Wayne M. Weil, M.D | Supracondylar osteotomy of the femur with use of compression. 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. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). 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. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. 2019 Jul;38(3):351-359. doi: 10.1016/j.csm.2019.02.004. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. . 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. This site needs JavaScript to work properly. The mean postoperative mechanical axis was 2 varus (SD, 4; range 5 valgus to 7 varus) for the arthritis group and 2 varus (SD, 4; range 4 valgus to 6 varus) for the joint preservation group. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? Conclusions: Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. 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). Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. Fourteen of 19 knees in the arthritis group and nine of 12 knees in the joint preservation group underwent concurrent procedures at the time of distal femoral opening-wedge osteotomy (Table 3). All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. 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. 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]. Orthop J Sports Med. In the joint preservation group, the mean IKDC pain score improved from 6 (SD, 1) to 2 (SD, 2), the mean IKDC function score improved from 3 (SD, 3) to 6 (SD, 2), and the mean total IKDC score improved from 36 (SD, 12) to 62 (SD, 18). Clin Orthop Relat Res. 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. 15. View Doctor Profile. Bookshelf The calculation of 1 mm of linear correction for 1 of axial correction may be oversimplified. 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). 2700 Vikings Circle Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. 3. *StimuBlast is a registered trademark of AlloSource. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. Knee Surg Sports Traumatol Arthrosc. Survivorship at 74 months with the endpoint of TKA was 83%. sharing sensitive information, make sure youre on a federal Time to radiographic union, complications, and reoperations were captured. EDINA- CROSSTOWN OFFICE However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. Federal government websites often end in .gov or .mil. Additionally, each screw can be . The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. Our reoperation and survivorship rates for patients with arthritis are similar to these other studies discussed previously. [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. We offer 1 hour response time for Mold Remediation and Mold Inspection Services in Vallejo, CA and Surrounding areas. [4] reported that four of 19 patients who had an opening-wedge osteotomy underwent hardware removal, one patient underwent fracture fixation, and two patients were converted to TKA. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. 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. Data is temporarily unavailable. Further surgery after lateral opening-wedge distal femoral osteotomy. Its combination with various cartilage repair procedures has been shown to further improve outcomes. 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. DFO to correct genu valgum has traditionally been completed through a medial closing wedge distal femoral osteotomy (MCWDFO). 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. A sterile tourniquet was used. HSS J. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. A survivorship analysis. Epub 2022 Jun 8. Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. your express consent. 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. 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. Disclaimer, National Library of Medicine 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. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. 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. Book an appointment today! Based on these studies, a wide variation exists in the amount of correction as well as the final alignment correction achieved. A 57-year-old man presented to our orthopedic outpatient . 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. 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 realignment moves the force on the arthritis part of the knee to the normal part. 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 . Emed Res 2: 100013. . Seattle Shoulder Surgery | I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. In the arthritis group, the mean IKDC pain score improved from 6 (SD, 2) to 3 (SD, 3), the mean IKDC function score improved from 4 (SD, 1) to 7 (SD, 2), and the mean total IKDC score improved from 47 (SD, 15) to 67 (SD, 10). This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at, Creative Commons Attribution 4.0 International License, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597517/pdf/, http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA, http://nrs.harvard.edu/urn-3:HUL.InstRepos:23845128. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. 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. 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. Phil Downer, M.D | This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. eCollection 2016 Jun. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. [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 Even with evolving fixation strategies and implants, . View Profile, Grant H. Garcia, MD 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 work was performed at Scripps Clinic, La Jolla, CA, USA. The distal femur was resected en bloc . 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. The indications for osteotomy included symptomatic lateral compartment arthritis with valgus deformity or an isolated cartilage defect in the lateral compartment with valgus or minimal varus alignment. Grant H. Garcia, MD 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. After surgery patients are non-weight bearing for 6 weeks. 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. Long-term follow-up of distal femoral varus osteotomy of the knee.