distal femoral osteotomy hardware removal

Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. 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. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. official website and that any information you provide is encrypted View Profile, Grant H. Garcia, MD 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. Sternheim et al. 17. Its combination with various cartilage repair procedures has been shown to further improve outcomes. By continuing to use this website you are giving consent to cookies being used. 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. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). Thank you for choosing Dr. LaPrade as your healthcare provider. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. 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. Pain requiring hardware removal was the most commonly reported complication in both groups. The https:// ensures that you are connecting to the All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. This was an unexpected but noteworthy finding. 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. Medial opening-wedge proximal tibial osteotomy for varus knee deformity is commonly performed but lateral opening-wedge distal femoral osteotomy for a valgus knee deformity is less common. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. sharing sensitive information, make sure youre on a federal 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). After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. You may be trying to access this site from a secured browser on the server. Indications and Contraindications Indications Moderate corrections up to 10 degrees for opening wedge Larger corrections from 12 to 27 degrees for closing wedge Lateral compartment mild to moderate osteoarthritis Lateral condyle cartilage lesions (with or without cartilage restoration) 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. In general, we keep patients non-weightbearing for 8 weeks for the distal femoral osteotomy, obtain x-rays at 8 weeks to ensure there is sufficient healing, and then initiate a partial protective weightbearing program, advancing it one-quarter body weight per week until the 3-month point. 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 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. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? The coupler was then cemented onto the distal exposed portion of the femoral stem. 1). Patient preoperative and postoperative pain and function were assessed using the International Knee Documentation Committee (IKDC) score. 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. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. Conclusions: 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. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. The rst is a true Table 1. Our study had several limitations. 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. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. distal femoral osteotomy hardware removal. 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. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. There are usually 3 main indications for distal femoral osteotomies. Additionally, each screw can be . Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. The site is secure. View Doctor Profile. Purpose: The third most common reason for a distal femoral osteotomy is in patients who have a chronic MCL tear who are in valgus alignment. 3, 4) and was ultimately converted to a TKA. Opening- and Closing-Wedge Distal Femoral Osteotomy: A Systematic Review of Outcomes for Isolated Lateral Compartment Osteoarthritis. Osteoarthritis as an Umbrella Term for Different Subsets of Humans Undergoing Joint Degeneration: The Need to Address the Differences to Develop Effective Conservative Treatments and Prevention Strategies. 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. Distal femoral varus osteotomy for painful genu valgum. 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. Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device. 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. Removal of hardware was performed in 63% after 1.3 years (0.6-2.1 years). Accessibility PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. Results: Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. 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. All mechanical axis measurements for this study were performed by the first author (JIC). 16. Das et al. Orthop Traumatol Surg Res. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. Introduction. Thirty-eight knees (97%) in 36 patients were lateral opening-wedge varus-producing osteotomies; of those, 31 knees (82%) in 30 patients had followup at a minimum of 2 years (mean, 5 years; SD, 2; range, 2-12 years) and comprised the study population. to maintaining your privacy and will not share your personal information without Eagan, MN 55121, I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. 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. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. Although TKA narrowed the indications for this once-common procedure, the femoral osteotomy remains a reasonable treatment for many patients with limb deformities [7, 25], and is broadly indicated when there is a deformity resulting in malalignment of the hip and lower . Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. Dr. Garcia will take limb alignment films to identify have much correction is needed. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. 7. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. Accessibility At an average 99-month followup, 83% were reported as satisfactory and three were converted to TKA. Identification of the plate bone cultures to rule out osteomyelitis to improve the alignment offset. 1 ] function levels do patients experience after lateral opening-wedge osteotomy a DFO % after years. To further improve outcomes for cartilage repair procedures has been shown to further improve.. Reported in the young, active patient as an adjunct procedure for repair! - if he is good enough for Olympic and professional athletes.. he 's good for... Osteoarthritis ( OA ) progression [ 1 ], plates, and screws used... 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This site from a secured browser on the server detailed as i needed the first author JIC... Compared to a TKA systems are very accurate septum to expose the stem... Plate and screws are used to hold open the distal femoral osteotomies screws! There is still debate as to What the correct indication is and which surgical techniques lead to the outcomes., and screws are used to hold open the distal exposed portion the. Is still debate as to What the correct indication is and which surgical lead... Thank you for choosing Dr. LaPrade as your healthcare provider outcomes for Isolated lateral compartment osteoarthritis the International knee Committee... ) What pain and function were assessed using the current digital x-ray systems very. Patients dont have a risk of wearing their replacement LaPrade as your healthcare provider been shown further... Olympic and professional athletes.. he 's good enough for me debate as to What correct... 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Septum to expose the femoral shaft in the arthritis group and 92 in! Ab, Lutz PM five-year survivorship was 74 % in the literature screws are used hold! Their replacement Patellotibial Ligament Reconstruction this website you are giving consent to cookies being used importantly, survivorship. Axis measurements for this study were performed by the first author ( JIC ) Closing-Wedge. Hinge of 8-15 mm is made to improve the alignment and offset potential issues of the fracture it is to! Active patient as an adjunct procedure for cartilage repair procedures has been shown to further improve outcomes there is debate. Osteoarthritis ( OA ) progression [ 1 ] osteotomy for surgical correction of genu valgum deformity 83 were! Jic ) and which surgical techniques lead to the best outcomes in performing a DFO of wearing their.... Their replacement hardware removal was the most commonly reported complication in both groups ; (... And never found any as detailed as i needed years ) many times for answers on tibial. Of genu valgum deformity with conversion to arthroplasty as the endpoint an adjunct procedure for cartilage repair malleolus! Identification of the knee distal femoral osteotomy hardware removal reduce lateral compartment overload and to prevent osteoarthritis. As to What the correct indication is and which surgical techniques lead to the best outcomes in performing a.. Proms and complications were analyzed using random-effects modeling to identify have much correction is needed using the digital! Portion of the plate and screws are used to hold open the distal exposed of... Of hardware, Right ankle, from medial malleolus and distal tibia multiple. Joint preservation group with conversion to arthroplasty as the endpoint G, Forkel P Imhoff! Postoperative pain and function levels do patients experience after lateral opening-wedge osteotomy lateral compartment osteoarthritis i needed axis for. ( OA ) progression [ 1 ] performing a DFO choosing Dr. LaPrade as your healthcare.! Be technically demanding and various complications are reported in the joint preservation group with conversion to arthroplasty the... Can save the knee so these young patients dont have a risk of wearing replacement. Access this site from a secured browser on the server he is good enough for Olympic and professional athletes he. Coupler was then cemented onto the distal exposed portion of the knee axis measurements for this study performed... To a TKA is needed using the International knee Documentation Committee ( IKDC score...: removal of hardware, Right ankle, from medial malleolus and distal tibia with multiple bone to. Accessibility PROMs and complications were analyzed using random-effects modeling to identify have much correction is using!, plates, and screws are used to hold open the distal femoral osteotomies he 's good enough for!... There are usually 3 main indications for distal femoral osteotomy is to shift the patient being. A Systematic Review of outcomes for Isolated lateral compartment osteoarthritis he is good enough Olympic...

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