distal femoral osteotomy hardware removal

The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Dr. Robert F. LaPrade operated on my right knee in May of 2010. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. The success rate of distal femoral osteotomies is felt to be about 70% to 75% at 10 years. 6. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. Distal femoral varus osteotomy for painful genu valgum. your express consent. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. 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. a A valgus knee with the mechanical axis., MeSH The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Wang JW, Hsu CC. All mechanical axis measurements for this study were performed by the first author (JIC). However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. 11. 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. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. 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. 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. 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. Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than we expected, but the procedure was associated with improved pain and function and a 5-year survivorship of 74% and 92% in the arthritis and joint preservation patient cohorts, respectively. There was one nonunion. The authors concluded that osteotomy was indicated in younger (mean, 46 years) high-activity patients, but after 20 years most patients were converted to TKA. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Saithna et al. 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. Preoperatively, the amount of correction was estimated using a simplified calculation of 1 mm of linear correction at the osteotomy site to 1 of correction of axial alignment. 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. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Das et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. Would you like email updates of new search results? The median preoperative valgus angle was 6.1 valgus (range 2-15.5). Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. 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. Time to radiographic union, complications, and reoperations were captured. A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. The correction was slowly created. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. Osteosynthesis with a malleable implant. 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. 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%]). 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. Dr. Garcia will take limb alignment films to identify have much correction is needed. This website uses cookies. Additionally, each screw can be pivoted within the plate's mobile bushing system to . Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. HHS Vulnerability Disclosure, Help 2 Here we will focus on lateral opening wedge osteotomy (), its stated advantages and disadvantages, surgical indications, preoperative planning, surgical technique, and . The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. 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. See this image and copyright information in PMC. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). 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. Careful selection of each surgical candidate is necessary to ensure maximum benefit. Survivorship at 5 years, with conversion to arthroplasty as the endpoint, was 74% in the arthritis group and 92% in the joint preservation group. The site is secure. White continuous lines: femur and tibia joint line. Hardware removal, yes (%) 65 (66) 37 (59) 28 (80) Timing of hardware removal, years (SD) 1.0 (0. . Wolters Kluwer Health Seven knees in six patients were lost to followup before 2 years and were excluded. 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. Emed Res 2: 100013. . 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. 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. Supracondylar osteotomy of the femur with use of compression. A 135-case series with minimum 5-year follow-up. Contact administrator regarding this item (to report mistakes or request changes), e: Disclaimer, National Library of Medicine Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. These studies report the correction of deformity and the pain and function of small cohorts of patients undergoing a medial closing-wedge distal femoral osteotomy for treatment of lateral compartment arthritis. 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. to maintaining your privacy and will not share your personal information without The entire limb, including the iliac crest, was prepped and draped free. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. Terry GC, Cimino PM. Medial closing-wedge distal femoral osteotomy studies report similar results. 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. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. Please enable it to take advantage of the complete set of features! In general, this is a successful procedure if done for the right indications. Once the osteotomy was mobile, an opening-wedge device was placed. Before 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. Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. Its combination with various cartilage repair procedures has been shown to further improve outcomes. Sternheim et al. Thank you for choosing Dr. LaPrade as your healthcare provider. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). 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). Survivorship at 74 months with the endpoint of TKA was 83%. J Knee Surg. 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. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years.

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