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. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. No postoperative infections, nerve palsies, or wound complications occurred. Further research with larger groups in this area is needed. Its combination with various cartilage repair procedures has been shown to further improve outcomes. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. HHS Vulnerability Disclosure, Help 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. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Unfortunately, pre-bending the plate may not always be successful at eliminating future hardware irritation in smaller patients, so these patients may have to wait until the osteotomy is completely healed and a minimum of one year after surgery prior to having the plate and screws that are causing any of the hardware irritation removed. your express consent. 2022 Jun 8;7(6):396-403. doi: 10.1530/EOR-22-0057. 2014. 15. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. We achieved our goal of within 3 of mechanical neutral alignment in seven of 15 patients in the arthritis group and three of six patients in the joint preservation group who had followup mechanical axis radiographs. The success rate of distal femoral osteotomies is felt to be about 70% to 75% at 10 years. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. Broken hardware and screws were removed. Additionally, each screw can be pivoted within the plate's mobile bushing system to . 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. 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). Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. Grant H. Garcia, MD may email you for journal alerts and information, but is committed Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. Our study had several limitations. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. closing wedge; distal femoral osteotomy; opening wedge; valgus. A five-to-11-year follow-up study. 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. 11. 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. Bethesda, MD 20894, Web Policies 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. Call Us Today (888) 260-0449 The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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. For more information, please refer to our Privacy Policy. Indications and Contraindications Indications Moderate corrections up to 10 degrees for opening wedge Larger corrections from 12 to 27 degrees for closing wedge Lateral compartment mild to moderate osteoarthritis Lateral condyle cartilage lesions (with or without cartilage restoration) Clipboard, Search History, and several other advanced features are temporarily unavailable. In general, this is a successful procedure if done for the right indications. Distal femoral osteotomy for valgus deformity of the knee. 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). The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. Epub 2018 Oct 5. FOIA 8600 Rockville Pike Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. 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. 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. 6. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. eCollection 2016 Jun. In these patients that are knock knee, straightening out the femur will shift the weight to the more normal cartilage surfaces on the inside of the knee and can be very beneficial to allow one to not have to undergo a total knee replacement or a partial knee replacement for the arthritis on the outside of their knee. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. Future studies with more patients and longer followup will provide clarity on this topic. Distal Femoral Osteotomy. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE 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. Please enable it to take advantage of the complete set of features! Careful selection of each surgical candidate is necessary to ensure maximum benefit. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. lateral, distal femoral osteotomy. Further studies on alignment correction are needed for clinicians to determine the optimum position of the mechanical axis and to decide whether opening-wedge or closing-wedge osteotomy provides optimal improvement in alignment. Long-term follow-up of distal femoral varus osteotomy of the knee. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. MeSH 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. 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). At 74 months followup, the Lysholm scores improved from 64 to 77 and the clinical Hospital for Special Surgery knee score improved from 42 to 64. Between 2000 and 2010, we performed 40 distal femoral osteotomies. Epub 2016 Jun 3. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. Bookshelf Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. An official website of the United States government. 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. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Orthopedic Surgeon & Sports Medicine Specialist However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Once the osteotomy was mobile, an opening-wedge device was placed. 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 average patient age at surgery is 33 11 years with mean BMI of 28 6. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. PMC 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. 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. 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.
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