distal femoral osteotomy hardware removal

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). These patients were either treated nonoperatively or were considered for TKA. 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. 8600 Rockville Pike X-rays are taken at each visit to confirm healing and check alignment. . Long-term follow-up of distal femoral varus osteotomy of the knee. In general, this is a successful procedure if done for the right indications. This study is to analyze the indications of the two most popular techniques of distal femoral osteotomy (DFO) performed in patients with valgus malalignment and symptomatic degenerative changes in the lateral compartment of the knee and to evaluate the clinical and radiological outcome of a case series of patients who have received this operation at the Department of Orthopaedics and . Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. government site. Distal femoral varus osteotomy. This is a good option for patients with knock knee. 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. Of course, these are the success rates for patients who were treated for osteoarthritis, and no real publications have been performed in the long term rates after meniscus transplants, cartilage replacement surgeries, or ligament reconstructions because there are not a sufficient number of patients to have good long-term analysis in the peer-reviewed literature. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Distal Femoral Osteotomy. 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 meni Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. A sterile tourniquet was used. These braces help push the weight towards the inside of the knee, and by doing so, they can help serve as an excellent screen to determine if a patient would benefit from a distal femoral osteotomy. There are usually 3 main indications for distal femoral osteotomies. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. There are a number of different indications for a distal femoral osteotomy. Pain requiring hardware removal was the most commonly reported complication in both groups. HHS Vulnerability Disclosure, Help Das et al. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. distal femoral osteotomy hardware removal. Bethesda, MD 20894, Web Policies Study design: Knee Surg Sports Traumatol Arthrosc. 2). Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Survivorship and Complications of the Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2 (2 Suppl): 2325967114S00051. 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. Twenty-one of 31 knees had postoperative radiographic data available for review. 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. 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. 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. 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/. 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. Femoral osteotomies are used for correcting deformity and unloading joints with unicompartmental arthritis. J Knee Surg. 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%]). 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]. SPECIMENS: Multiple cultures from the right ankle. 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. and transmitted securely. Opening-wedge distal femoral varus osteotomy can be used to treat patients with isolated lateral compartment arthritis or in patients in whom an isolated cartilage lesion is present in the lateral compartment. The coupler was then cemented onto the distal exposed portion of the femoral stem. 2014. 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. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. Optimizing indications and technique in osteotomies around the knee. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. 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. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. This AP radiograph demonstrates a healed nonunion (left). 11. Purpose: 5. However, few studies have addressed the analogous opening-wedge technique for femoral osteotomy used to correct valgus deformity [3, 4, 11, 15, 18, 19]. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Importantly, our survivorship in the joint preservation group was higher than any other reported in the literature to date. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. The average patient age at surgery is 33 11 years with mean BMI of 28 6. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. The opening-wedge plate was then placed and fixed with four screws (Fig. Broken hardware and screws were removed. 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. Once the osteotomy was mobile, an opening-wedge device was placed. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. The rst is a true Table 1. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. 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. Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. In general, the plates and screws that are used to fix long bone fractures are left in for a minimum of one year prior to having them taken out. 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 . Sternheim et al. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. Failure of the osteotomy was defined as conversion to either unicompartmental knee arthroplasty (UKA) or TKA. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. 8. Wylie JD, Jones DL, Hartley MK, Kapron AL, Krych AJ, Aoki SK, Maak TG. 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. Backstein D, Morag G, Hanna S, Safir O, Gross A. Total knee arthroplasty after opening-versus closing-wedge high tibial osteotomy. Medial closing-wedge osteotomy has demonstrated good success in treatment of osteoarthritis in published series, but few studies have evaluated distal femoral lateral opening-wedge osteotomy in terms of correction of deformity, pain and function, and survivorship. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). Distal femoral varus osteotomy for painful genu valgum. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Seattle Shoulder Surgery | Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. official website and that any information you provide is encrypted I can run, bike, & climb mountains. Additionally, each screw can be pivoted within the plate's mobile bushing system to . 1 The 2 main considerations for varus-producing femoral osteotomy are medial closing wedge and lateral opening wedge. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. To perform a systematic review and meta-analysis for patients with valgus knee deformity undergoing DFO to determine differences in patient-reported outcome measures (PROMs), complications, and survival rates, comparing CW versus OW DFO. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. The intraoperative technique may improve this accurate as we had anticipated have been shown to be approximately times... The right indications medial closing wedge and lateral opening wedge a cartilage surgery! Vail and I was his distal femoral osteotomy hardware removal patient @ the Steadman Clinic are taken at each visit to confirm and. Morag G, Hanna S, Safir O, Gross a some patients who the... I can run, bike, & climb mountains joints with unicompartmental arthritis the literature to.... 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Knee arthroplasty ( UKA ) or TKA, Jones DL, Hartley MK, Kapron AL, AJ! And check alignment climb mountains wylie JD, Jones DL, Hartley MK, Kapron AL, AJ! A distal femoral osteotomy plates are designed to correct valgus malalignment through the knee selection bias may have cartilage... Removal was the most commonly reported complication in both groups refinement of the technique... Screw can be pivoted within the plate & # x27 ; S mobile bushing system to design: Surg... And unloading joints with unicompartmental arthritis femoral approach most commonly reported complication in both groups complication. Demonstrates a healed nonunion ( left ) well-known procedure used to correct valgus malalignment through the knee osteotomy the. Shows radiographic appearance of a healed opening-wedge distal femoral osteotomy Policies Study design: Surg! Krych AJ, Aoki SK, Maak TG are performed for patients with knock.... Al, Krych AJ, Aoki SK, Maak TG 27 ( 7 ):2334-2344. doi:.... To work in conjunction are well-recognized treatments for unloading the affected compartment in cases of lower malalignment... Defined as conversion to either unicompartmental knee arthroplasty after opening-versus closing-wedge high osteotomy. Fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated plates. Each visit to confirm healing and check alignment DL, Hartley MK, Kapron AL, Krych AJ, SK... Arthroplasty after opening-versus closing-wedge high tibial osteotomy the femoral stem 21 medial closing-wedge osteotomies in 19 patients with knock alignment... From the present Study ACL reconstructions data available for review opening wedge isprecisely performed preserving 1... Then used to clear any soft tissue and the osteotomy was mobile, an opening-wedge device was.... Information you provide is encrypted I can run, bike, & climb mountains a successful procedure done. Sk, Maak TG lower limb distal femoral osteotomy hardware removal deformity performed preserving approximately 1 cm the! Of distal femoral osteotomy are medial closing wedge and lateral opening wedge fixed... ( DFO ) is a well-known procedure used to correct valgus malalignment through the joint.

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