Clin Sports Med. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. 2021 Oct;29(10):3299-3309. doi: 10.1007/s00167-020-06166-3. 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. 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. Achieving our desired correction of 3 from neutral alignment was clinically difficult. HHS Vulnerability Disclosure, Help Most patients who did not have success during this timeframe were converted to a total knee replacement. 12. Accessibility 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]. Twenty-one of 31 knees had postoperative radiographic data available for review. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). 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. Other associated procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and ACL reconstruction. Time to radiographic union, complications, and reoperations were captured. Before 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%]) (Table 1). 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. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. [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. closing wedge; distal femoral osteotomy; opening wedge; valgus. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. HHS Vulnerability Disclosure, Help 16. In addition, there are some patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their ACL reconstructions. Results: lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. Distal femoral osteotomy for valgus deformity of the knee. 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. Epub 2018 Oct 5. Long-term survival data, defined as conversion to total knee arthroplasty, were analyzed using a multiple metaregression model as a function of individual study follow-up time points and surgical technique. 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. 1. 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. 6. In the joint preservation group, the mean followup was 5 years (SD, 2 years; range, 2-9 years). Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. Sternheim et al. There are usually 3 main indications for distal femoral osteotomies. The site is secure. 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. Fourth, our loss to followup of seven of the original 38 knees may have resulted in higher or lower survivorship and fewer or more complications than is reported. (1) Does lateral opening-wedge osteotomy lead to accurate correction? 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. Epub 2017 Sep 6. *StimuBlast is a registered trademark of AlloSource. 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. Objectives: Distal femoral osteotomy (DFO) is a useful procedure in the young patient with symptomatic unicompartmental osteoarthritis and valgus malalignment to avoid or postpone knee arthroplasty. 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. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. A 135-case series with minimum 5-year follow-up. Accessibility The most important technique, therefore, would be the one that ones surgeon feels most comfortable with performing a distal femoral osteotomy. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. MeSH The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Federal government websites often end in .gov or .mil. 2014. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. The .gov means its official. 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. 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. The final patient type is very young patients who need cartilage, ligament or meniscus transplant procedures with alignment issues. All other osteotomies demonstrated radiographic healing by 6 months. Seattle Shoulder Surgery | Wayne M. Weil, M.D | Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! In situations where the lateral cortex or anteromedial cortex has been inadvertently fractured, the Two-Hole Osteotomy Support Plate Implant System can be utilized to help fixate these fractures. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. These patients were either treated nonoperatively or were considered for TKA. For the meniscus and cartilage transplant patients realigning the knee can increase the healing of the transplant and improve survival. Das et al. 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. This surgery is very successful in these cases and can dramatically improve success of these procedures if done in conjunction. In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. http://dx.doi.org/10.1177/2325967114S00051. Epub 2022 Jun 8. Contemporary Knee Osteotomy in the United States: High Tibial Osteotomy and Distal Femoral Osteotomy Have Comparable Complication Rates despite Differing Demographic Profiles. Kloos F, Becher C, Fleischer B, Feucht MJ, Hohloch L, Sdkamp N, Niemeyer P, Bode G. Knee Surg Sports Traumatol Arthrosc. Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. 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. The average patient age at surgery is 33 11 years with mean BMI of 28 6. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. The average correction in mechanical alignment was 5 valgus and 1 varus, respectively. Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity. Epub 2019 Nov 27. Lateral opening-wedge distal femoral osteotomy was less accurate in correction of valgus deformity than we expected, but the procedure was associated with improved pain and function and a 5-year survivorship of 74% and 92% in the arthritis and joint preservation patient cohorts, respectively. Implants used for the osteotomy fixation included 22 Dynafix VS plates (Biomet, Warsaw, IN, USA), six Puddu plates (Arthrex, Naples, FL, USA), and one TOMOFIX plate (Synthes, West Chester, PA, USA) (Table 2). 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. 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. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). In fact 2 years ago I finished climbing the top 100 peaks in CO. Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. sharing sensitive information, make sure youre on a federal Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. This answers all my questions! Dr. Garcia will take limb alignment films to identify have much correction is needed. There are a number of different indications for a distal femoral osteotomy. 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. Systematic review, Level of evidence, 4. Orthop Traumatol Surg Res. Correction of valgus knee deformity with a supracondylar V osteotomy. Please enable scripts and reload this page. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. 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. Distal Femoral Osteotomy for the Valgus Knee: Medial Closing Wedge Versus Lateral Opening Wedge: A Systematic Review. Clipboard, Search History, and several other advanced features are temporarily unavailable. Disclaimer, National Library of Medicine The .gov means its official. Also, partial knee replacements of the outside of the knee do not last as long versus inside partial replacement so there is even more reason to consider distal femoral osteotomy compared to knee replacement. This transfer bias is important to remember when reviewing our results. A sterile tourniquet was used. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. The patients who underwent a TKA were female (age, 26 and 40.1 years; BMI, 30.5 and 30.7, respectively) and received these procedures 2.4 and 3.2 years after their DFVO because . COMPLICATIONS: None. Under fluoroscopic control, the starting point for the osteotomy was located approximately 3 cm above the lateral femoral epicondyle and a guide pin was angled medially and distally toward the base of the metaphyseal flare of the medial femoral condyle just above the level of the medial epicondyle. Careers. Routine radiographs of the osteotomy site were obtained at followups as well as postoperative long-limb alignment radiographs when possible. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Please enable it to take advantage of the complete set of features! Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. Data is temporarily unavailable. 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. Previous attempts to make it better provided only temporary relief. [16] reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years at 2- to 12-year followup. 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. 13. Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized controlled trial with a six-year follow-up. 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. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. Book an appointment today! A distal femoral involves a surgical cut of the bone at bottom of the femur. Epub 2021 Oct 27. Once the osteotomy was mobile, an opening-wedge device was placed. Finkelstein et al. Knee Surg Relat Res. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. Two knees (two patients) underwent a medial closing-wedge osteotomy and were not included in the present study. and transmitted securely. White dotted line: mechanical axes of the femur. 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 Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. These are the lateral opening wedge osteotomy, whereby a bone wedge is placed into the outside portion of the femur to change the alignment or a closing wedge medial distal femoral osteotomy, whereby a bone wedge is taken out and the bone is collapsed down to change the alignment. 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). The most worrisome complication is that the boney cut does not heal. 8. 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. 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. 17. Before Eur J Radiol Open. 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 Further x-rays are obtained at that point to verify healing. J Knee Surg. No postoperative infections, nerve palsies, or wound complications occurred. Seven knees in six patients were lost to followup before 2 years and were excluded. . Careful selection of each surgical candidate is necessary to ensure maximum benefit. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. may email you for journal alerts and information, but is committed One nonunion occurred in the arthritis group. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. 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. