PMID- 20676825
OWN - NLM
STAT- MEDLINE
DCOM- 20110110
LR  - 20220309
IS  - 1439-0981 (Electronic)
IS  - 0934-6694 (Linking)
VI  - 22
IP  - 3
DP  - 2010 Jul
TI  - [The medial closed-wedge osteotomy of the distal femur for the treatment of 
      unicompartmental lateral osteoarthritis of the knee].
PG  - 317-34
LID - 10.1007/s00064-010-9006-9 [doi]
AB  - OBJECTIVE: Shifting of the mechanical axis from the lateral to the medial 
      compartment in patients with lateral osteoarthritis in combination with valgus 
      deformity. INDICATIONS: Osteoarthritis of the lateral compartment in combination 
      with valgus deformity of the (distal) femur. Posttraumatic and congenital valgus 
      deformities of the (distal) femur. CONTRAINDICATIONS: Osteoarthritis of the 
      medial compartment (>or=grade 3 on Outerbridge Scale). Total loss of the medial 
      meniscus. Acute or chronic infections. Rheumatoid arthritis. Heavy smoking. 
      Extension or flexion deficit>20 degrees. Poor soft-tissue conditions on site of 
      surgery. SURGICAL TECHNIQUE: Optional: arthroscopy before osteotomy. Anteromedial 
      skin incision, subvastus approach with blunt preparation around the vastus 
      medialis muscle and separation of this muscle from the intermuscular septum. The 
      posterior osteotomy is marked with Kirschner wires (OGD [osteotomy guiding 
      device], Synthes, Switzerland, can be used optionally). The biplanar cut is 
      marked on the bone with an electrocautery device. The bone cuts start with the 
      posterior incomplete osteotomy, followed by the anterior biplanar cut. After 
      finishing the osteotomy (three bone cuts!), the bone wedge can be removed. 
      Closing the osteotomy should start very gently as a plastic deformation of the 
      bone. A radiologic control of the leg alignment and the mechanical axis is 
      achieved with an alignment rod (Synthes, Switzerland). The plate should be 
      inserted under the vastus medialis muscle. It is very important, that the surgeon 
      controls the correct anteromedial position of the plate at the distal femur 
      (right and left version of the implant). Fixation of the plate with locking 
      screws distally. Positioning of a lag screw in the dynamic hole directly above 
      the osteotomy. Insertion of monocortical screws in the three remaining holes 
      proximal of the lag screw. Finally, the lag screw is changed to a self-tapping 
      bicortical locking head screw. X-ray control, wound closure. POSTOPERATIVE 
      MANAGEMENT: Elastic bandage of the leg up to the thigh in the operating room. 
      Change of the dressing on day 1 after surgery. Ice treatment. Walking on crutches 
      starting day 1 after surgery. Physiotherapy and manual lymph drainage starting on 
      day 1 after surgery. Partial weight bearing for the first 4-6 weeks after 
      surgery. Suture removal after 10-12 days. X-ray control on day 3 and 6 weeks 
      after surgery. Discharge possible, if wounds are dry (day 4-7). RESULTS: Between 
      January 2005 and October 2008, 60 patients were treated with medial closed-wedge 
      osteotomy of the distal femur (since 11/2006 only with biplanar osteotomy 
      technique) at the Department of Trauma and Reconstructive Surgery, 
      Diakoniekrankenhaus Henriettenstiftung Hannover, Germany. The average wedge size 
      was 7.6 mm (4-13 mm). The mean age was 39.7 years (17-79 years). The patients had 
      had 2.3 previous surgeries. The mean follow- up was 21 months (3-45 months). 
      Freiling D, et al. Biplanare Osteotomie bei unikompartimentaler lateraler 
      Kniegelenkarthrose Flexion was 126 degrees (95-140 degrees) preoperatively, and 
      128 degrees (105-140 degrees) postoperatively. 25 patients had at least 5 degrees 
      extension deficit (5-15 degrees) before surgery, whereas ten patient did not 
      reach the full extension at follow-up examination. The Tegner Activity Score 
      increased from 2.8 (1-4) preoperatively to 5.6 (2-9) postoperatively, in IKDC 
      (International Knee Documentation Committee) Score, 18 patients reached grade A, 
      27 grade B, nine grade C, and six grade D. The visual analog scale (VAS) score 
      decreased from 6.8 (8-2) preoperatively to 3.1 (0-7) postoperatively. Seven 
      patients had revision surgery (three times delayed union/nonunion of the 
      osteotomy, one superficial and one deep infection, one hematoma, one fracture 
      [proximal of the internal plate fixator] after a fall).
FAU - Freiling, Denise
AU  - Freiling D
AD  - Klinik fur Unfall- und Wiederherstellungschirurgie, Diakonie- krankenhaus 
      Henriettenstiftung, Hannover, Germany. d.freiling@gmx.de
FAU - van Heerwaarden, Ronald
AU  - van Heerwaarden R
FAU - Staubli, Alex
AU  - Staubli A
FAU - Lobenhoffer, Philipp
AU  - Lobenhoffer P
LA  - ger
PT  - English Abstract
PT  - Journal Article
TT  - Die varisierende Closed-Wedge-Osteotomie am distalen Femur zur Behandlung der 
      unikompartimentalen lateralen Arthrose am Kniegelenk.
PL  - Germany
TA  - Oper Orthop Traumatol
JT  - Operative Orthopadie und Traumatologie
JID - 9604937
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Female
MH  - Femur/*surgery
MH  - Humans
MH  - Knee Joint/*abnormalities/*surgery
MH  - Male
MH  - Middle Aged
MH  - Osteoarthritis, Knee/*surgery
MH  - Osteotomy/*instrumentation/*methods
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2010/08/03 06:00
MHDA- 2011/01/11 06:00
CRDT- 2010/08/03 06:00
PHST- 2010/08/03 06:00 [entrez]
PHST- 2010/08/03 06:00 [pubmed]
PHST- 2011/01/11 06:00 [medline]
AID - 10.1007/s00064-010-9006-9 [doi]
PST - ppublish
SO  - Oper Orthop Traumatol. 2010 Jul;22(3):317-34. doi: 10.1007/s00064-010-9006-9.