There are usually 3 main indications for distal femoral osteotomies. Int J Mol Sci. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). 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. Distal femoral osteotomy for valgus deformity of the knee. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). The average patient age at surgery is 33 11 years with mean BMI of 28 6. 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. Achieving our desired correction of 3 from neutral alignment was clinically difficult. Epub 2019 Nov 27. 15. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. Time to radiographic union, complications, and reoperations were recorded. This is what this term means. Federal government websites often end in .gov or .mil. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. official website and that any information you provide is encrypted Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. Most osteotomies done are opening wedge as previously described. The .gov means its official. 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. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. 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. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. Wang JW, Hsu CC. 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 Disclaimer, National Library of Medicine Further x-rays are obtained at that point to verify healing. 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. 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. 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). Correction of valgus knee deformity with a supracondylar V osteotomy. 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. Distal femoral varus osteotomy in the valgus osteoarthritic knee. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Backstein D, Morag G, Hanna S, Safir O, Gross A. An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. 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. The IKDC score improved from 36 to 53 (p < 0.05). Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. 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 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). 1 Even with evolving fixation strategies and implants, . 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. Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. Purpose: PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. 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. 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. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. 3. Background: For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. 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. 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. Grant H. Garcia, MD The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. [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. A distal femoral involves a surgical cut of the bone at bottom of the femur. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. 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. eCollection 2016 Jun. Epub 2016 Dec 21. +1 (617) 495 4089. 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. Epub 2022 Jun 8. 10. A 57-year-old man presented to our orthopedic outpatient . 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. 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. Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. 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). For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. Call Us Today (888) 260-0449 (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? 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. 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 osteotomy can be technically demanding and various complications are reported in the literature. 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. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 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. This was an unexpected but noteworthy finding. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Late recurrence of varus deformity after proximal tibial osteotomy. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. . Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. Would you like email updates of new search results? The site is secure. 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. This AP radiograph demonstrates a healed nonunion (left). 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. 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 addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. They also reported two cases of loss of correction, one infection, and one nonunion. A five-to-11-year follow-up study. MeSH Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. 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. 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. COMPLICATIONS: None. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Phil Downer, M.D | This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. 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. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. Orthopedic Surgeon & Sports Medicine Specialist 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). may email you for journal alerts and information, but is committed Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. 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. 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. Otherwise, there is a risk that the hinge on the inside part of the knee could crack or the screws could break because too much weight is being placed on them from relying on the plate and screws to hold the fracture apart rather than allowing the bone to heal.