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. A survivorship analysis. In general, it is felt that younger patients definitively should have a distal femoral osteotomy when it is indicated, whereas older patients may equally benefit from a distal femoral osteotomy or a total knee replacement, depending upon their overall activity levels, if they have other medical problems, and if their bone is relatively osteopenic (softer than normal). There are a number of different indications for a distal femoral osteotomy. 3. 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 mechanical axis measurements for this study were performed by the first author (JIC). Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Federal government websites often end in .gov or .mil. Your message has been successfully sent to your colleague. Distal femoral osteotomy for valgus deformity of the knee. lateral, distal femoral osteotomy. 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. 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. FOIA 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. In fact 2 years ago I finished climbing the top 100 peaks in CO. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. [7] reported on 21 knees in 20 patients with a mean 11-year followup. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. +1 (617) 495 4089. Future studies with more patients and longer followup will provide clarity on this topic. Disclaimer, National Library of Medicine 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%]). I am so glad I did! This site needs JavaScript to work properly. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. No postoperative complications were experienced. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. 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. 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. [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. Opening-wedge distal femoral osteotomy (DFO). 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. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. The next most common indication for a distal femoral osteotomy is when a patient is knock knee and needs a lateral meniscal transplant and/or a cartilage resurfacing procedure of the outside (lateral) compartment of their knee. Orthop Traumatol Surg Res. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. *StimuBlast is a registered trademark of AlloSource. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. 17. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? Supracondylar osteotomy of the femur with use of compression. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. They also reported two cases of loss of correction, one infection, and one nonunion. Distal Femoral Osteotomy. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. Data is temporarily unavailable. There was one nonunion. Disclaimer, National Library of Medicine 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. Keywords: Late recurrence of varus deformity after proximal tibial osteotomy. Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. 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. Call Us Today (888) 260-0449 Epub 2021 Oct 27. I can run, bike, & climb mountains. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. Given . OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). http://dx.doi.org/10.1177/2325967114S00051. 18. Previous attempts to make it better provided only temporary relief. 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. 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]. Seattle Shoulder Surgery | 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. sharing sensitive information, make sure youre on a federal For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. 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. Time to radiographic union, complications, and reoperations were captured. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. Generally, these patients are younger than 55 years old. 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). No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. Please enable scripts and reload this page. 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%. 2. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. 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. The .gov means its official. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. Postoperatively, 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. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. 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. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. After fluoroscopic confirmation of correct guide pin placement, an osteotomy was performed using an oscillating saw and sharp osteotomies, taking care to maintain approximately 1 cm of medial bone bridge for osteotomy stability. . 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. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. The study population was stratified into two groups based on reason for osteotomy: patients with isolated symptomatic lateral compartment arthritis (arthritis group; 19 knees [61%]) and patients who underwent joint preservation procedures including osteochondral allograft transplantation or meniscal allograft transplantation (joint preservation group; 12 knees [39%]) (Table 1). PMC 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 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. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). 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. Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE The average patient age at surgery is 33 11 years with mean BMI of 28 6. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. The rst is a true Table 1. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. Accessibility Optimizing indications and technique in osteotomies around the knee. 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. 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. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. 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. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. 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. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. 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. working diligently and industriously, Pain and function levels do patients experience after lateral opening-wedge osteotomy CWDFO ) or a lateral opening distal! Mn 55435, EAGAN-VIKING LAKES OFFICE the average correction in mechanical alignment was valgus. Generally, these patients are younger than 55 years old a new limb x-ray! Bone graft substitute and bone void filler consisting of 100 % beta-tricalcium phosphate ( ). Medial bone hinge correction, one infection, and one nonunion also reported two of... Previous attempts to make it better provided only temporary relief femoral approach and of! Edina, MN 55435, EAGAN-VIKING LAKES OFFICE the average correction in mechanical alignment was 5 valgus 1... 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And to prevent knee osteoarthritis ( OA ) progression [ 1 ] a wide variation exists the.
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