Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. 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. An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. 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. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. Disclaimer, National Library of Medicine One nonunion occurred in the arthritis group. 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. Care was taken to maintain the line above the articular surface of the trochlea. (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. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. 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. lateral, distal femoral osteotomy. 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. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. doi:10.1177/2325967114S00051. 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). These studies have small numbers of patients and variable lengths of followup. 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. 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. All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. Would you like email updates of new search results? All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Dr. Garcia will take limb alignment films to identify have much correction is needed. Epub 2022 Jun 8. The .gov means its official. 2014. 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]. 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 frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. Objectives: 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. 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. Osteosynthesis with a malleable implant. Your message has been successfully sent to your colleague. 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. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. This was an unexpected but noteworthy finding. 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. In general, patients who wish to remain relatively high impact, especially laborers or patients who are still pretty active, or in younger patients, a distal femoral osteotomy would be preferred over a total knee replacement. 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. JavaScript is disabled for your browser. Further surgery after lateral opening-wedge distal femoral osteotomy. Unable to load your collection due to an error, Unable to load your delegates due to an error. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Please try after some time. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. 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. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. The https:// ensures that you are connecting to the Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. . Please try again soon. Clipboard, Search History, and several other advanced features are temporarily unavailable. Distal femoral varus osteotomy for osteoarthritis of the knee. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. 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. In fact 2 years ago I finished climbing the top 100 peaks in CO. 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. A 135-case series with minimum 5-year follow-up. sharing sensitive information, make sure youre on a federal 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). Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. Late recurrence of varus deformity after proximal tibial osteotomy. Systematic review, Level of evidence, 4. Inclusion criteria consisted of studies reporting outcomes in patients undergoing CW or OW DFO for the treatment of valgus knee deformities with symptomatic lateral compartment pathology with a minimum 2-year follow-up. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. 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. In the joint preservation group, the mean IKDC total score improved from 36 (SD, 12) preoperatively to 62 (SD, 18) postoperatively. Clin Sports Med. 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 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). This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. The site is secure. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. 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. Patients who are bowlegged are in varus alignment. A 57-year-old man presented to our orthopedic outpatient . 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. Introduction. The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. Saithna et al. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. 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]. Medial closing-wedge distal femoral osteotomy studies report similar results. Additionally, each screw can be pivoted within the plate's mobile bushing system to . DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). There are a number of different indications for a distal femoral osteotomy. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? There are often many symposia and debates at national and international meetings on this topic. 4010 W. 65th St. An official website of the United States government. 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. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. Eur J Radiol Open. Some error has occurred while processing your request. 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. 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. Epub 2016 Jun 3. sharing sensitive information, make sure youre on a federal Bookshelf Many of the patients who had postoperative films were not within 3 of neutral alignment. 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. The IKDC score improved from 36 to 53 (p < 0.05). 20. 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. Cameron, James I. MD1; McCauley, Julie C. MPHc2; Kermanshahi, Arash Y. MD3; Bugbee, William D. MD1,a, 1Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS116, 92037, La Jolla, CA, USA, 2Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA, Received August 10, 2014/Accepted December 9, 2014; previously published online December 24, 2014. 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. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Medial Closing-Wedge distal femoral varus deformity after proximal tibial osteotomy have small numbers of and! 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distal femoral osteotomy hardware removal