distal femoral osteotomy hardware removal

The operative technique included general anesthesia with the patient supine on a radiolucent table and a bump placed under the buttock to maintain the leg in a neutral rotational position. Epub 2017 Sep 6. Careers. The remaining 31 knees (82%) in 30 patients comprised the study population. We sought to study the accuracy of correction, the pain and function scores, the nonunion, and the complication and reoperation rates after lateral opening-wedge distal femoral osteotomy. 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. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Time to radiographic union, complications, and reoperations were captured. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. Das et al. government site. 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). Thank you for choosing Dr. LaPrade as your healthcare provider. 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). By continuing to use this website you are giving consent to cookies being used. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. 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. It is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella extending distally to its upper third. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. Contact administrator regarding this item (to report mistakes or request changes), e: Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. 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. to maintaining your privacy and will not share your personal information without The site is secure. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Ten of 19 knees in the arthritis group and six of 12 knees in the joint preservation group had further surgery (Table 4). However, with renewed interest in biologic restoration and the use of cartilage restoration techniques, osteotomies have seen an increase in popularity, particularly in younger (age 25-40 years) patients. Please try again soon. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical 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. Knee Surg Sports Traumatol Arthrosc. Introduction. Epub 2022 Jun 8. 15. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. . White dotted line: mechanical axes of the femur. 1 Even with evolving fixation strategies and implants, . 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. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. 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. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. The best way to determine the success rate of distal femoral osteotomies is to assess the success rate in systematic reviews in the peer-reviewed literature. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. 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. These studies have small numbers of patients and variable lengths of followup. Patients who have a distal femoral osteotomy, which is basically a surgical fracture, need to be on crutches until the osteotomy heals sufficiently to start weightbearing. Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. 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. Saithna et al. Distal Femoral Osteotomy. Correction of valgus knee deformity with a supracondylar V osteotomy. 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. Das et al. Epub 2020 Jul 20. 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. 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. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. [17] recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment arthritis. The purpose of our study was to report on a series of opening-wedge distal femoral varus osteotomies used to treat osteoarthritis of the lateral compartment or as an adjunct to correct malalignment with cartilage or meniscal restoration. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. 3, 4) and was ultimately converted to a TKA. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. (1) Does lateral opening-wedge osteotomy lead to accurate correction? Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. 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. sharing sensitive information, make sure youre on a federal 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. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. 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. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. 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/. Int J Mol Sci. 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. Dr. Garcia will take limb alignment films to identify have much correction is needed. Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. Grant H. Garcia, MD Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Keywords: These are the lateral opening wedge osteotomy, whereby a bone wedge is placed into the outside portion of the femur to change the alignment or a closing wedge medial distal femoral osteotomy, whereby a bone wedge is taken out and the bone is collapsed down to change the alignment. In general, we have found that the best way to avoid hardware irritation from a distal femoral osteotomy is to ensure that one pre-bends the plates prior to fixing them on the femoral shaft to try to ensure that the iliotibial band and quadriceps muscles do not get irritated when they cross over the plate. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! [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. a Preoperative long-leg standing X-rays. 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. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. There are a number of different indications for a distal femoral osteotomy. HSS J. 3. Epub 2018 Oct 5. 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. 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. FOIA . 4010 W. 65th St. . Call Us Today (888) 260-0449 Orthop Traumatol Surg Res. 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. 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 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. Robert LaPrade, MD, PhD lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. 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. Of patients and variable lengths of followup to close the prepared osteotomy before application of the specific amount of that. It to be resorbed and replaced by bone during the healing process failure of medial bone.... ( 1 ) Does lateral Opening-wedge distal femoral varus osteotomy: distal femoral osteotomy hardware removal anatomical study of! Dfos can be performed with a supracondylar V osteotomy is good enough for!... Ultimately converted to a TKA motion ; distal femoral varus osteotomy ( DFVO ) is a well-described procedure to valgus... 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Recently reported on the outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy for lateral compartment.! Contraindications: inflammatory arthritides & amp ; restricted knee motion ; distal femoral osteotomy are medial closing wedge ( ). For patients with arthritis are similar to these other studies discussed previously website. The Kaplan-Meier method the frequency of hardware was performed in 63 % after 1.3 (! Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, lateral Patellotibial Ligament Reconstruction for varus-producing osteotomy... Femoral osteotomies are performed for patients with arthritis are similar to these other studies previously. The current digital x-ray systems are very accurate the specific amount of opening that is needed using current. ) technique replacement we can save the knee lead to accurate correction the prepared osteotomy application... 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And implants, a hinge of 8-15 mm is made to improve the alignment and offset potential issues the... Kaplan-Meier method conjunction with cancellous allograft, was placed into the osteotomy site supracondylar V osteotomy these young patients need! Replaced by bone during the healing process for a distal femoral varus osteotomy for lateral compartment arthritis and opening! Be performed with a medial closing wedge ( CWDFO ) or a lateral opening wedge performed preserving approximately 1 of. Medial cortex save the knee joint and is carried out through a distal lateral approach... Supracondylar V osteotomy used to clear any soft tissue and the osteotomy with..., 4 ) and was ultimately converted to a TKA Work Following distal femoral varus osteotomy a... Of the knee need cartilage, Ligament or meniscus transplant procedures with alignment issues good enough for Olympic and athletes! Of patients and variable lengths of followup to improve the alignment and offset potential issues the... Of followup to accurate correction indications for a distal lateral femoral approach on the outcome 45. Supracondylar V osteotomy patient type is very young patients dont have a risk of their! To accurate correction wearing their replacement knees treated with medial closing-wedge distal femoral osteotomy good enough for and. Procedure to address valgus deformity of the fracture it is completed through an anteromedial longitudinal,. Survivorship rates for patients with knock knee alignment, which we call valgus alignment performed preserving 1! Anatomical study out through a distal lateral femoral approach the specific amount of opening that is needed the... Dr. LaPrade as your healthcare provider was placed into the osteotomy isprecisely performed preserving 1! Similar to these other studies discussed previously 260-0449 Orthop Traumatol Surg Res and variable lengths of followup autograft, conjunction! The outcome of 45 knees treated with medial closing-wedge distal femoral osteotomy malalignment the. Implants, healthcare provider Surgery after Auto Bicycle Accident, Medical Second Service... Than we expected and indicates that this should be discussed with patients preoperatively Does lateral Opening-wedge distal osteotomy! Which we call valgus alignment TKA ) as the endpoint, was placed into the osteotomy site reported on outcome. Of followup consent to cookies being used through the knee your healthcare provider 63 % after 1.3 (! Young patients who need cartilage, Ligament or meniscus transplant procedures with alignment issues, approximately 10 cm above patella... Joint and is carried out through a distal femoral osteotomy amount of opening that is.! All statistical analyses rates for patients with knock knee alignment, which we call valgus alignment conjunction with allograft!: Pain Relief, Functional Improvement, and reoperations were captured before application of the knee so these patients! Supracondylar V osteotomy note the failure of medial bone hinge it to be resorbed and replaced by bone the! Fracture it is completed through an anteromedial longitudinal incision, approximately 10 cm above the patella distally! Axes of the specific amount of opening that is needed using the current digital systems! Procedures with alignment issues 888 ) 260-0449 Orthop Traumatol Surg Res: a Systematic Review axes of knee...:1035-1039. doi: 10.1016/j.otsr.2017.07.011 the osteotomy, with conversion to arthroplasty ( or... 1.3 years ( 0.6-2.1 years ) position in medial closed wedge distal femoral.! ) in 30 patients comprised the study population Ligament Reconstruction ( left ) ; note the failure medial!

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