Routine closure was then performed and the patient was placed into a ROM brace. This is what this term means. 13. Our study had several limitations. This was an unexpected but noteworthy finding. Bookshelf 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. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. 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. Some distal femoral osteotomies involve taking out bone where you let the . As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Bookshelf Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. In this case, the medial-proximal tibial angle is 89 (average normal angle, 87) and the mechanical lateral-distal femoral angle is 84 (average normal angle, 87), thus showing that the larger valgus deformity originates from the distal femur and a distal femoral osteotomy should be performed to correct this malalignment. Book an appointment today! Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. Some features of this site may not work without it. Seattle Shoulder Surgery | 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. Please try again soon. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. 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. 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. 18. EDINA- CROSSTOWN OFFICE 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. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. Late recurrence of varus deformity after proximal tibial osteotomy. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. Clipboard, Search History, and several other advanced features are temporarily unavailable. Correction of valgus knee deformity with a supracondylar V osteotomy. 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. doi:10.1177/2325967114S00051. This AP radiograph demonstrates a healed nonunion (left). Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. ESTIMATED BLOOD LOSS: Minimal. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. See this image and copyright information in PMC. One nonunion occurred in the arthritis group. We used the method of Paley [14] to determine the mechanical axis deviation and amount of required correction. . 2021 Oct;29(10):3299-3309. doi: 10.1007/s00167-020-06166-3. 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. official website and that any information you provide is encrypted 10. I am so glad I did! 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. Aglietti P, Menchetti PP. X-rays are taken at each visit to confirm healing and check alignment. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. The remaining 31 knees (82%) in 30 patients comprised the study population. Clin Sports Med. 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. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. The femur is cut with surgical instruments to about 1 cm away from the medial edge of the femur, commonly at a 45-degree angle and angling towards the adductor tubercle, and the bone is then slowly opened up to the point where the weightbearing goes through the center of the knee. Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2014 Dec 24. Between 2000 and 2010, we performed 40 distal femoral osteotomies. Before 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. 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. Das et al. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. 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 Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. 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. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. 5. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. HHS Vulnerability Disclosure, Help Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. The average patient age at surgery is 33 11 years with mean BMI of 28 6. I can run, bike, & climb mountains. 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. 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. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. The distal femur was resected en bloc . 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. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. eCollection 2022. Distal femoral varus osteotomy for painful genu valgum. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. For younger patients with ligament and cartilage surgeries the success rate is much high as 90% at 10 years and these procedures in young patients can last upwards of 20 years. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 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. 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. By continuing to use this website you are giving consent to cookies being used. The patients who underwent a TKA were female (age, 26 and 40.1 years; BMI, 30.5 and 30.7, respectively) and received these procedures 2.4 and 3.2 years after their DFVO because . 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. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. Generally, these patients are younger than 55 years old. This is a good option for patients with knock knee. Distal femoral varus osteotomy for osteoarthritis of the knee. Stahelin T, Hardegger F, Ward JC. Ehlinger M, D'Ambrosio A, Vie P, Leclerc S, Bonnomet F, Bonnevialle P, Lustig S, Parratte S, Colmar M, Argenson JN; French Society of Orthopedic Surgery, Traumatology (SoFCOT). 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). Knee Surg Relat Res. 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. 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. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. 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. Emphasis on surgeon preference and technique familiarity and check alignment into a ROM brace Presidents Fellows. Is recommended to close the prepared osteotomy before application of the femur osteotomies involve taking out,... Was then performed and the patient was placed into a ROM brace radiograph a. 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Copyright Policy 2022 Presidents and Fellows of Harvard College 11 years with mean BMI of 28 6: Systematic... Official website and that any information you provide is encrypted 10 error, unable to load delegates... Taken at each visit to confirm healing and check alignment the method of Paley [ ]...
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