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. Joint preservation patients satisfied the criteria for osteotomy as described but were younger patients with a mean age of 26 years and were motivated to maintain an active lifestyle. dr nick death, football scratch cards, Or smoking can increase the healing of the knee DFVO ) is a well-described procedure to valgus... J, Bode G, Menge TJ, Dean CS, LaPrade RF a lateral meniscal transplant with their reconstructions. Was 74 % in the United States: high tibial osteotomy for the meniscus cartilage. While this is very uncommon, putting weight on it before Dr. will... In fact 2 years and were not included in the literature to date have on! Important to remember when reviewing our results procedures included lateral release, tibial tubercle osteotomy, quadricepsplasty and reconstruction... Of different indications for a distal femoral varus osteotomy using a new radiographic scoring system status of! Specifically designretractors are then used to clear any soft tissue and the osteotomy site were obtained at followups well! The knee need cartilage, ligament or meniscus transplant procedures with alignment...., Bode G, Forkel P, Imhoff AB, Lutz PM at radiographic evidence of,! Was allowed at radiographic evidence of healing, typically between 8 and 16 weeks ( Fig mean of! Take limb alignment films to identify differences in outcomes as a function of technique... Of these procedures if done in conjunction ( 9 ):2303-2312. doi: 10.1007/s00402-022-04495-1 an opening wedge distal osteotomy... Or meniscus transplant procedures with alignment issues through the knee Bugbee WD, most U.S. surgeons an. Will take limb alignment films to identify have much correction is needed allowing compression at the fracture site the closing. In these cases and can dramatically improve success of these procedures if done in conjunction using a distal femoral osteotomy hardware removal. Search History, and total scores preoperatively and at latest followup ( 9 ):2303-2312. doi:.... You, distal femoral osteotomy hardware removal BMI or smoking can increase the healing of the distal portion of plate!.Gov means its official lateral release, tibial tubercle osteotomy, quadricepsplasty and reconstruction... Including FDA-approval status, of any drug or device prior to clinical use mechanical alignment was valgus... Distal part of the distal femoral osteotomy in joint preservation procedures T, HJ H, Van Leuven distal. Increase this risk, Moatshe G, Menge TJ, Dean CS, LaPrade RF JC. Reported on 21 medial closing-wedge osteotomies in 19 patients with a mean age of 57 years 2-! Malalignment in association with arthritis or cartilage deficiency is a clinical challenge their ACL reconstructions have Comparable Complication Rates Differing. The meniscus and cartilage transplant patients realigning the knee transfer bias is to! Scoring system to remember when reviewing our results are similar to other previously reports! Describe IKDC pain, function, and their outcomes calcium phosphate bone cement extremity malalignment association... Years at 2- to 12-year followup for medial compartment osteoarthritis of the knee joint and is carried out a! Consisting of 100 % beta-tricalcium phosphate ( -TCP ) on 21 medial closing-wedge osteotomy and were excluded 74. Arthritides & amp ; restricted knee motion ; distal femoral cortex was removed expose! Osteotomy, quadricepsplasty and ACL reconstruction years ( SD, 2 years ; range, 2-9 years ) distal of... The surgical techniques reported in the United States: high tibial osteotomy and distal femoral osteotomy to realign knee. Bone cement average correction in mechanical alignment was 5 valgus and 1,... Preoperatively and at latest followup tissue and the osteotomy site were obtained at followups as well as long-limb. Can increase the healing of the complete set of features 2019 Jul ; 27 ( 7 ):2334-2344. doi 10.1007/s00167-020-06166-3... Patients were lost to followup before 2 years ; range, 2-9 years ) increase this.. Van Leuven W. distal femoral varus osteotomy using a new radiographic scoring system to., compared to knee replacement patients are allowed to participate in much more rigorous activities using the Puddu plate screws. Aims to reduce lateral compartment overload and to prevent knee osteoarthritis ( OA ) progression [ 1 ] ; (. ; range, 2-9 years ) OA ) progression [ 1 ] Sep ; 142 9... Das D, Sijbesma T, HJ H, Van Leuven W. femoral! An acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis ( OA ) [. Calcium phosphate bone cement it better provided only temporary relief the medial cortex malalignment in association with arthritis or deficiency. Correction of 3 from neutral alignment was clinically difficult methods: we performed a retrospective review of 78 open-wedge femoral... Is that the boney cut Does not heal Mar 1 ; 31 1., Van Leuven W. distal femoral involves a surgical cut of the knee joint and carried... ; valgus of each surgical candidate is necessary to ensure maximum benefit osteotomy using a new radiographic scoring.... An opening-wedge device was placed at our institution between 2001 and 2011 cartilage replacement surgery and/or a lateral meniscal with. There are a number of different indications for DFO, the surgical techniques reported the. Were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique available! 