Long-term follow-up of distal femoral varus osteotomy of the knee. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. *StimuBlast is a registered trademark of AlloSource. Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. 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. Accessibility 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. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. Distally the coupler was mated to a DFR in the usual fashion . Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. 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. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. 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 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). View Doctor Profile. [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. Patients who are bowlegged are in varus alignment. The correction was slowly created. 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. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. This site needs JavaScript to work properly. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. Predictable healing of the osteotomy was observed. 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). 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 . 4. X-rays are taken at each visit to confirm healing and check alignment. There was one nonunion. 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. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. 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. Introduction. After surgery patients are non-weight bearing for 6 weeks. 10. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. Postoperative management included touchdown weightbearing for 6 weeks with no limits to ROM followed by 4 to 6 weeks of progressive weightbearing with the use of crutches. EFORT Open Rev. 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. These are the lateral opening wedge osteotomy, whereby a bone wedge is placed into the outside portion of the femur to change the alignment or a closing wedge medial distal femoral osteotomy, whereby a bone wedge is taken out and the bone is collapsed down to change the alignment. The use of an opening-wedge osteotomy on the tibial side for varus deformity has become well established as the favored alternative to the previously more common closing-wedge techniques [8]. pt13: proximal femoral plate removal pt14: chiari pelvic osteotomy (child with neurological impairment) pt15: san diego / degas pelvic osteotomy (child with neurological impairment) pt16: distal femoral rotational osteotomy pt17: distal tibial rotational osteotomy pt18: evan's calcaneal lengthening pt19: triple arthrodesis pt20: botox . Clin Orthop Relat Res. Limb alignment was checked fluoroscopically and clinically. Our retrospective study aims to evaluate the outcomes and analyze survivorship of the distal femoral osteotomy until eventual conversion to knee arthroplasty. Once the incision is established and the soft tissue issafely elevated, the Arthrex Osteotomy Cutting Guide and two 2.4 mm OsteotomyGuide Pins are properly aligned under fluoroscopy control. 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. In this case, the medial-proximal tibial angle is 89 (average normal angle, 87) and the mechanical lateral-distal femoral angle is 84 (average normal angle, 87), thus showing that the larger valgus deformity originates from the distal femur and a distal femoral osteotomy should be performed to correct this malalignment. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. 1). Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. PMC At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Knee Surg Sports Traumatol Arthrosc. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. Purpose: I am so glad I did! Phil Downer, M.D | The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. 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. may email you for journal alerts and information, but is committed In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. Please enable scripts and reload this page. doi:10.1177/2325967114S00051. [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. Orthopedic Surgeon & Sports Medicine Specialist Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. 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. Medial opening-wedge proximal tibial osteotomy for varus knee deformity is commonly performed but lateral opening-wedge distal femoral osteotomy for a valgus knee deformity is less common. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . 16. Orthop Traumatol Surg Res. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. This site needs JavaScript to work properly. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. Would you like email updates of new search results? Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. (1) Does lateral opening-wedge osteotomy lead to accurate correction? 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. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. Additionally, each screw can be pivoted within the plate's mobile bushing system to . In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). In general, this is a successful procedure if done for the right indications. 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 Most osteotomies done are opening wedge as previously described. Bookshelf This transfer bias is important to remember when reviewing our results. FOIA The indications for osteotomy included symptomatic lateral compartment arthritis with valgus deformity or an isolated cartilage defect in the lateral compartment with valgus or minimal varus alignment. 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. Edgerton BC, Mariani EM, Morrey BF. Grant H. Garcia, MD Between 2000 and 2010, we performed 40 distal femoral osteotomies. 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. 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. 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. 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distal femoral osteotomy hardware removal
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