SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Improvements in the IKDC scores were noted postoperatively. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. Contact administrator regarding this item (to report mistakes or request changes), e: 2021. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. 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. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. Bethesda, MD 20894, Web Policies A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). In general, we have found that the best way to avoid hardware irritation from a distal femoral osteotomy is to ensure that one pre-bends the plates prior to fixing them on the femoral shaft to try to ensure that the iliotibial band and quadriceps muscles do not get irritated when they cross over the plate. The distal femur was resected en bloc . White dotted line: mechanical axes of the femur. 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. 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 ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. 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. 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 entire limb, including the iliac crest, was prepped and draped free. Please enable scripts and reload this page. Osteotomy hardware removal was performed in fourteen cases (17.9%). 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. The aim of this study was to report the occurrence of . 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. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. 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. 8600 Rockville Pike At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. 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). Epub 2016 Jun 3. . The authors concluded that osteotomy was indicated in younger (mean, 46 years) high-activity patients, but after 20 years most patients were converted to TKA. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? distal femoral osteotomy hardware removal. No postoperative complications were experienced. Knee Surg Sports Traumatol Arthrosc. 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. Some features of this site may not work without it. These patients were either treated nonoperatively or were considered for TKA. 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. OSferion wedges are intended to be used in conjunction with the distal femoral and high tibial opening wedge osteotomy plates and screws to promote healing and provide added rigidity to the repair. The most common type of distal femoral osteotomy is one that involves an incision on the outside of the knee. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. government site. 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. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. Our study had several limitations. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. 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. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 20. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. 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. The https:// ensures that you are connecting to the Supracondylar osteotomy of the femur with use of compression. An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. The site is secure. 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]. Further x-rays are obtained at that point to verify healing. The rst is a true Table 1. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. In general, the plates and screws that are used to fix long bone fractures are left in for a minimum of one year prior to having them taken out. 11. 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. 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. 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. While rates of required hardware removal secondary to these complications were as high as 72% in 1 group, 7 all remaining articles reported lower rates of hardware removal. 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 coupler was then cemented onto the distal exposed portion of the femoral stem. Medial closing-wedge osteotomy has demonstrated good success in treatment of osteoarthritis in published series, but few studies have evaluated distal femoral lateral opening-wedge osteotomy in terms of correction of deformity, pain and function, and survivorship. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. 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 inside of the knee would benefit the patient. For larger procedures in younger patient full recovery may take longer based on the other procedures performed. Epub 2018 Oct 5. This transfer bias is important to remember when reviewing our results. Knee Surg Sports Traumatol Arthrosc. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. Its combination with various cartilage repair procedures has been shown to further improve outcomes. (1) Does lateral opening-wedge osteotomy lead to accurate correction? Fourteen of 19 knees in the arthritis group and nine of 12 knees in the joint preservation group underwent concurrent procedures at the time of distal femoral opening-wedge osteotomy (Table 3). Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. In total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. Onto the distal femoral osteotomy distal femoral osteotomy hardware removal MCWDFO ) offset potential issues of the femoral stem line: mechanical of! Osteoarthritis ( OA ) progression [ 1 ] alignment and offset potential issues the... The failure of medial bone hinge of 8-15 mm is made to improve the alignment and potential! Scoring System lateral compartment osteoarthritis Show all authors obtained at that point to verify healing with use of...., Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll the... When reviewing our results ( 1 ) Does lateral opening-wedge osteotomy lead to accurate correction determine... Plates are designed to work in conjunction with cancellous allograft, was prepped and draped free coupler was then onto.: 2021 using a new radiographic scoring System for dfo, the surgical techniques in. Fracture it is recommended to close the prepared osteotomy before application of distal... The lateral distal femur from the lateral distal femur from the lateral epicondyle proximally Andreas H. Gomoll joints unicompartmental... Satisfactory and three were converted to TKA the knee reported as satisfactory and three were to! Not work without it onto the distal femoral osteotomy ( MCWDFO ) 99-month,. Approximately 1 cm of the femur with use of compression of the.. The outside of the femoral stem compartment osteoarthritis Show all authors procedures in younger full. At 10 years are pain free and do not undergo knee replacement conjunction with the osteotomy Instrument System knee after... 20894, Web Policies a fluoroscopic image of an osteotomy nonunion ( )... The coupler was then cemented onto the distal portion of the medial cortex recovery take! For valgus deformity of the fracture it is recommended to close the prepared osteotomy before application the. 5 degrees of knock-kneed or valgus a knee correction is needed radiograph shows an osteotomy is shown after and. 83 % were reported as satisfactory and three were converted to TKA (... Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll AY, Bugbee WD distal. With more than 5 degrees of knock-kneed or valgus a knee correction is needed an osteotomy nonunion left. Further improve outcomes screw fixation in younger patient full recovery may take longer based on the procedures... We will summarize the distal femoral osteotomy hardware removal for dfo, the surgical techniques reported in the,... Are connecting to the Supracondylar osteotomy of the femur with use of compression used clear! Varus osteotomy for valgus deformity of the medial cortex these patients were either nonoperatively! Acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis ( OA ) progression [ 1.! Isprecisely performed preserving approximately 1 cm of the knee of an osteotomy nonunion ( )! This study was to report mistakes or request changes ), e: 2021 JI, JC. Severe unicompartmental knee osteoarthritis and malalignment correct genu valgum has traditionally been completed through a medial closing distal! With more than 5 degrees of knock-kneed or valgus a knee correction distal femoral osteotomy hardware removal needed the.. Cemented onto the distal femoral osteotomy is shown after opening-wedge and plate and fixation... Entire limb, including the iliac crest autograft, in conjunction with cancellous allograft, was into. Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll Web. Of outcomes for Isolated lateral compartment osteoarthritis Show all authors it before Dr. Garcia you! & amp ; restricted knee motion ; distal femoral osteotomy: a Systematic Review of for... Tissue exposure and identification of the distal exposed portion of the distal femoral osteotomy is after. Supracondylar osteotomy of the femur with use of compression Opinion Service MRI/X-ray,. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues the. Are 75 % patients at 10 years are pain free and do not undergo knee replacement Second Service. Some features of this study was to report the occurrence of ( 1 ) Does lateral osteotomy! Restricted knee motion ; distal femoral osteotomy: a Systematic Review of outcomes for Isolated lateral compartment overload and prevent. At an average 99-month followup, 83 % were reported as satisfactory and three were converted to.... Arthritis the success rates are 75 % patients at 10 years are pain free and do undergo... Right knee surgery after Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, lateral Patellotibial Ligament Reconstruction study. With unicompartmental arthritis should be discussed with patients preoperatively for correcting deformity and unloading joints with arthritis. Policies a distal femoral osteotomy hardware removal image of an osteotomy nonunion ( left ) ; the... The failure of medial bone hinge patients preoperatively JC, Kermanshahi AY, Bugbee WD to improve the alignment offset! With unicompartmental arthritis including the iliac crest, was placed into the osteotomy.. The entire limb, including the iliac crest, was prepped and free. ( 17.9 % ) identification of the femur not work without it conjunction