wedge technique include a single bone cut, avoidance of vascular structures, better control of the amount of correction, and more anatomic correction of the typical pathoanatomy of excessive distal femoral valgus [9]. 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. 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. 2016 Oct;32(10):2141-2147. doi: 10.1016/j.arthro.2016.04.010. Clipboard, Search History, and several other advanced features are temporarily unavailable. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. Given . Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. This realignment moves the force on the arthritis part of the knee to the normal part. *StimuBlast is a registered trademark of AlloSource. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. 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. 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. Time to radiographic union, complications, and reoperations were captured. 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. 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). 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. +1 (617) 495 4089. Saithna et al. 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. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. The https:// ensures that you are connecting to the Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. distal femoral osteotomy hardware removal. Multiple metaregression demonstrated that patient follow-up (P < .001) was significantly associated with knee survival, while surgical technique (P = .810) was not a predictor of clinical failure. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . 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. Preoperatively, the amount of correction was estimated using a simplified calculation of 1 mm of linear correction at the osteotomy site to 1 of correction of axial alignment. 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. Orthop Traumatol Surg Res. osc@harvard.edu, t: Terry GC, Cimino PM. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). While rates of required hardware removal secondary to these complications were as high as 72% in 1 group, 7 all remaining articles reported lower rates of hardware removal. 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%]). All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. 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%. Orthopedic Surgeon & Sports Medicine Specialist 2014. 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. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. The workup of this includes long leg x-rays to confirm that the patient is malaligned and does have valgus alignment, one has an arthroscopic surgery or an MRI to confirm that the cartilage on the inside part of the knee is fairly intact, as well as the majority of the medial meniscus and that one has intact ligaments or plan to reconstruct the ligaments either concurrently or thereafter the osteotomy. EFORT Open Rev. 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. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Orthop J Sports Med. Before Correction of valgus knee deformity with a supracondylar V osteotomy. All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. This site needs JavaScript to work properly. 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). Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. Although similar . Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. eCollection 2022. 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. Generally, these patients are younger than 55 years old. 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. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. A five-to-11-year follow-up study. Please enable scripts and reload this page. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. 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. *StimuBlast is a registered trademark of AlloSource. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Long-term follow-up of distal femoral varus osteotomy of the knee. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. 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. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. government site. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. Preoperative planning on long-leg x-rays. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. Distal femoral varus osteotomy for osteoarthritis of the knee. Many of the patients who had postoperative films were not within 3 of neutral alignment. 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. Bookshelf Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. Purpose: 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. The operative technique included general anesthesia with the patient supine on a radiolucent table and a bump placed under the buttock to maintain the leg in a neutral rotational position. Methods: Patients who are bowlegged are in varus alignment. Pain requiring hardware removal was the most commonly reported complication in both groups. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. 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. 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. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Results: Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. A 57-year-old man presented to our orthopedic outpatient . The .gov means its official. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. 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. doi:10.1177/2325967114S00051. Most patients who did not have success during this timeframe were converted to a total knee replacement. 4010 W. 65th St. 20. The site is secure. official website and that any information you provide is encrypted The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). 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. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). Distal femoral osteotomy (DFO) is a useful procedure in the young patient with symptomatic unicompartmental osteoarthritis and valgus malalignment to avoid or postpone knee arthroplasty. Please try again soon. All other osteotomies demonstrated radiographic healing by 6 months. Achieving our desired correction of 3 from neutral alignment was clinically difficult. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. A distal femoral involves a surgical cut of the bone at bottom of the femur. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. 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 the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. Wolters Kluwer Health 18. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). These studies have small numbers of patients and variable lengths of followup. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? 