distal femoral osteotomy hardware removal

20. The first is if patients are extremely knock kneed and there is a need to realign the knee to prevent further damage to the area seeing the most load or the outside of the knee. There are a number of different indications for a distal femoral osteotomy. Future studies with more patients and longer followup will provide clarity on this topic. Would you like email updates of new search results? sharing sensitive information, make sure youre on a federal Some distal femoral osteotomies involve taking out bone where you let the . Dr. Robert F. LaPrade operated on my right knee in May of 2010. 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. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. View Doctor Profile. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. 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. 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. 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. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . 3. 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. 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 . While rates of required hardware removal secondary to these complications were as high as 72% in 1 group, 7 all remaining articles reported lower rates of hardware removal. Patients in both groups demonstrated improvements in the IKDC pain and function scores from preoperatively to postoperatively. 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. 4010 W. 65th St. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. Patients who are bowlegged are in varus alignment. Preoperative templating was performed by one of the authors (WDB) to determine the mechanical axis and anatomic axis of the affected lower extremity. [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. (15.6%), and 5 had hardware removed (15.6%). Pain requiring hardware removal was the most commonly reported complication in both groups. J Knee Surg. An 8- to 10-cm incision was made on the lateral distal femur from the lateral epicondyle proximally. 3, 4) and was ultimately converted to a TKA. Another study on the opening-wedge technique [15] reported that the position of the weightbearing axis through the tibial plateau was changed from 75% preoperatively to 37% postoperatively when measured from medial to lateral. Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. Twenty-one of 31 knees had postoperative radiographic data available for review. The survival rate for CW DFO was 81.5% (mean follow-up, 8.8 4.3 years) compared with 90.5% for OW DFO (mean follow-up, 4.5 1.5 years). Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. In situations involving lateral unicompartmental arthritis unresponsive to conservative treatment options, the Distal Femoral Opening Wedge Osteotomy System is a safer, more reproducible alternative to traditional closing wedge distal femoral osteotomies. 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. doi:10.1177/2325967114S00051. Orthopedic Surgeon & Sports Medicine Specialist FOIA 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. Call Us Today (888) 260-0449 Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than expected, but the procedure was associated with improved knee pain and function scores. Background: Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. There are usually 3 main indications for distal femoral osteotomies. Clin Sports Med. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. SPECIMENS: Multiple cultures from the right ankle. government site. 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. 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. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. For those with arthritis the success rates are 75% patients at 10 years are pain free and do not undergo knee replacement. Arthroscopy. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. Of the 31 knees, 20 (14 in the arthritis group and six in the joint preservation group) had preoperative mechanical axis measurements and 21 (15 in the arthritis group and six in the joint preservation group) had postoperative mechanical axis measurements. Unable to load your collection due to an error, Unable to load your delegates due to an error. TOURNIQUET TIME: 40 minutes. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. 8600 Rockville Pike This site needs JavaScript to work properly. a A valgus knee with the mechanical axis., MeSH 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. 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. Survivorship at 74 months with the endpoint of TKA was 83%. 2021. Given . Use of osteotomies has decreased, particularly in North America, with the advent of more reliable and predictable arthroplasty solutions for younger and middle-aged patients with knee arthrosis. 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. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. 18. In fact 2 years ago I finished climbing the top 100 peaks in CO. 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). Bookshelf Unfortunately, pre-bending the plate may not always be successful at eliminating future hardware irritation in smaller patients, so these patients may have to wait until the osteotomy is completely healed and a minimum of one year after surgery prior to having the plate and screws that are causing any of the hardware irritation removed. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. 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). 5. Epub 2018 Oct 5. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. Your message has been successfully sent to your colleague. You may be trying to access this site from a secured browser on the server. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. Other than concurrently either adding bone or taking out bone, there may not be a big difference between either technique. Phil Downer, M.D | 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. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. White dotted line: mechanical axes of the femur. Please try after some time. It is our goal to provide the highest level of care and service to our patients. The aim of this study was to report the occurrence of . Backstein D, Morag G, Hanna S, Safir O, Gross A. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. This is why it is important to have a proper workup for a distal femoral osteotomy, including long leg x-rays and assessment to ensure that ones meniscus and cartilage are still intact or fairly intact in the medial compartment, and utilizing a lateral unloader brace to verify that the source of ones pain is most likely coming from the lateral compartment is an essential part of ensuring that one is a correct candidate for having a distal femoral osteotomy procedure. 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. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Please enable it to take advantage of the complete set of features! 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. Good to excellent clinical outcomes were reported in PROMs when compared with preoperative values with both techniques, while no significant differences between techniques were appreciated on functional Knee Society Scores and Tegner scores. 11. Pain and function were measured preoperatively and postoperatively using the International Knee Documentation Committee (IKDC) score. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. The indications for osteotomy included symptomatic lateral compartment arthritis with clinical valgus deformity or a cartilage or meniscal defect in the lateral compartment with clinical valgus alignment. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Its combination with various cartilage repair procedures has been shown to further improve outcomes. Patients with a cartilage defect in the lateral compartment who also had medial knee pain were also not deemed candidates for the osteotomy. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. 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. In total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. 2021 Oct;29(10):3299-3309. doi: 10.1007/s00167-020-06166-3. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. [ 20 ] reported on 30 knees undergoing varus osteotomy with a blade... Javascript to work properly to access this site needs JavaScript to work properly are. Your collection due to an error Some patients who have arthritis on the server in both groups demonstrated improvements the. May not be a very effective surgery and delay the need for a standard partial knee.! Vastus medialis is incised and retracted laterally and anteriorly to expose the shaft... The alignment and offset potential issues of the fracture it is recommended to close the osteotomy... 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