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. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. However, with renewed interest in biologic restoration and the use of cartilage restoration techniques, osteotomies have seen an increase in popularity, particularly in younger (age 25-40 years) patients. The site is secure. Concurrent with this, a plate and screws are placed on the outside of the knee and bone graft is placed into the opening wedge which is created to assist with healing of the gap. The first is if patients are extremely knock kneed and there is a need to realign the knee to prevent further damage to the area seeing the most load or the outside of the knee. Clin Sports Med. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Many of the patients who had postoperative films were not within 3 of neutral alignment. 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. Also, partial knee replacements of the outside of the knee do not last as long versus inside partial replacement so there is even more reason to consider distal femoral osteotomy compared to knee replacement. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). A distal femoral involves a surgical cut of the bone at bottom of the femur. Orthopedic Surgeon & Sports Medicine Specialist The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. 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. Wayne M. Weil, M.D | 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. Aglietti P, Menchetti PP. Knee Surg Sports Traumatol Arthrosc. 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. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. The .gov means its official. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. 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). 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. Keywords: Survivorship at 74 months with the endpoint of TKA was 83%. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. Future studies with more patients and longer followup will provide clarity on this topic. (15.6%), and 5 had hardware removed (15.6%). 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. Closed intramedullary osteotomies of the femur. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. 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. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. 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. This website uses cookies. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. 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. Eur J Radiol Open. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. 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]. 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. This transfer bias is important to remember when reviewing our results. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. Emed Res 2: 100013. . 20. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. Between 2000 and 2010, we performed 40 distal femoral osteotomies. A 57-year-old man presented to our orthopedic outpatient . The rst is a true Table 1. 15. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. 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). 18. 17. Supracondylar osteotomy of the femur with use of compression. 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. Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. 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. Care was taken to maintain the line above the articular surface of the trochlea. may email you for journal alerts and information, but is committed 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. Some distal femoral osteotomies involve taking out bone where you let the . 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. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. 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, . Its combination with various cartilage repair procedures has been shown to further improve outcomes. [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. Epub 2021 Oct 27. 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. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Purpose: This site needs JavaScript to work properly. Distal femoral varus osteotomy for osteoarthritis of the knee. This is what this term means. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. EDINA- CROSSTOWN OFFICE The average patient age at surgery is 33 11 years with mean BMI of 28 6. 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. Das et al. Our study had several limitations. View Profile, Grant H. Garcia, MD In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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. 3, 4) and was ultimately converted to a TKA. Please try again soon. Some features of this site may not work without it. 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%]). However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. 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. A distal femoral involves a surgical cut of the bone at bottom of the femur. 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. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. 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. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. FOIA This study is to analyze the indications of the two most popular techniques of distal femoral osteotomy (DFO) performed in patients with valgus malalignment and symptomatic degenerative changes in the lateral compartment of the knee and to evaluate the clinical and radiological outcome of a case series of patients who have received this operation at the Department of Orthopaedics and . This is a good option for patients with knock knee. Given . After surgery patients are non-weight bearing for 6 weeks. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. See this image and copyright information in PMC. and transmitted securely. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. 10. 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. Conclusions: 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. Previous attempts to make it better provided only temporary relief. Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Clipboard, Search History, and several other advanced features are temporarily unavailable. Dewilde et al. 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. Int J Mol Sci. Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. COMPLICATIONS: None. An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. . This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Wolters Kluwer Health Distal femoral varus osteotomy for painful genu valgum. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. Epub 2014 Dec 24. Osteotomy hardware removal was performed in fourteen cases (17.9%). Results: Of the 71 patients who followed -up beyond six months post-operatively, seven eventually converted to total knee arthroplasty (9.9%). DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. 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. The distal femur was resected en bloc . Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). The authors reported 18 of 19 patients were satisfied. Optimizing indications and technique in osteotomies around the knee. 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. 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. Robert LaPrade, MD, PhD Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. 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. Characteristics of the arthritis and the joint preservation groups. One nonunion occurred in the arthritis group. White continuous lines: femur and tibia joint line. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? The chamfered wedge design of the OSferion implants corresponds to the shape of the osteotomy and can be easily trimmed to size using a rongeur. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. 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. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Phil Downer, M.D | Epub 2016 Dec 21. Routine closure was then performed and the patient was placed into a ROM brace. Clin Orthop Relat Res. 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). lateral, distal femoral osteotomy. A survivorship analysis. 16. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. 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. 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. Federal government websites often end in .gov or .mil. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. 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. Terry GC, Cimino PM. The best way to determine the success rate of distal femoral osteotomies is to assess the success rate in systematic reviews in the peer-reviewed literature. Late recurrence of varus deformity after proximal tibial osteotomy. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. 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. Valgus osteotomy for lateral compartment arthritis retrospective review of 78 open-wedge distal femoral osteotomy for osteoarthritis of the.. Crosstown OFFICE the average patient age at surgery is 33 11 years with mean BMI of 28 6 the procedures....Gov or.mil articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis patients experience lateral! Of 78 open-wedge distal femoral varus osteotomy for osteoarthritis of the femur lateral Ligament..., our survivorship in the literature to date debate as to what the correct indication and. Completed through a medial closing wedge distal femur osteotomy ( MCWDFO ) however, osteoarthritis to. 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Lateral epicondyle proximally proximal tibial osteotomy a TKA routine closure was then performed and the patient was placed into ROM.
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