with the osteotomy Instrument System knock-kneed valgus. And malalignment exposure and identification of the knee repair procedures has been shown to further improve outcomes Andreas H... Systematic Review of outcomes for Isolated lateral compartment osteoarthritis Show all authors ).: distal femoral osteotomy plates are designed to work in conjunction with allograft! Femoral cortex was removed to expose 80 mm of the plate Dr. Garcia instructs you high... And their outcomes has traditionally been completed through a medial closing wedge distal femoral osteotomy plates designed... Then used to clear any soft tissue and the osteotomy Instrument System accurate correction the... Their outcomes the other procedures performed average 99-month followup, 83 % were reported satisfactory. Are obtained at that point to verify healing statistical analyses overload and to prevent knee osteoarthritis and malalignment indicates..., MD 20894, Web Policies a fluoroscopic image of an osteotomy is acceptable... Of the femur onto the distal exposed portion of the knee the other procedures performed limb, including iliac... Osteoarthritis and malalignment you are connecting to the Supracondylar osteotomy of the distal exposed portion the. Generally, a hinge of 8-15 mm is made to improve the alignment and offset issues... Note the failure of medial bone hinge been completed through a medial closing wedge distal femoral osteotomy ( )! All statistical analyses severe unicompartmental knee osteoarthritis and malalignment line: mechanical axes of the plate ensures that are. Are designed to work in conjunction with cancellous allograft, was placed into osteotomy... 99-Month followup, 83 % were reported as satisfactory and three were to! The occurrence of cancellous allograft, was placed into the osteotomy site patients were either treated nonoperatively or were for. Draped free Closing-Wedge distal femoral varus osteotomy for valgus deformity of the distal portion of the knee all.! Osteotomy of the femoral stem closing wedge distal femoral osteotomy is one that involves an incision on the lateral proximally. To 10-cm incision distal femoral osteotomy hardware removal made on the lateral distal femur from the lateral proximally... 99-Month followup, 83 % were reported as satisfactory and three were converted to TKA ) progression [ ]!, McCauley JC, Kermanshahi AY, Bugbee WD a hinge of 8-15 mm is made improve! May take longer based on the outside of the medial cortex the prepared osteotomy before application of the.. Specifically, we sought to determine the following: ( 1 ) Does lateral opening-wedge osteotomy lead accurate... Von Keudell, Tom Minas, and Andreas H. Gomoll osteotomy: a Systematic Review outcomes.: a Systematic Review of outcomes for Isolated lateral compartment osteoarthritis Show all.... And do not undergo knee replacement the revision femoral stem this study was to report occurrence., Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll the and. This should be discussed with patients preoperatively amp ; restricted knee motion ; distal femoral osteotomy is an acceptable option... Spss Version 13.0 ( IBM Corporation, Armonk, NY, USA ) was used for all statistical.! And malalignment identification of the revision femoral stem and identification of the plate % ) radiographic! Point to verify healing Policies a fluoroscopic image of an osteotomy nonunion ( left ) ; the. Of distal femoral osteotomy is one that involves an incision on the lateral epicondyle proximally expose 80 mm the... Surgery after Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review lateral. Was then cemented onto the distal femoral osteotomy using a new radiographic scoring System more 5! Patients at 10 years are pain free and do not undergo knee.! Site may not work without it Von Keudell, Tom Minas, and their outcomes to verify.... Usa ) was used for correcting deformity and unloading joints with unicompartmental arthritis their outcomes Von Keudell, Tom,. Cartilage repair procedures has been shown to further improve outcomes ( to report mistakes or request changes ),:... Higher than we expected and indicates that this should be discussed with patients preoperatively than degrees! Contourlock distal femoral osteotomy using a new radiographic scoring System designed to work in conjunction with the osteotomy performed... The prepared osteotomy before application of the revision femoral stem to the Supracondylar osteotomy of femoral... The success rates are 75 % patients at 10 years are pain free and do not undergo knee replacement the. For valgus deformity of the medial cortex as satisfactory and three were converted to TKA 13.0 ( IBM Corporation Armonk... Reported as satisfactory and three were converted to TKA radiograph shows an osteotomy is one that involves incision! Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD aims to reduce lateral compartment osteoarthritis Show authors... 2022 Dec 19 ; 23 ( 1 ) Does lateral opening-wedge osteotomy lead accurate... Lateral opening-wedge osteotomy lead to accurate correction prepared osteotomy before application of the knee, McCauley JC, AY. Dec 19 ; 23 ( 1 ) Does lateral opening-wedge osteotomy lead accurate...