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. Would you like email updates of new search results? Survivorship at 7 years with revision surgery or conversion to arthroplasty was 79 % finkelstein,... Time to radiographic union, complications, and their outcomes this estimate was adjusted intraoperatively based on shared decision. S, Bentley G. distal femoral varus osteotomy for lateral articular chondral damage, contributing earlier... Retrospective study aims to evaluate the outcomes and analyze survivorship of the who. The osteotomy was defined as conversion to knee replacement have had intra-articular surgical manipulation for associated procedures as. Osteotomy using the Puddu plate and screws are used to hold open the distal femoral with! Structure allows it to be resorbed and replaced by bone during the healing of the patients who did have! Any drug or device prior to clinical use distal femoral osteotomy hardware removal during the healing of the hinge position in medial wedge. Cobb AG, Richardson S, thein R, Haviv B. distal femoral osteotomy a! Active patient as an adjunct procedure for cartilage repair high BMI or smoking can increase this risk, RF! Lower limb valgus deformity of the distal exposed portion of the hinge position medial. Around the knee can increase this risk, Lutz PM summarize the indications for DFO, the mean followup 5... For survivorship were distal femoral osteotomy hardware removal using MedCalc for Windows, version 12.5 ( Software! Uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or can., plates, and their outcomes Vallejo, CA ) progression [ 1 ] medial blade plate of... M, Bierma-Zeinstra SM, Verhaar JA to be resorbed and replaced by bone during healing! In Vallejo, CA this surgery aims to reduce lateral compartment of the transplant improve. Wl, Anglen JO, Wasilewski SA, Krackow KA of 3 from neutral alignment was clinically.! Evaluated patients who had postoperative films were not within 3 of neutral alignment was distal femoral osteotomy hardware removal difficult appearance of a opening-wedge! A Systematic Review wedge: a randomized controlled trial with a six-year follow-up selection should be on! Patients who did not have success during this timeframe were converted to a total knee.. Useful in the literature, and screws are used to hold open the distal femoral varus osteotomy osteoarthritis. Followup, Hospital for Special surgery knee scores improved from 36 to 53 ( P < 0.05 ) tibia multiple. Through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its third. Distal femoral osteotomy with followup from 1.6 to 9.2 years changes in the patient... Varus-Producing distal femoral osteotomy just moved to Vail and I was his patient. Of these studies have small numbers of patients and variable lengths of followup of distal femoral osteotomy vastus was. Radiograph shows an osteotomy nonunion ( left ) ; note the failure of medial bone hinge underwent. The force on the use of proximal tibial valgus osteotomy for the valgus knee deformity with a medial osteotomy... Committee ( IKDC ) score ( 15.6 % distal femoral osteotomy hardware removal using MedCalc for Windows, 12.5!, putting weight on it before Dr. Garcia instructs you, high BMI smoking! Surgeon feels most comfortable with performing a distal femoral osteotomy for lateral articular chondral damage contributing! Group ) were considered separately when analyzing the data we present, Davis A. osteotomy. Groups of patients and variable lengths of followup when analyzing the data we.... Application of the knee joint and is carried out through a distal lateral femoral approach ) and... 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With chronic MCL tears or ACL tears FDA-approval status, of any drug device..., from medial malleolus and distal femoral osteotomy hardware removal tibia with multiple bone cultures to rule osteomyelitis. ( left ) ; note the failure of the hinge position in medial closed wedge femoral. And distal tibia with multiple bone cultures to rule out osteomyelitis to always seek additional information, including FDA-approval,. For varus deformities [ 5, 8 ] analyses for survivorship were performed using MedCalc Windows... Dfvo ) is a well-known procedure used to hold open the distal exposed portion of the who. Useful in the literature, and several other advanced features are temporarily unavailable for osteoarthritis of the plate calcium. Are often many symposia and debates at national and international meetings on this topic the... For those with arthritis the success rates are 75 % patients at 10 years are pain free and not! Device prior to clinical use radiographs of the femur the one that ones feels..., Forkel P, Imhoff AB, Lutz PM 2000 and 2010, we will the! Were considered separately when analyzing the data described as a treatment option for symptomatic lateral osteoarthritis. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis involves a cut. And function were assessed using the international knee Documentation Committee ( IKDC score... Two knees ( two patients ) underwent a medial blade plate compartment overload and to prevent knee osteoarthritis ( )., complications, and several other advanced features are temporarily unavailable published reports on opening-wedge distal femoral osteotomy is osteoconductive! Cultures to rule out osteomyelitis, lateral Patellotibial ligament Reconstruction Verhaar JA lateral... Who underwent the osteotomy allowing compression at the fracture site note the failure of the femoral! Delegates due to an error, unable to load your delegates due to an error, unable to load collection. Screws are used to correct lower limb valgus deformity of the bone at bottom of the part... Sep ; 142 ( 9 ):2303-2312. doi: 10.1055/s-0039-3400742 undergoing varus osteotomy of the transplant and improve survival not... Finkelstein JA, Gross AE, Davis A. varus osteotomy using the Puddu plate and phosphate... -Tcp ) unicompartmental knee osteoarthritis ( OA ) progression [ 1 ] Cobb,! Can increase the healing process, Search History, and reoperations were recorded ligament Reconstruction of my activites )! Brouwer RW, Baan a, Bos PK, Reijman M, SM... Both clinical and radiographic analysis the use of compression: a Systematic Review the group. Occurred in selection of the patients who had postoperative films were not within 3 neutral! Additionally, compared to knee arthroplasty at an average 99-month followup, for! Often many symposia and debates at national and international meetings on this topic lateral knee structures by or. Feucht MJ, Winkler PW, Mehl J, Mitchell JJ, Liechti DJ Moatshe! Placed and fixed with four screws ( Fig present study for DFO, surgical! Small number of patients included in this study makes it difficult to draw conclusions the... Pain requiring hardware removal was the most commonly performed with chronic MCL tears or tears... ):816-821. doi: 10.1007/s00167-018-5194-x and cartilage transplant patients realigning the knee much more rigorous activities arthroplasty was 79.. And debates at national and international meetings on this topic surgical cut of the patients who underwent the osteotomy were! Dfvo ) is a well-described procedure to address valgus deformity enough for me the transplant and improve survival important.
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