For larger procedures in younger patient full recovery may take longer based on the other procedures performed. Keywords: Patients with a cartilage defect in the lateral compartment who also had medial knee pain were also not deemed candidates for the osteotomy. This realignment moves the force on the arthritis part of the knee to the normal part. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. 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. Further surgery after lateral opening-wedge distal femoral osteotomy. FOIA We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. 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 fact 2 years ago I finished climbing the top 100 peaks in CO. 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). 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). This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. 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. +1 (617) 495 4089. 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. 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 . Careers. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. Bethesda, MD 20894, Web Policies My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Once this is indicated, Dr. Garcia will discuss when this portion of the surgery will occur, or if a separate surgery is needed. [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. 1). Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum.1 Even with evolving fixation strategies and implants, . Generally, these patients are younger than 55 years old. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. This is the first study to our knowledge to look at both of these groups of patients undergoing the same procedure by the same surgeon. 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. Two knees (two patients) underwent a medial closing-wedge osteotomy and were not included in the present study. Accessibility Knee Surg Relat Res. This may be attributable in part to the younger age of this patient population, but it is an important finding nevertheless. The rst is a true Table 1. All mechanical axis measurements for this study were performed by the first author (JIC). Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. It is our goal to provide the highest level of care and service to our patients. PMC 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/. 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. This AP radiograph demonstrates a healed nonunion (left). Federal government websites often end in .gov or .mil. COMPLICATIONS: None. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). 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%]). Additionally, each screw can be pivoted within the plate's mobile bushing system to optimize placement prior to being locked to the plate, creating a rigid construct. ESTIMATED BLOOD LOSS: Minimal. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. This is what this term means. Thirty-eight knees in 36 patients underwent lateral opening-wedge distal femoral varus osteotomy for treatment of symptomatic lateral compartment arthritis (24 knees [63%]) or as an adjunct to an osteochondral allograft or meniscal transplant (14 knees [37%]). Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. 10. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. Would you like email updates of new search results? Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis Show all authors. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. Download Citation | Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures | Background: A locking compression plate (LCP . If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. Dr. Robert F. LaPrade operated on my right knee in May of 2010. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. HSS J. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Before 2). Orthopedic Surgeon & Sports Medicine Specialist 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. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. 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. View Profile, Grant H. Garcia, MD Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. 7. Epub 2021 Oct 27. An official website of the United States government. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. Characteristics of the arthritis and the joint preservation groups. We have found that performing the distal femoral osteotomy and the MCL reconstruction at the same time is successful and does not require two separate reconstructions. Kaplan - Meier survivorship analysis estimates mean survival time of 123 8 months (with 95% confidence interval of 107 - 138) and survival probability at 10 years follow-up is estimated at 78%. Medial closing-wedge distal femoral osteotomy studies report similar results. A 135-case series with minimum 5-year follow-up. 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. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. Distal Femoral Osteotomy. 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. Phil Downer, M.D | Epub 2020 Jul 20. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. and transmitted securely. Also, partial knee replacements of the outside of the knee do not last as long versus inside partial replacement so there is even more reason to consider distal femoral osteotomy compared to knee replacement. The workup of this includes long leg x-rays to confirm that the patient is malaligned and does have valgus alignment, one has an arthroscopic surgery or an MRI to confirm that the cartilage on the inside part of the knee is fairly intact, as well as the majority of the medial meniscus and that one has intact ligaments or plan to reconstruct the ligaments either concurrently or thereafter the osteotomy. Saithna et al. *StimuBlast is a registered trademark of AlloSource. In general, one should be between the ages of 16 (with closed growth plates) and a roughly upper age of 55 to benefit from a distal femoral osteotomy. Patients completed the IKDC preoperatively during their history and physical examination with a lower-extremity reconstruction fellow and nurse clinician and postoperatively during their followup examination with the surgeon (WDB). All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re A survivorship analysis. There are usually 3 main indications for distal femoral osteotomies. 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). Terry GC, Cimino PM. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. 19. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? 16. . 2014. eCollection 2022. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Grant H. Garcia, MD Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. 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. Seattle Shoulder Surgery | [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. Accessibility Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. I can run, bike, & climb mountains. Although similar . 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. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Achieving our desired correction of 3 from neutral alignment was clinically difficult. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. 3. to maintaining your privacy and will not share your personal information without
eCollection 2016 Jun. Postoperatively, 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. The small number of patients included in this study makes it difficult to draw conclusions on the data we present. In general, patients who wish to remain relatively high impact, especially laborers or patients who are still pretty active, or in younger patients, a distal femoral osteotomy would be preferred over a total knee replacement. 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. 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