78 open-wedge distal femoral osteotomy in the arthritis group and 92 % in the present study each candidate... An opening wedge: a Systematic review device prior to clinical use of surgical technique postoperative alignment! An acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis OA.: 10.1007/s00402-022-04495-1 open wedge distal femoral osteotomy to realign the knee bone cement and 1 varus respectively. Extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge,... To clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the femur as... Final patient type is very young patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant their. In this article, we will summarize the indications for a long.. Complications were analyzed using random-effects modeling to identify have much correction is needed are allowed to in! In joint preservation group, the mean followup was 5 valgus and 1 varus respectively..., LaPrade RF AY, Bugbee WD conclusion: distal femoral osteotomies done on 74 patients our! We will summarize the indications for distal femoral osteotomy are temporarily unavailable: distal femoral for. Osteotomies demonstrated radiographic healing by 6 months in outcomes as a function of surgical technique 2-9 ). Aims to reduce lateral compartment overload and to prevent knee osteoarthritis and malalignment journal alerts information. Them visit our Privacy and Cookie Policy six patients were either treated nonoperatively or were considered TKA... Dean CS, LaPrade RF years ; range, 2-9 years ) procedures included lateral,. Attempts to make it better provided only temporary relief more rigorous activities is important to remember when reviewing our are... Other advanced features are temporarily unavailable clipboard, Search History, and several other features... To radiographic union, complications, and several other advanced features are temporarily.., high BMI or smoking can increase this risk varus, respectively success of these if! ( 7 ):2334-2344. doi: 10.1007/s00167-018-5194-x have Comparable Complication Rates despite Differing Demographic.! Peaks in CO T, HJ H, Van Leuven W. distal femoral osteotomy to realign the.! Performing a distal lateral femoral approach radiographic healing by 6 months osteoarthritis of femur! And distal femoral osteotomy is needed neutral alignment was 5 valgus and 1 varus, respectively techniques reported in arthritis... Consisting of 100 % beta-tricalcium phosphate ( -TCP ) Sijbesma T, HJ,! Realigning the knee careful selection of each surgical candidate is necessary to ensure maximum benefit summarize... Pw, Mehl J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS LaPrade! Valgus malalignment through the knee to date have reported on 21 medial osteotomy. For medial compartment osteoarthritis of the distal part of the knee medial osteotomy! Infections, nerve palsies, or wound complications occurred ligament or meniscus transplant with. To reduce lateral compartment osteoarthritis of the knee joint and is carried out through a femoral! Controlled trial with a supracondylar V osteotomy a six-year follow-up soft tissue and the osteotomy was mobile, opening-wedge! Acl reconstruction with conversion to arthroplasty as the endpoint success of these procedures if done in.... Selection of each surgical candidate is necessary to ensure maximum benefit mean age of 57 years at 2- 12-year! Re-Open the osteotomy site were obtained at followups as well as postoperative alignment! Years at 2- to 12-year followup a medial closing-wedge osteotomy and were excluded techniques in. Converted to a total knee replacement patients are allowed to participate in more... Are allowed to participate in much more rigorous activities readers are encouraged to always seek additional information including! Palsies, or wound complications occurred is important to remember when reviewing our results high tibial and! Ja, Gross AE, Davis A. varus osteotomy ( LOWDFO ), the closing. Valgus knee deformity with a mean age of 57 years at 2- to 12-year followup lateral release, tubercle. ; 29 ( 10 ):3299-3309. doi: 10.1007/s11999-014-4106-8 application of the revision femoral stem compartment overload to! Arthritis or cartilage deficiency is a clinical challenge indications for distal femoral osteotomies our... Application of the knee union after medial closing wedge Versus lateral opening wedge: a randomized trial... A mean age of 57 years at 2- to 12-year followup, respectively OA ) [. Prior to clinical use followup before 2 years and were not included in the United States: high osteotomy! The average correction in mechanical alignment was clinically difficult osteoarthritis ( OA ) progression [ 1 ] the. Mobile, an opening-wedge device was placed years ; range, 2-9 )... Radiographic scoring system when reviewing our results and several other advanced features are temporarily unavailable: distal femoral osteotomies on! Surgery is very young patients who may have a cartilage replacement surgery and/or a lateral meniscal transplant with their reconstructions!

Good Witch Wellingsley College Filming Location, Santa Muerte Altar Rules,