I am so glad I did! Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. Stahelin T, Hardegger F, Ward JC. Use of osteotomies has decreased, particularly in North America, with the advent of more reliable and predictable arthroplasty solutions for younger and middle-aged patients with knee arthrosis. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Care was taken to maintain the line above the articular surface of the trochlea. (15.6%), and 5 had hardware removed (15.6%). Saithna et al. 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. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. Sternheim et al. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Routine closure was then performed and the patient was placed into a ROM brace. Our study had several limitations. For more information, please refer to our Privacy Policy. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. This answers all my questions! It is felt that if the valgus alignment is not corrected with a reconstruction of a chronic MCL tear, that there is a much higher risk the MCL tear will stretch out. Epub 2019 Nov 27. Distal Femoral Osteotomy. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. Further surgery after lateral opening-wedge distal femoral osteotomy. PMC Stahelin et al. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. http://dx.doi.org/10.1177/2325967114S00051. Patients who are bowlegged are in varus alignment. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. 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. Further x-rays are obtained at that point to verify healing. The coupler was then cemented onto the distal exposed portion of the femoral stem. 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. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! Arthroscopy. There are few papers in the literature describing the outcomes of distal femoral osteotomy (DFO), as compared with the studies reporting on high tibial osteotomy (HTO), probably because valgus malalignment is less common than the varus one. 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). Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. Would you like email updates of new search results? 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. Wolters Kluwer Health Additionally, each screw can be pivoted within the plate's mobile bushing system to . After surgery patients are non-weight bearing for 6 weeks. 2). The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. Time to radiographic union, complications, and reoperations were captured. Please enable it to take advantage of the complete set of features! Distal Femoral Osteotomy vlog: Hardware removal - YouTube Last vlog!My blog: https://orbite-beast.tumblr.com/ Last vlog!My blog: https://orbite-beast.tumblr.com/. The .gov means its official. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. Its combination with various cartilage repair procedures has been shown to further improve outcomes. Epub 2019 Mar 26. Call Us Today (888) 260-0449 At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. All surgeries were performed by two of the senior authors and 60.3% were done in conjunction with cartilage repair procedures such as autologous chondrocyte implantation and osteochondral graft transfer. Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. Edgerton BC, Mariani EM, Morrey BF. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. pt13: proximal femoral plate removal pt14: chiari pelvic osteotomy (child with neurological impairment) pt15: san diego / degas pelvic osteotomy (child with neurological impairment) pt16: distal femoral rotational osteotomy pt17: distal tibial rotational osteotomy pt18: evan's calcaneal lengthening pt19: triple arthrodesis pt20: botox . OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. 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. FOIA 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. 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. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. The most worrisome complication is that the boney cut does not heal. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). X-rays are taken at each visit to confirm healing and check alignment. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. Predictable healing of the osteotomy was observed. 2700 Vikings Circle Wang JW, Hsu CC. 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. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Epub 2018 Oct 5. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. 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). 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. View Doctor Profile. View Profile, Grant H. Garcia, MD Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. 2. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re Opening-wedge distal femoral varus osteotomy can be used to treat patients with isolated lateral compartment arthritis or in patients in whom an isolated cartilage lesion is present in the lateral compartment. This realignment moves the force on the arthritis part of the knee to the normal part. There are few papers in the literature describing the outcomes of distal femoral osteotomy (DFO), as compared with the studies reporting on high tibial osteotomy (HTO), probably because valgus malalignment is less common than the varus one. 1). FOIA 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. Emed Res 2: 100013. . An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. 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. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. 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%]). Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. Distal femoral varus osteotomy. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. No postoperative complications were experienced. Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. Hartley MK, Kapron al, Krych AJ, Aoki SK, Maak TG Contraindications: inflammatory &. Lower extremity coronal alignment, and reoperations were captured lateral femoral approach was higher than we and. 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