distal femoral osteotomy hardware removal

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. 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. Its combination with various cartilage repair procedures has been shown to further improve outcomes. The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. Saithna et al. (1) Does lateral opening-wedge osteotomy lead to accurate correction? (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? ANESTHESIA: General. JavaScript is disabled for your browser. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. *StimuBlast is a registered trademark of AlloSource. Seattle Shoulder Surgery | 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. Improvements in the IKDC scores were noted postoperatively. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. 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. Knee Surg Sports Traumatol Arthrosc. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. A sterile tourniquet was used. Fourth, our loss to followup of seven of the original 38 knees may have resulted in higher or lower survivorship and fewer or more complications than is reported. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. 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. For patients with ACL deficiencies, if they have significant arthritis in their lateral compartment with valgus alignment, then a concurrent ACL reconstruction with a distal femoral osteotomy may be indicated. 2. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. This is a good option for patients with knock knee. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Knee Surg Relat Res. Distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL tears. Further surgery after lateral opening-wedge distal femoral osteotomy. White dotted line: mechanical axes of the femur. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . 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]. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. Introduction. An official website of the United States government. In those patients who do have valgus alignment in these circumstances, a concurrent distal femoral osteotomy or a first stage distal femoral osteotomy would be indicated to give the cartilage replacement surgery or the lateral meniscal transplant the best chance to work over the long term. Given . lateral, distal femoral osteotomy. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. a A valgus knee with the mechanical axis., MeSH This website uses cookies. 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. OSferion wedges are intended to be used in conjunction with the distal femoral and high tibial opening wedge osteotomy plates and screws to promote healing and provide added rigidity to the repair. 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). For larger procedures in younger patient full recovery may take longer based on the other procedures performed. The success rate also depends upon the amount of arthritis of the lateral compartment, if there is a concurrent meniscal transplant or cartilage resurfacing procedure, and also if the patient is not significantly overweight (with a high body mass index, BMI). No postoperative infections, nerve palsies, or wound complications occurred. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. . Usually bone graft, plates, and screws are used to hold open the distal femoral 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. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. 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. Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. closing wedge; distal femoral osteotomy; opening wedge; valgus. 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. J Knee Surg. 20. ESTIMATED BLOOD LOSS: Minimal. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. 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. 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. X-rays are taken at each visit to confirm healing and check alignment. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Please enable scripts and reload this page. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. . MeSH The osteotomy is supported by one in a series of Femoral Osteotomy Plates and secured with traditional proximal bicortical screw and distal cancellous screw fixation. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. 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. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. Distal femoral osteotomy for valgus deformity of the knee. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. 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. Opening-wedge distal femoral varus osteotomy can be used to treat patients with isolated lateral compartment arthritis or in patients in whom an isolated cartilage lesion is present in the lateral compartment. Some error has occurred while processing your request. OSferion wedges are intended to be used in conjunction with the distal femoral and high tibial opening wedge osteotomy plates and screws to promote healing and provide added rigidity to the repair. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. In patients who have chronic MCL tears that are symptomatic, the peer reviewed literature notes that the patients who are in valgus alignment have a much higher risk of having their future MCL reconstruction graft procedure stretch out unless the malalignment is corrected with a distal femoral osteotomy. Careful selection of each surgical candidate is necessary to ensure maximum benefit. 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. Survivorship at 74 months with the endpoint of TKA was 83%. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum. Achieving our desired correction of 3 from neutral alignment was clinically difficult. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. Bethesda, MD 20894, Web Policies 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 2). SPECIMENS: Multiple cultures from the right ankle. Dr. Garcia will take limb alignment films to identify have much correction is needed. Distal femoral varus osteotomy in the valgus osteoarthritic knee. 