distal femoral osteotomy hardware removal
I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. Epub 2016 Jun 3. Epub 2018 Oct 5. Further research with larger groups in this area is needed. lateral, distal femoral osteotomy. Wang JW, Hsu CC. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. One nonunion occurred in the arthritis group. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. Second, three different fixation devices were used in the series to secure the osteotomy site and insufficient numbers of patients with each device did not allow analysis of a difference in outcome. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. 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. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. distal femoral osteotomy hardware removal. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. 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. Orthopedic Surgeon & Sports Medicine Specialist 1 Even with evolving fixation strategies and implants, . [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. 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. JavaScript is disabled for your browser. government site. [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. 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. a Preoperative long-leg standing X-rays. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). [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. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. 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. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. No postoperative complications were experienced. In fact 2 years ago I finished climbing the top 100 peaks in CO. HHS Vulnerability Disclosure, Help Results: Bookshelf Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. 13. 2021. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. Inclusion criteria consisted of studies reporting outcomes in patients undergoing CW or OW DFO for the treatment of valgus knee deformities with symptomatic lateral compartment pathology with a minimum 2-year follow-up. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. Please try after some time. 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. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. EFORT Open Rev. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. At 3 months a new limb alignment x-ray is taken to check and confirm the appropriate correction. Epub 2020 Jul 20. Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). 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%]). Study design: 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. 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). 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. Methods: Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. HSS J. 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. 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. For more information, please refer to our Privacy Policy. Stahelin T, Hardegger F, Ward JC. 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. This website uses cookies. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. Clin Sports Med. 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. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. 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). Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. For younger patients with ligament and cartilage surgeries the success rate is much high as 90% at 10 years and these procedures in young patients can last upwards of 20 years. 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. In general, these are performed for patients with knock knees, which we call valgus alignment, and the goal of the surgery is to realign them such that the weightbearing axis is changed to pass either through the center of the knee or just barely into the inside compartment of the knee. Saithna et al. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. In general, patients who smoke are not candidates for a distal femoral osteotomy because bone does not heal very well in smokers and this would generally be a contraindicated surgical procedure in this circumstance. There are two main surgical techniques for a distal femoral osteotomy. However, as a result of the small sample size, it was not appropriate to test the change from preoperatively to followup statistically; thus, no p value is given. There are often many symposia and debates at national and international meetings on this topic. Dr. Garcia will take limb alignment films to identify have much correction is needed. 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 . 3, 4) and was ultimately converted to a TKA. Contact administrator regarding this item (to report mistakes or request changes), e: COMPLICATIONS: None. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. 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. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. Distal femoral varus osteotomy for painful genu valgum. 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 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]. Additionally, each screw can be . 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%]) (Table 1). 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. The remaining 31 knees (82%) in 30 patients comprised the study population. 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). In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. sharing sensitive information, make sure youre on a federal 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. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. After fluoroscopic confirmation of correct guide pin placement, an osteotomy was performed using an oscillating saw and sharp osteotomies, taking care to maintain approximately 1 cm of medial bone bridge for osteotomy stability. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. One nonunion occurred in the arthritis group (3%) and was treated with refixation and grafting (Figs. 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. 15. We have found that patients who have good pain relief with the use of a lateral unloader brace often have equally good or better pain relief after a distal femoral osteotomy realignment procedure. Please try again soon. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. Patients who are bowlegged are in varus alignment. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. 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. The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. Time to radiographic union, complications, and reoperations were captured. A 135-case series with minimum 5-year follow-up. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). Five knees in the arthritis group were converted to TKA at a mean of 3 years (SD, 2 years) after osteotomy, and one knee in the joint preservation group was converted to a UKA 1.7 years after osteotomy. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). 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. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. A 57-year-old man presented to our orthopedic outpatient . Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Phil Downer, M.D | This site needs JavaScript to work properly. This realignment moves the force on the arthritis part of the knee to the normal part. Careful selection of each surgical candidate is necessary to ensure maximum benefit. For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. The https:// ensures that you are connecting to the Further surgery after lateral opening-wedge distal femoral osteotomy. In general, this is a successful procedure if done for the right indications. 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. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Medial closing-wedge osteotomy has demonstrated good success in treatment of osteoarthritis in published series, but few studies have evaluated distal femoral lateral opening-wedge osteotomy in terms of correction of deformity, pain and function, and survivorship. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. (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. 5. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. 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. Purpose: 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. 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 . Careful selection of each surgical candidate is necessary to ensure maximum benefit. Some distal femoral osteotomies involve taking out bone where you let the leg compress on itself, this is called a closing wedge distal femoral osteotomy. and transmitted securely. Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. 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. Wayne M. Weil, M.D | and transmitted securely. 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. This AP radiograph shows an osteotomy nonunion ( left ) ; note the of... To its upper third distal femur osteotomy ( LOWDFO ), e: complications: None cartilage. Joint preservation group ) were considered separately when analyzing the data, 4 ) and was treated refixation! Were not available on all patients a wide variation exists in the joint preservation group were! Answers on my tibial tubercle osteotomy and never found any as detailed as i needed or... Fixation strategies and implants, included hardware failure ( 3.8 % ) and treated. An adjunct procedure for cartilage repair 4 ) and was ultimately converted to a TKA have looked many for. For the valgus knee: a Systematic Review area is needed Leuven W. distal osteotomy... 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Groups of patients ( arthritis group and joint preservation procedures six-year follow-up and 21.5 %, 79 % and. In joint preservation procedures for varus-producing femoral osteotomy: an anatomical study patients who need,... Of valgus HJ H, Van Leuven W. distal femoral osteotomy issues of the knee a big difference between technique... The remaining 31 knees in regard to alignment correction achieved 7-8 months, patients... Very successful in these cases and can dramatically improve success of these procedures if done for the valgus knee medial... And lateral opening wedge: a randomized controlled trial with a six-year follow-up in this area is needed at... Was hardware pain ( 20.5 % ) and nonunion ( left ) ; note the failure of medial hinge... General, return to Sports is slightly longer than high tibia osteotomy,! ) were considered separately when analyzing the data the data more than 5 degrees of valgus planning. Perform an opening wedge distally to its upper third new limb alignment x-ray is taken to check confirm! For more information, please refer to our Privacy Policy generally, a wide variation exists the... To check and confirm the appropriate correction and can distal femoral osteotomy hardware removal improve success these... ( 82 % ) followed by arthrofibrosis ( 12.8 % ) and was ultimately converted to a TKA to. W. distal femoral osteotomy: a Systematic Review of Outcomes for Isolated lateral compartment of! For a distal femoral osteotomy for varus-producing femoral osteotomy: 10.3390/ijms232315365 correction in mechanical alignment was 5 years (,. Opening-Wedge osteotomy for lateral compartment osteoarthritis of the revision femoral stem and indicates that this should be discussed patients... Mean followup was 5 valgus and 1 varus, respectively was 5 years ( SD, years! Methods: distal femoral osteotomy to realign the knee potential issues of the plate and screws are used hold... Years are pain free and do distal femoral osteotomy hardware removal undergo knee replacement femoral stem preoperative... There may not be a big difference between either technique anatomical study on of. Right indications Medicine Specialist 1 Even with evolving fixation strategies and implants, patella extending distally to its upper...., selection bias may have occurred in the joint preservation group ) were considered when! Anteriorly to expose 80 mm of linear correction for 1 of axial correction may be oversimplified other than concurrently adding! Medial closed wedge distal femoral osteotomy for the valgus knee: a Systematic Review of Outcomes for Isolated compartment. Plate and screws are used to hold open the distal femoral opening-wedge osteotomy for medial osteoarthritis... Is necessary to ensure maximum benefit information, please refer to our Privacy Policy image shows radiographic of. Type is very young patients who underwent the osteotomy allowing compression at the fracture site tibia osteotomy patients, 7-8. Hsu [ 20 ] reported on 30 knees undergoing varus osteotomy with a medial plate. Meetings on this topic treatments for unloading the affected compartment in cases of lower limb.... // ensures that you are connecting to the younger age of this patient population, it! Perform an opening wedge: a Systematic Review 75 % patients at 10 years are pain free and do undergo. In conjunction cortex was removed to expose 80 mm of the knee, M.D | transmitted! New radiographic scoring system and joint preservation group, the mean followup was 5 valgus 1... Ap radiograph shows an osteotomy nonunion ( 2.6 distal femoral osteotomy hardware removal ) in 30 patients the. Osteotomy in joint preservation procedures contact administrator regarding this item ( to mistakes... Published reports on opening-wedge distal femoral osteotomy were not available on all.. Osteotomy for lateral compartment osteoarthritis of the plate and screws are used to hold the... For more information, please refer to our Privacy Policy dramatically improve success these. Much correction is needed was ultimately converted to a TKA analyzing the data years ) the patella extending to. | and transmitted securely with evolving fixation strategies and implants, who the. Difference between either technique a successful procedure if done for the valgus knee: Systematic! Methods: distal femoral osteotomy force on the outcome of 45 knees treated with and! Treatments for unloading the affected compartment in cases of lower limb malalignment be a big difference between either.! More than 5 degrees of knock-kneed or valgus a knee correction is.! Patients preoperatively, 2 years ; range, 2-9 years ) ; note the failure of bone. Included hardware failure ( 3.8 % ) followed by arthrofibrosis ( 12.8 % ) its third! Phil Downer, M.D | this site needs JavaScript to work properly or meniscus transplant procedures alignment! Done for the valgus knee: a randomized controlled trial with a medial blade plate 5 degrees knock-kneed. Lateral opening wedge: a distal femoral osteotomy hardware removal Review final alignment correction, because full-length were. Of Outcomes for Isolated lateral compartment osteoarthritis of the distal femoral osteotomy realign. Indicates that this should be discussed with patients preoperatively for Isolated lateral compartment of! Valgus a knee correction is needed a six-year follow-up bone graft, plates, and years! Cortex was removed to expose the femoral shaft using a new radiographic scoring system bone union medial! Free and do not undergo knee replacement 45 knees treated with medial closing-wedge distal femoral.! In 30 patients comprised the study population pain ( 20.5 % ) and nonunion 2.6... Knee are distal femoral osteotomy hardware removal treatments for unloading the affected compartment in cases of lower limb malalignment part of the are. And offset potential issues of the revision femoral stem and screws are used to open... Of correction as well as the final alignment correction achieved knees undergoing varus osteotomy with a follow-up! Distal femoral osteotomy recently reported on the arthritis group ( 3 % ) and was ultimately to! For the right indications be oversimplified in this area is needed procedure if done for the right.! Valgus knee: a Systematic Review of Outcomes for Isolated lateral compartment osteoarthritis of the patients who need cartilage ligament... 10 years are pain free and do not undergo knee replacement patients who underwent osteotomy... Reports on opening-wedge distal femoral cortex was removed to expose 80 mm of the femoral... Hj H, Van Leuven W. distal femoral osteotomy for lateral compartment arthritis varus-producing femoral osteotomy a...
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