Wedge Distal Femoral Osteotomy Research Articles

Simplified digital technique for distal femoral osteotomy

A simplified technique for performing an opening wedge distal femoral osteotomy was adapted from a previously described technique of high tibial osteotomy. This technique uses digital radiographic calculations to preoperatively determine both the desired angular correction and correct plate size to avoid intraoperative measurements. The preoperative digital templating technique and operative method for distal femoral osteotomy are described for genu valgum deformity and isolated lateral compartment gonarthrosis.

Midterm results following medial closed wedge distal femoral osteotomy stabilized with a locking internal fixation device

Aim of this study was to evaluate the subjective and radiological outcome and to evaluate the complications of a medial closing wedge osteotomy at the femur for lateral osteoarthritis with genu valgum. Twenty-three patients with grade III to IV cartilage damage and valgus knee alignment were treated with medial closing wedge osteotomy at the distal femur. The osteotomy was stabilized with an internal plate fixator. Age varied between 25 and 55 years (mean 47 years). One patient was lost to final follow-up. After 3.5 years, all Knee Osteoarthritis Outcome Score (KOOS) subitems increased significantly. There was no significant difference in the subgroup analysis of KOOS subitems for patients with and without microfracture or age (>50 vs. <50 years). There were no perioperative complications. One patient had an overcorrection. All, but one osteotomy, showed stable bone healing. There was a loss of correction due to delayed bone healing in one case. Possible explanations for this complication were injury of the lateral cortex or smoking. This case required revision with bone graft and an additional lateral plate. In no case, a conversion to an endoprosthesis was necessary. The femoral medial closing wedge osteotomy is a surgical method for improving symptoms of lateral osteoarthritis in the valgus knee. IV.

Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee

IntroductionOsteotomy aims to reduce pain and the rate of progression of arthritis by correcting deformity and offloading the affected compartment. This study reports the results of a case series of opening wedge distal femoral varus osteotomies for valgus lateral osteoarthritis of the knee. Patients and methodsEighteen patients underwent osteotomy surgery (21 knees) with the aim of correcting the mechanical axis to 48–50% from medial to lateral. ResultsThe mean follow-up for the study population was 4.5years (range 1.6 to 9.2years). Four patients underwent conversion to arthroplasty at a mean time of 3.3years postosteotomy. Kaplan–Meier analysis demonstrates a cumulative survival of 79% at 5years. In the remaining 17 osteotomies, all patients reported that outcome measures improved from baseline. However, only the IKDC and pain subdomain of KOOS showed a statistically significant and clinically relevant difference. Re-operation for non-arthroplasty related surgery was common. In part this was due to symptoms related to prominence of metalwork (10). Other reasons included non-union (1), loss of correction (2), infection (1), and persistent symptoms (2). ConclusionCumulative survival of opening wedge DFVO is comparable with that reported in closing wedge series. Clinically relevant differences in the IKDC and KOOS pain scores suggest that opening wedge DFVO is a useful option in the management of valgus gonarthrosis. However, DFVO is a technically demanding procedure and re-operation, particularly for removal of metalwork, is common.

The effect of lateral opening wedge distal femoral osteotomy on medial knee opening: clinical and biomechanical factors

The case of a patient with knee valgus and instability due to combined ACL-MCL laxity who underwent lateral opening wedge distal femoral osteotomy (DFO) is presented. The symptoms of instability resolved following the surgery. It was unclear whether the increase in valgus stability was related only to a decrease in valgus moments during stance or also to a medial tensioning effect. We therefore performed a laboratory cadaveric study. The purpose of this study was to examine whether after MCL and ACL sectioning, lateral opening wedge DFO would result in decrease in medial opening under static conditions of valgus stress. Medial knee opening under valgus load of 9.8 Nm was tested in 8 cadaveric specimens in scenarios of MCL and ACL sectioning and compared before and after performing lateral opening wedge DFO. When the superficial MCL was sectioned, medial knee opening in 30° flexion decreased after lateral opening wedge DFO compared to medial opening before the osteotomy (i.e. from 6.5 ± 0.5° to 5.6 ± 0.5°, p = 0.01). When the superficial MCL, deep MCL, and ACL were all sectioned, medial knee opening in extension decreased after lateral opening wedge DFO compared to medial opening before the osteotomy but this was not significant (i.e. from 6.8 ± 0.5° to 6.1 ± 0.5°, p = n.s.). In superficial MCL-transected knees, medial laxity at 30° of knee flexion decreased after lateral opening wedge DFO. However, the clinical relevance of the laxity decrease observed remains uncertain since the reduction was small in magnitude.

Distal femoral osteotomy for valgus arthritic knees

BackgroundPatients with genu valgum and isolated osteoarthritis of the lateral compartment are candidates for distal femoral varus osteotomy. Opening wedge osteotomy is a precise method to realign the knee axis with good short to midterm results. The aim of this study was to evaluate the outcome of patients who have had opening wedge distal femoral varus osteotomy utilizing the Puddu plate (Arthrex, Naples, FL, USA) fixation. MethodsThe study included 6 patients (7 knees) followed for an average of 6.5 ± 1.5 years after distal femoral varus osteotomy with Puddu fixation and iliac crest allograft. Clinical outcome was assessed by the Oxford Knee Score and subjective satisfaction rating. Pre- and postoperative radiographs were evaluated for tibiofemoral angle, Insall-Salvati index and Kellgren-Lawrence Grading Scale for osteoarthritis. ResultsThe mean age at surgery was 46.7 ± 10.7 years. The mean body mass index at surgery was 29.6 ± 5.6 kg/m2. Overall at the last follow-up the mean Oxford Knee Score improved from 13.1 ± 8.6 to 26 ± 12.5. The average subjective satisfaction rate at the last follow-up was 6.6 ± 2.8. The measured tibiofemoral angle was corrected by an average of 11.9°. There was no worsening of arthritic changes in comparison to the preoperational radiographs. All radiographs showed full incorporation of the bone grafts, and there were no hardware failures. At the end of this study none of the patients required additional surgery, and none had knee replacement. ConclusionsOpening wedge distal femoral varus osteotomy with Puddu plate fixation can be a reliable procedure for the treatment of lateral compartment osteoarthritis of the knee associated with valgus deformity.

Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement

The goal of this study was to document the outcome at midterm follow-up of 19 patients treated for lateral osteoarthritis of the knee between 1999 and 2007. It was our hypothesis that the results and complication rate would be comparable to or better than those reported in the literature for closing wedge or alternative open wedge techniques. All patients underwent an open wedge distal femoral varisation osteotomy using the Puddu plate system combined with calcium phosphate injection into the defect. Knee Society Knee Score and Kellgren-Lawrence osteoarthritis score were assessed preoperatively and at final follow-up. The average knee score improved significantly from 43 ± 8 preoperatively to 78 ± 23 at final follow-up. The Kellgren-Lawrence osteoarthritis score remained unchanged. Kaplan-Meier analysis using revision surgery or conversion to TKA as an endpoint demonstrated an 82% successful survivorship at 7 years of follow-up. Based upon these results, we believe that a distal femoral varisation osteotomy using the Puddu plate and injectable bone cement is an equivalent treatment option compared to closing wedge techniques and leading to good results at midterm follow-up in patients with lateral gonarthrosis and valgus alignment. IV.