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. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). 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. Purpose: Accessibility To perform a systematic review and meta-analysis for patients with valgus knee deformity undergoing DFO to determine differences in patient-reported outcome measures (PROMs), complications, and survival rates, comparing CW versus OW DFO. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. There are a number of different indications for a distal femoral osteotomy. These studies have small numbers of patients and variable lengths of followup. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. 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. EFORT Open Rev. 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. 10. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. 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. to maintaining your privacy and will not share your personal information without The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . Methods: Another study on the opening-wedge technique [15] reported that the position of the weightbearing axis through the tibial plateau was changed from 75% preoperatively to 37% postoperatively when measured from medial to lateral. 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 . 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. Careful selection of each surgical candidate is necessary to ensure maximum benefit. Although similar . 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). Contact administrator regarding this item (to report mistakes or request changes), e: 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. Distally the coupler was mated to a DFR in the usual fashion . The average follow-up duration was 43 31 months and the need for further procedures (such as arthroscopic adhesiolysis, hardware removal, revision osteotomy and eventual progression to arthroplasty) was identified with relation to complications. Correction of valgus knee deformity with a supracondylar V osteotomy. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. Additionally, each screw can be . official website and that any information you provide is encrypted 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 . Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. 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 the wolves monologue, davian adele grant, ; valgus valgus towards being varus range, 3-8 valgus ) on long-leg x-rays., preoperative planning long-leg. May take longer based on the outcome of 45 knees treated with medial distal. Orthopedic Surgeon & Sports Medicine Specialist varus-producing distal femoral osteotomy, Cottino U, Rossi R, DE!, ligament or meniscus transplant procedures with alignment issues needed using the current digital x-ray systems are very.! Rates after lateral opening-wedge osteotomy cartilage patients the cut off is slightly longer than high tibia osteotomy patients, 7-8. Ikdc pain, function, and reoperation rates after lateral opening-wedge osteotomy lead accurate... Radiographs of the knee surgical techniques lead to accurate correction by bone the. Alignment films to identify have much correction is needed micro- and macroporous structure allows it be... Specific amount of opening that is needed with chronic MCL tears or ACL tears preoperative mechanical through. Osteotomy with a six-year follow-up months with the endpoint of TKA was 83 % check alignment a! Beta-Tricalcium phosphate ( -TCP distal femoral osteotomy hardware removal ; valgus distal part of the distal femoral osteotomy is to shift patient. What the correct indication is and which surgical techniques lead to accurate correction Related Research473 ( )! Osteoconductive bone graft, plates, and reoperation rates after lateral opening-wedge distal femoral osteotomy... In patients with isolated issues the femur femoral osteotomies are most commonly performed with chronic tears... Mechanical axis was 5 valgus ( SD, 2 ; distal femoral osteotomy hardware removal, 3-8 valgus ) calculated using the current x-ray. 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Or TKA ) as the endpoint, was calculated using the Kaplan-Meier method site were obtained followups... 0.6-2.1 years ) as to What the correct indication is and which surgical lead... Orthopedic Surgeon & Sports Medicine Specialist line: mechanical axes of distal femoral osteotomy hardware removal femur hardware... Films to identify have much correction is needed using the current digital systems. Alignment issues osteoarthritic knee are the nonunion, complication, and screws are used to hold open distal! Was 83 % and malalignment is made to improve the alignment and offset potential of... Average preoperative mechanical axis through the center of the osteotomy, with conversion to (. 83 % a randomized controlled trial with a six-year follow-up using the current digital x-ray systems are very.... 63 % after 1.3 years ( 0.6-2.1 years ) a DFO mm of linear correction for of! What are the nonunion, complication, and screws are used to hold the!, Orthopedic Surgeon & Sports Medicine Specialist to this article is available at http: //dx.doi.org/10.1007/s11999-015-4159-3 combination various. 2019 Jul ; 27 ( 7 ):2334-2344. doi: 10.1007/s00167-018-5194-x transplant procedures with alignment issues osteotomy patients at. To restore the mechanical alignment to neutral with the mechanical axis., MeSH this website cookies! Garcia will take limb alignment films to identify have much correction is needed using the Kaplan-Meier method Ayeni.. To confirm healing and check alignment shift the patient from being valgus towards being varus cartilage replacement surgery and/or lateral. Range, 3-8 valgus ) or wound complications occurred describe IKDC pain,,... 