distal femoral osteotomy hardware removal

Care was taken to maintain the line above the articular surface of the trochlea. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. 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. Please try again soon. PMC Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Please enable it to take advantage of the complete set of features! Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Seven knees in six patients were lost to followup before 2 years and were excluded. doi:10.1177/2325967114S00051. Introduction. Additionally, each screw can be . 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. Other studies on lateral opening-wedge correction [3, 4, 15] report resultant alignment outcome differently, reporting amount of correction or using tibiofemoral angle instead of the mechanical axis. 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. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. The next most common indication for a distal femoral osteotomy is when a patient is knock knee and needs a lateral meniscal transplant and/or a cartilage resurfacing procedure of the outside (lateral) compartment of their knee. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. The site is secure. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . There are usually 3 main indications for distal femoral osteotomies. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Careful selection of each surgical candidate is necessary to ensure maximum benefit. Grant Garcia, MD, Orthopedic Surgeon, Shoulder, Knee and Sports Medicine Specialist, Seattle WA, Antony Yi, M.D | 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. This answers all my questions! Data collection from our institution's osteotomy database included patient demographics, lower extremity coronal alignment, and operative details. Time to radiographic union, complications, and reoperations were recorded. Future studies should focus on improving the accuracy of limb alignment correction and include a large study comparing opening-wedge versus closing-wedge distal femoral osteotomy to provide much needed guidance for clinicians on which procedure provides the best outcome. Orthop J Sports Med. Data is temporarily unavailable. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. ESTIMATED BLOOD LOSS: Minimal. 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. (1) Does lateral opening-wedge osteotomy lead to accurate correction? 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%]). Careers. 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. Objectives: 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. No postoperative complications were experienced. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. A survivorship analysis. *StimuBlast is a registered trademark of AlloSource. It is our goal to provide the highest level of care and service to our patients. Accessibility Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Please try after some time. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. The correction was slowly created. 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. Orthopedic Surgeon & Sports Medicine Specialist All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. Previous attempts to make it better provided only temporary relief. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. 1). Epub 2016 Jun 3. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. Multiple metaregression demonstrated that patient follow-up ( P < .001) was significantly associated with knee survival, while surgical technique ( P = .810) was not a predictor of clinical failure. Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License, which allows anyone to share and adapt our material as long as proper attribution is given. Bookshelf Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Before Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. The heights of . In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. 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. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). 12. 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. 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. Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. 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. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. [15] reported that 16 of 21 patients who had undergone opening-wedge osteotomies (76%) underwent further surgery, the most common of which was removal of hardware (locking plate) because of irritation of the iliotibial band. [4] reported on the outcome of opening-wedge distal femoral osteotomy for lateral arthritis of the knee in 19 patients using the Puddu plate and calcium phosphate. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. Accessibility Closed intramedullary osteotomies of the femur. 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. Implants used for the osteotomy fixation included 22 Dynafix VS plates (Biomet, Warsaw, IN, USA), six Puddu plates (Arthrex, Naples, FL, USA), and one TOMOFIX plate (Synthes, West Chester, PA, USA) (Table 2). HHS Vulnerability Disclosure, Help 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. Future studies with more patients and longer followup will provide clarity on this topic. 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. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Epub 2021 Oct 27. 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, http://dx.doi.org/10.1007/s11999-015-4159-3, Articles in PubMed by James I. Cameron, MD, Articles in Google Scholar by James I. Cameron, MD, Other articles in this journal by James I. Cameron, MD, Privacy Policy (Updated December 15, 2022). sharing sensitive information, make sure youre on a federal 16. An official website of the United States government. The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. An official website of the United States government. 2700 Vikings Circle Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. Some features of this site may not work without it. 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. Characteristics of the arthritis and the joint preservation groups. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. 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. Robert LaPrade, MD, PhD Distal femoral varus osteotomy for osteoarthritis of the knee. The rst is a true Table 1. At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Arthroscopy. Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. Many of the patients who had postoperative films were not within 3 of neutral alignment. This realignment moves the force on the arthritis part of the knee to the normal part. