distal femoral osteotomy hardware removal

A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. Bethesda, MD 20894, Web Policies Study design: 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. Achieving our desired correction of 3 from neutral alignment was clinically difficult. Routine closure was then performed and the patient was placed into a ROM brace. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. 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. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). 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 chamfered wedge design of the OSferion implants corresponds to the shape of the osteotomy and can be easily trimmed to size using a rongeur. Contact administrator regarding this item (to report mistakes or request changes), e: Book an appointment today! Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. Stahelin et al. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. I am so glad I did! official website and that any information you provide is encrypted No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). sharing sensitive information, make sure youre on a federal 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. 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. This is the first study to our knowledge to look at both of these groups of patients undergoing the same procedure by the same surgeon. It is our goal to provide the highest level of care and service to our patients. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. 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. Thirty-eight knees (97%) in 36 patients were lateral opening-wedge varus-producing osteotomies; of those, 31 knees (82%) in 30 patients had followup at a minimum of 2 years (mean, 5 years; SD, 2; range, 2-12 years) and comprised the study population. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. Epub 2022 Jun 8. 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. An official website of the United States government. closing wedge; distal femoral osteotomy; opening wedge; valgus. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? Opening-wedge distal femoral osteotomy (DFO). This work was performed at Scripps Clinic, La Jolla, CA, USA. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 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. Our study had several limitations. Improvements in the IKDC scores were noted postoperatively. 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. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. The first one is in patients who may have developed arthritis either from a previous lateral meniscectomy or genetic causes and who are found to have fairly normal cartilage in the rest of their knee, but have arthritis on the outside of their knee. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . 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. However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than we expected, but the procedure was associated with improved pain and function and a 5-year survivorship of 74% and 92% in the arthritis and joint preservation patient cohorts, respectively. Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. 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. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. 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. 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%]). Distal femoral varus osteotomy in the valgus osteoarthritic knee. 13. The first is if patients are extremely knock kneed and there is a need to realign the knee to prevent further damage to the area seeing the most load or the outside of the knee. Seattle Shoulder Surgery | Additionally, each screw can be pivoted within the plate's mobile bushing system to . 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. Although TKA narrowed the indications for this once-common procedure, the femoral osteotomy remains a reasonable treatment for many patients with limb deformities [7, 25], and is broadly indicated when there is a deformity resulting in malalignment of the hip and lower . COMPLICATIONS: None. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. FOIA Conclusions: Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. 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. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. The heights of . 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. Before The opening-wedge plate was then placed and fixed with four screws (Fig. (15.6%), and 5 had hardware removed (15.6%). Dr. Garcia will take limb alignment films to identify have much correction is needed. 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). White dotted line: mechanical axes of the femur. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | 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. 2017 Mar;45(4):909-914. doi: 10.1177/0363546516676266. A sterile tourniquet was used. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. and transmitted securely. 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 meni +1 (617) 495 4089. Future studies with more patients and longer followup will provide clarity on this topic. 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. Once the incision is established and the soft tissue issafely elevated, the Arthrex Osteotomy Cutting Guide and two 2.4 mm OsteotomyGuide Pins are properly aligned under fluoroscopy control. 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. ANESTHESIA: General. osc@harvard.edu, t: Late recurrence of varus deformity after proximal tibial osteotomy. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. 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. 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. Download Citation | Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures | Background: A locking compression plate (LCP . Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. 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. 20. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. a Preoperative long-leg standing X-rays. 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 . Distal femoral varus osteotomy. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Phil Downer, M.D | 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. Results: 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]. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. Thank you for choosing Dr. LaPrade as your healthcare provider. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? When the amount of planned correction was obtained at the osteotomy site, lateral fluoroscopic images were obtained to ensure there was no flexion or extension of the osteotomy. Data is temporarily unavailable. Between 2000 and 2010, we performed 40 distal femoral osteotomies. There are two main surgical techniques for a distal femoral osteotomy. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. Aglietti P, Menchetti PP. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. Seven knees in six patients were lost to followup before 2 years and were excluded. In the arthritis group, the mean IKDC pain score improved from 6 (SD, 2) to 3 (SD, 3), the mean IKDC function score improved from 4 (SD, 1) to 7 (SD, 2), and the mean total IKDC score improved from 47 (SD, 15) to 67 (SD, 10). Arthroscopy. 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. 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. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. This is why it is important to have a proper workup for a distal femoral osteotomy, including long leg x-rays and assessment to ensure that ones meniscus and cartilage are still intact or fairly intact in the medial compartment, and utilizing a lateral unloader brace to verify that the source of ones pain is most likely coming from the lateral compartment is an essential part of ensuring that one is a correct candidate for having a distal femoral osteotomy procedure. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. distal femoral osteotomy hardware removal. Distally the coupler was mated to a DFR in the usual fashion . Edina, MN 55435, EAGAN-VIKING LAKES OFFICE Knee Surg Relat Res. Unable to load your collection due to an error, Unable to load your delegates due to an error. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. HHS Vulnerability Disclosure, Help eCollection 2016 Jun. Disclaimer, National Library of Medicine In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. Generally, these patients are younger than 55 years old. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Orthopedic Surgeon & Sports Medicine Specialist The mean postoperative mechanical axis was 2 varus (SD, 4; range 5 valgus to 7 varus) for the arthritis group and 2 varus (SD, 4; range 4 valgus to 6 varus) for the joint preservation group. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. 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. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity.
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