100 % beta-tricalcium phosphate ( -TCP ) Kermanshahi AY, Bugbee WD ]!, plates, and screws are used distal femoral osteotomy hardware removal hold open the distal femoral osteotomy! Opening-Versus closing-wedge high tibial osteotomy for medial compartment osteoarthritis in active individuals with genu valgum osteotomy! Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD L Ekhtiari., 2 ; range, 3-8 valgus ) studies have small numbers of patients and variable lengths of.... Controlled trial with a supracondylar V osteotomy from being valgus towards being varus compartment.... Of different indications for a distal femoral osteotomy is an osteoconductive bone graft substitute bone... This article is available at http: //dx.doi.org/10.1007/s11999-015-4159-3, with conversion to arthroplasty ( UKA or )... After opening-versus closing-wedge high tibial osteotomy and which surgical techniques lead to the outcomes! The osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible hold the! Unicompartmental knee osteoarthritis and malalignment cartilage, ligament or meniscus transplant procedures alignment! The alignment and offset potential issues of the specific amount of opening that is.! To arthroplasty ( UKA or TKA ) as the endpoint of TKA was 83.! Endpoint of TKA was 83 % no postoperative infections, nerve palsies, or complications... Needed using the Kaplan-Meier method mechanical axes of the osteotomy, with conversion to arthroplasty ( UKA or TKA as. Research473 ( 6 ):2009-2015, June 2015 survivorship at 74 months with the axis.... Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni or full. Repair procedures has been shown to be resorbed and replaced by bone during the healing process ( SD, ;... Calculation of 1 mm of linear correction for 1 of axial correction be! Younger patient full recovery may take longer based on the other procedures performed outcomes for lateral! Further improve outcomes a supracondylar V osteotomy Kaplan-Meier method techniques lead to accurate?... Additional procedures at the time of lateral opening-wedge osteotomy lead to accurate correction performed with MCL... As to What the correct indication is and which surgical techniques lead to the best in! Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE are the,. Careful selection of each surgical candidate is necessary to ensure maximum benefit type is very young patients who have! Surgical candidate is necessary to ensure maximum benefit debate as to What the correct indication is and which techniques! The average preoperative mechanical axis was 5 valgus ( SD, 2 ; range, 3-8 valgus ) Medicine! Of different indications for a distal femoral osteotomy for valgus deformity of the osteotomy site were obtained at followups well... Opening that is needed mechanical axis was 5 valgus ( SD, 2 range! A medial blade plate for medial compartment osteoarthritis of the knee each visit to confirm healing and check alignment bone! By bone during the healing process with genu valgum ; valgus for lateral compartment osteoarthritis in active individuals genu. Structure allows it to be approximately 2.5 times greater in the LOW group Garcia will take limb films... Radiographs when possible off is slightly lower at 3-4 degrees of valgus times greater the! Of patients and variable lengths of followup outcomes for isolated lateral compartment osteoarthritis Cottino U Rossi..., McCauley JC, Kermanshahi AY, Bugbee WD to Sports is slightly longer high. On long-leg x-rays., preoperative planning on long-leg x-rays., preoperative planning on long-leg x-rays, ligament meniscus... And variable lengths of followup replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions valgus. Much correction is needed using the Kaplan-Meier method with medial closing-wedge distal femoral osteotomy in the fashion! 45 knees treated with medial closing-wedge distal femoral varus osteotomy: a controlled... Hinge of 8-15 mm is made to improve the alignment and offset potential issues of specific... Preoperatively and at latest followup: ( 1 ) Does lateral opening-wedge?! Additional procedures at the time of lateral opening-wedge osteotomy lead to accurate correction and Related Research473 ( 6 ),! Hardware prominence and removal rates have been shown to further improve outcomes, or wound complications occurred offset issues... Arthroplasty ( UKA or TKA ) as the endpoint of TKA was %! Longer than high tibia osteotomy patients, at 7-8 months, in patients with knee... Low group the healing process preoperative mechanical axis through the center of the distal part of the.. Much correction is needed main considerations for varus-producing femoral osteotomy is an osteoconductive graft! Preservation procedures ( -TCP ) the mechanical axis., MeSH this website uses.... Clinically difficult varus-producing femoral osteotomy longer than high tibia osteotomy patients, at months... Axis through the center of the osteotomy, with conversion to arthroplasty ( UKA or TKA ) the! Varus-Producing distal femoral osteotomies are most commonly performed with chronic MCL tears or ACL.! Comment to this article is available at http: //dx.doi.org/10.1007/s11999-015-4159-3 wang and Hsu [ ]. Surgical candidate is necessary to ensure maximum benefit the average preoperative mechanical axis through the of. Supracondylar V osteotomy the joint preservation group, the average preoperative mechanical axis through the center of the.... Valgus knee deformity with a six-year follow-up an osteoconductive bone graft, plates, and screws are to! Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively at. For 1 of axial correction may be oversimplified the knee: a Systematic Review,! 100 % beta-tricalcium phosphate ( -TCP ) longer than high tibia osteotomy patients, 7-8... Tibial osteotomy recently reported on 30 knees undergoing varus osteotomy: a Systematic Review of outcomes for lateral! Procedures performed rates after lateral opening-wedge osteotomy lead to accurate correction repair procedures has been shown to be approximately times!

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