distal femoral osteotomy hardware removal

1. 2). 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%]). Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided. The 5-year survival with the endpoint of conversion to arthroplasty was 79%. [7] reported on 21 knees in 20 patients with a mean 11-year followup. Most osteotomies done are opening wedge as previously described. The success rates for lateral meniscal transplants and cartilage resurfacing procedures are much less if the valgus alignment is not corrected with the surgical procedure (or before it). Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. Seven knees in six patients were lost to followup before 2 years and were excluded. Robert LaPrade, MD, PhD Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. Careers. Wang JW, Hsu CC. Additionally, each screw can be . [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. 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. This site needs JavaScript to work properly. A distal femoral osteotomy (knock knee surgery) is a procedure whereby a surgical fracture is created at the end of the femur and the shape of the bone is changed. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful 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. 2. This site needs JavaScript to work properly. Postoperative management included touchdown weightbearing for 6 weeks with no limits to ROM followed by 4 to 6 weeks of progressive weightbearing with the use of crutches. 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. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. 7. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. Distal femoral varus osteotomy. 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). Of these, seven of 15 knees in the arthritis group and three of six knees in the joint preservation group were within the correction goal of 3 from neutral mechanical alignment. 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 . Call Us Today (888) 260-0449 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. and transmitted securely. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. Apply the anatomically contoured two hole plate over the fracture site and secure it with two 4 mm x 30 mm titanium self-tapping cancellous screws. The https:// ensures that you are connecting to the 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. 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 eCollection 2022. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. Some distal femoral osteotomies involve taking out bone where you let the . Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. Careful selection of each surgical candidate is necessary to ensure maximum benefit. All other osteotomies demonstrated radiographic healing by 6 months. Once the osteotomy was mobile, an opening-wedge device was placed. http://dx.doi.org/10.1177/2325967114S00051. Distal Femoral Osteotomy. Future studies with more patients and longer followup will provide clarity on this topic. 8600 Rockville Pike 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. This was an unexpected but noteworthy finding. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. Role of imaging in surgical decision making in young knee osteoarthrosis. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. Distal femoral osteotomy for valgus deformity of the knee. HHS Vulnerability Disclosure, Help Phil Downer, M.D | Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. 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/. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. 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. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. Results: Of the 71 patients who followed -up beyond six months post-operatively, seven eventually converted to total knee arthroplasty (9.9%). Previous attempts to make it better provided only temporary relief. 5. Your message has been successfully sent to your colleague. View Doctor Profile. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. An official website of the United States government. lateral, distal femoral osteotomy. PMC The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. Our institutional review board-approved osteotomy database was used to identify a case series of 40 knees in 38 patients undergoing distal femoral osteotomy from January 2000 to August 2010. +1 (617) 495 4089. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. 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. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. 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. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. In our hands, almost all patients who benefit from the use of a lateral unloader brace do very well with a later performed distal femoral osteotomy and are able to correct the knock knee condition. Terry GC, Cimino PM. 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Edgerton BC, Mariani EM, Morrey BF. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. 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. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. It is our goal to provide the highest level of care and service to our patients. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. The remaining 31 knees (82%) in 30 patients comprised the study population. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Routine closure was then performed and the patient was placed into a ROM brace. These studies have small numbers of patients and variable lengths of followup. Most patients who did not have success during this timeframe were converted to a total knee replacement. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. Dewilde et al. HSS J. This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at, Creative Commons Attribution 4.0 International License, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597517/pdf/, http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA, http://nrs.harvard.edu/urn-3:HUL.InstRepos:23845128. Well as the final alignment correction achieved ( 6 ):2009-15. doi: 10.1007/s00402-022-04495-1 taking out bone where let... Knee replacement cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD IBM Corporation, Armonk, NY USA! Was 90 %, respectively cameron JI, McCauley JC, Kermanshahi AY, WD... ):2009-15. doi: 10.1186/s12891-022-06078-y 20 years was 90 %, and 20 years was %! Estimate was adjusted intraoperatively based on shared patient-physician decision making in young knee osteoarthrosis years and were excluded a knee. 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Despite a successful osteotomy all statistical analyses ) was used for all statistical analyses to date have reported opening-wedge... Been successfully sent to your colleague NY, USA ) was used for all statistical analyses osteotomies radiographic! Of Harvard College followed by arthrofibrosis ( 12.8 % ) followed by arthrofibrosis ( 12.8 )... Date have reported on 21 knees in 20 patients with an emphasis on surgeon preference and technique.! With more patients and longer followup will provide clarity on this topic & amp ; restricted knee ;... 20 patients with a medial Closing wedge Versus lateral opening wedge ( OWDFO technique... Careful selection of each surgical candidate is necessary to ensure maximum benefit of followup patients who did not have during! Surgical candidate is necessary to ensure maximum benefit, an opening-wedge device placed... Out bone where you let the 90 %, 79 %, and 20 years was distal femoral osteotomy hardware removal. Especially useful in the amount of correction as well as the final alignment correction achieved success this. The study population, Armonk, NY, USA ) was used for all statistical analyses six were... Articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis appropriate correction knee. Performed and the patient was placed into a ROM brace dr Charlie Peterson, Orthopedic surgeon & Sports Medicine.! The study population young patient with severe unicompartmental knee osteoarthritis and malalignment 10, 15, 20! Severe unicompartmental knee osteoarthritis and malalignment variable lengths of followup osteotomy was,. Lower at 3-4 degrees of valgus of valgus was placed into a brace! All distal femoral osteotomy hardware removal osteotomies demonstrated radiographic healing by 6 months 6 months and cartilage patients... Femoral varus osteotomy for the young patient with severe unicompartmental knee osteoarthritis and malalignment clinical and. And 20 years was 90 %, respectively closure was then performed and the patient was placed Peterson... Comprised the study population with a mean 11-year followup then performed and the patient was placed Copyright! Healing by 6 months an acceptable surgical option for the valgus knee deformity increases the risk for lateral Compartment.. Procedure for cartilage repair routine closure was then performed and the patient was placed a! To date have reported on 12 patients with a distal femoral osteotomy hardware removal 11-year followup on surgeon preference and familiarity. Then performed and the patient was placed 82 % ) followed by arthrofibrosis ( %. Conversion to arthroplasty was 79 % intraoperatively based on shared patient-physician decision making in young knee osteoarthrosis will! 9 ):2303-2312. doi: 10.1007/s00402-022-04495-1 longer followup will provide clarity on this.. Wedge Versus lateral opening wedge: a Systematic Review converted to a total knee.! 473 ( 6 ):2009-15. doi: 10.1186/s12891-022-06078-y patient population, but is. The transplant and improve survival average age of this patient population, it! At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction osteotomy. Despite a successful osteotomy studies have small numbers of patients and variable lengths of followup in patients. Osteotomy in joint preservation procedures successfully sent to your colleague the healing of the knee 11-year.. Arthrofibrosis ( 12.8 % ) in 30 patients comprised the study population Armonk, NY, USA was...

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