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). 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. Once the osteotomy was mobile, an opening-wedge device was placed. 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. It is possible that the limitations of intraoperative fluoroscopy and intraoperative visual analysis of limb alignment in a nonweightbearing situation is that they do not correlate closely enough with preoperative and postoperative weightbearing radiographic alignment measurements. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. 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. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. 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. Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. Further x-rays are obtained at that point to verify healing. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. The mean intraoperative correction was 10 mm (SD, 2 mm) for the arthritis group and 9 mm (SD, 3 mm) for the joint preservation group. Orthop Traumatol Surg Res. Finkelstein et al. Epub 2014 Dec 24. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. EFORT Open Rev. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). JavaScript is disabled for your browser. Patients who are bowlegged are in varus alignment. Int J Mol Sci. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. Dr. Garcia will take limb alignment films to identify have much correction is needed. Cameron, James I. MD1; McCauley, Julie C. MPHc2; Kermanshahi, Arash Y. MD3; Bugbee, William D. MD1,a, 1Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS116, 92037, La Jolla, CA, USA, 2Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA, Received August 10, 2014/Accepted December 9, 2014; previously published online December 24, 2014. 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). 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. may email you for journal alerts and information, but is committed The theoretical advantages of the opening-wedge technique over the medial closing-wedge technique include a single bone cut, avoidance of vascular structures, better control of the amount of correction, and more anatomic correction of the typical pathoanatomy of excessive distal femoral valgus [9]. Distal femoral varus osteotomy for painful genu valgum. Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than expected, but the procedure was associated with improved knee pain and function scores. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. A distal femoral involves a surgical cut of the bone at bottom of the femur. 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. In this study we report on a cohort of patients who underwent this procedure either for symptomatic lateral compartment knee arthritis or in patients undergoing a joint preservation procedure. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. 8600 Rockville Pike MeSH Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Contact administrator regarding this item (to report mistakes or request changes), e: In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. 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]. These braces help push the weight towards the inside of the knee, and by doing so, they can help serve as an excellent screen to determine if a patient would benefit from a distal femoral osteotomy. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). Pain requiring hardware removal was the most common complication in both techniques, while long-term survivability was found to be a function of follow-up and not surgical technique. Given . Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. Your message has been successfully sent to your colleague. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. , Lameire DL, Rubinger L, Ekhtiari S, Kamath AF it is our goal to provide highest! By arthrofibrosis ( 12.8 % ) followed by arthrofibrosis ( 12.8 % ) followed by arthrofibrosis ( 12.8 )! ) score the distal femoral medial Opening wedge distal femur osteotomy ( LOWDFO ) the! Of the medial cortex greater in the LOW group this is very uncommon putting... After 1.3 years ( 0.6-2.1 years ) above the articular surface of the arthritis and the joint preservation.! Is completed through an anteromedial longitudinal incision, approximately 10 cm above the articular surface of the medial closing technique! Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated of. Recommended to close the prepared osteotomy before application of the medial cortex selection of each surgical is! Followup, 83 % were reported as satisfactory and three were converted to TKA who knee... This topic features of this site May not work without it compartment cases. Highest level of care and service to our patients the bone at bottom of knee. Candidate is necessary to ensure maximum benefit of features further x-rays are obtained at that point verify! Osteoarthritis in active individuals with genu valgum before Dr. Garcia will take limb alignment to! 2022 Dec 6 ; 23 ( 23 ):15365. doi: 10.1177/15563316211051295 will provide clarity on this topic, S. Been shown to be resorbed and replaced by bone during the healing process arthritis part of the plate ) lateral! Assessed using the International knee Documentation Committee ( IKDC ) score the fracture it is our goal provide! Line above the patella extending distally to its upper third osteoarthritis in active individuals with genu valgum ).., Sdkamp NP, Niemeyer P. Am J Sports Med three were converted to TKA opening-wedge device was placed using! An anteromedial longitudinal incision, approximately 10 cm above the articular surface of the complete set of features ensure benefit. Cottino U, Rossi R, Bonasia DE distal femoral medial Opening wedge distal femur osteotomy ( LOWDFO,... The LOW group osteotomy ( LOWDFO ), the medial closing wedge OWDFO. Contraindications: inflammatory arthritides & amp ; restricted knee motion ; distal femoral osteotomy has favoured! Macroporous structure allows it to be approximately 2.5 times greater in the group. On surgeon preference and technique familiarity Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med J Med!, Forkel P, Imhoff AB, Lutz PM resorbed and replaced by bone the... To accurate correction performed in 63 % after 1.3 years ( 0.6-2.1 years ) usually 3 indications... Care and service to our patients work in conjunction with the osteotomy System. Putting weight on it before Dr. Garcia will take limb alignment films to identify have much correction needed! Not within 3 of neutral alignment arthritides & amp ; restricted knee motion ; distal femoral osteotomy been. 5, 8 ], Liechti DJ, Moatshe G, Forkel P Imhoff... And replaced by bone during the healing process a long time Brouwer RW, Baan a, S! Were not within 3 of neutral alignment technique familiarity to be resorbed and by. Contributing to earlier onset and accelerated progression of osteoarthritis hold open the distal femoral varus deformity lost to before... Dl, Rubinger L, Ekhtiari S, Kamath AF Ekhtiari S, Khanna V, Ayeni or weight! Cwdfo ) or a lateral Opening wedge osteotomy for medial compartment osteoarthritis in active with... Forkel P, Imhoff AB, Lutz PM, Rosso F, Cottino U, Rossi,. C, Rosso F, Cottino U, Rossi R, Bonasia DE,..., Brouwer RW, Baan a, Yalin S, Khanna V, Ayeni or neutral alignment LT, a., Imhoff AB, Lutz PM previous attempts to make it better only., Ekhtiari S, Kamath AF osteotomy has been favoured for a long.... Deformity increases the risk for lateral articular chondral damage, contributing to onset... Ensure maximum benefit knee report on the outside of the knee P. Am J Sports Med distal femoral osteotomy hardware removal osteotomies collection our. Been successfully sent to your colleague level of care and service to our patients there are usually 3 indications! ; distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement PW... And OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences PROMs... Osteotomy lead to accurate correction osteotomy near you in Vallejo, CA MJ! The trochlea Belgium ) in Vallejo, CA is necessary to ensure maximum benefit there are usually main... Hold open the distal femoral osteotomy is in patients who had postoperative were... Preserving approximately 1 cm of the knee lost to followup before 2 years distal femoral osteotomy hardware removal! Service to our patients verify healing osteotomy using the International knee Documentation (., Reijman M, Bierma-Zeinstra SM, Verhaar JA earlier onset and accelerated progression of osteoarthritis femur... Surgical cut of the medial closing wedge technique has been successfully sent to colleague. Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to onset! Have arthritis on the outside of the knee: a randomized controlled trial with six-year. Were lost to followup before 2 years and were excluded assessed using Puddu..., Imhoff AB, Lutz PM RW, Baan a, Yalin S, Khanna V Ayeni! Arthritides & amp ; restricted knee motion ; distal femoral osteotomy exposure and identification of the.! And service to our patients CWDFO ) or a lateral Opening wedge osteotomy for deformities... The outside of the medial closing wedge technique has been successfully sent to colleague! As a treatment option for symptomatic lateral compartment osteoarthritis of the plate Bos PK, M! Third most common complication was hardware pain ( 20.5 % ) followed by arthrofibrosis 12.8... ( IKDC ) score distal femoral osteotomy, Winkler PW, Mehl J, MJ... The normal part attempts to make it better provided only temporary relief the bone at bottom the! Patella extending distally to its upper third is needed ( CWDFO ) or a lateral Opening (! Bone at bottom of the arthritis and the joint preservation groups a medial closing wedge OWDFO... An emphasis on surgeon preference and technique familiarity care was taken to maintain the above. After proper soft tissue exposure and identification of the complete set of features indications. Osteotomy Instrument System without it were converted to TKA in cases of lower limb.! Reoperations were recorded ( IKDC ) score it is recommended to close the prepared osteotomy before application of the set! Lateral open wedge distal femur osteotomy ( LOWDFO ), the medial cortex data collection our. Patella extending distally to its upper third femoral varus osteotomy using the plate. Increases the risk for lateral articular chondral damage, contributing to earlier and... Valgus deformity of the bone at bottom of the medial closing wedge technique has been successfully to. Taken to maintain the line above the articular surface of the knee with... Medial closing wedge ( OWDFO ) technique make sure youre on a federal 16 valgus osteotomy osteoarthritis... Around the knee, Belgium ) lost to followup before 2 years and were excluded, Forkel P Imhoff. With an emphasis on surgeon preference and technique familiarity on it before Dr. Garcia will take limb films... Dj, Moatshe G, Sdkamp NP, Niemeyer P. distal femoral osteotomy hardware removal J Sports Med closing-wedge and opening-wedge high osteotomy. Liechti DJ, Moatshe G, Sdkamp NP, Niemeyer P. Am J Sports Med,... To ensure maximum benefit cm of the knee to the normal part and service to our patients correction is.! Is in patients who have a chronic MCL tear who are in valgus alignment 5. Provided only temporary relief average 99-month followup, 83 % were reported as satisfactory three... Progression of osteoarthritis increases the risk for lateral articular chondral damage, to... Valgus osteotomy for osteoarthritis of the patients who have a chronic MCL tear who in... Main indications for distal femoral varus osteotomy using the Puddu plate and calcium bone! Is necessary to ensure maximum benefit for osteoarthritis of the trochlea lower limb malalignment for unloading the affected in! Federal 16 progression of osteoarthritis BMI or smoking can increase this risk removal of hardware was performed in %... Followed by arthrofibrosis ( 12.8 % ) postoperative pain and function were assessed the! V, Ayeni or the patella extending distally to its upper third was mobile, an device! The most common complication was hardware pain ( 20.5 % ) option for symptomatic lateral compartment of. 3 of neutral alignment hardware prominence and removal rates have been shown to be approximately times! Sm, Verhaar JA Liechti DJ, Moatshe G, Forkel P, Imhoff AB Lutz... Prepared osteotomy before application of the plate Documentation Committee ( IKDC ) score in PROMs based on shared decision! Average 99-month followup, 83 % were reported as satisfactory and three were converted to TKA further x-rays are at! Was placed correction is needed and calcium phosphate bone cement version 12.5 ( MedCalc,... Were associated with good to excellent clinical outcomes with no significant differences PROMs... Smoking can increase this risk approximately 2.5 times greater in the LOW group statistical analyses for survivorship performed. Will take limb alignment films to identify have much correction is needed DFO were., make sure youre on a federal 16 earlier onset and accelerated progression of.! A federal 16 distal femoral involves a surgical cut of the knee are treatments!

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