Nonunion and delayed union in lateral open wedge distal femoral osteotomies—a legitimate concern?

Liska, Franz; Voß, Andreas; Imhoff, Florian B.; Willinger, Lukas; Imhoff, Andreas B.

doi:10.1007/s00264-017-3504-4

Cited by 24 publications

(27 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Here, our findings suggest that the benefit of bone grafting is limited in lateral opening-wedge distal femoral osteotomies. Moreover, our findings are supported by Liska et al, who reported comparable results in a slightly older cohort using a similar technique [19].…”

Section: Discussionsupporting

confidence: 90%

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting

Kolb

Isak

Hobusch

et al. 2018

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

BackgroundThe lateral opening wedge distal femoral osteotomy (LOWDFO) to reconstruct knee alignment in patients with genu valgum originating in the distal femur has gained importance within the last years.PurposeTo analyze clinical and radiographic outcome of patients treated with LOWDFO with respect to bone healing without grafting and patient age.Material and methodsTwenty-two consecutive patients with genu valgum corrected with 23 LOWDFOs using a Tomofix-locking plate were retrospectively analyzed (mean age 23.7 years). Clinical evaluation was based on pre- and post-operative KOOS scores. A pre- and post-operative radiographic assessment, including MAD, mLDFA, LLD, bone healing, and patella parameters, was performed. Differences between subgroups (age, bone grafting) were analyzed.ResultsThe restoration of MAD and mLDFA resulted in significantly improved post-operative KOOS5 scores in younger and older patients (p = 0.001). Bone healing without bone grafting was reliable in all patients. The leg length was significantly increased post-operatively (p = 0.001). The Blackburne-Peel ratio was significantly reduced to more normal values post-operatively (p < 0.001).ConclusionLOWDFO without bone grafting is a reliable procedure representing a promising treatment option particularly in young patients with genu valgum. Besides correction of the MAD, a significant leg length increase and additional patella stability can be expected.

show abstract

Section: Discussionsupporting

confidence: 90%

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting

Kolb

Isak

Hobusch

et al. 2018

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…Nevertheless, DFO has been shown to achieve satisfactory pain relief and functional improvement in patients with unicompartmental OA, with a complication rate comparable with that of high tibial osteotomy. [1][2][3]5,8,10,11 Previous studies investigating DFO have been limited by small sample sizes, constraining the generalizability of the results, especially pertaining to survivorship estimates. In their retrospective review, Backstein et al 1 identified only 38 patients (40 knees), despite analyzing records from a 30-year time period.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Factors Associated With Distal Femoral Osteotomy Survivorship: Data From the California Office of Statewide Health Planning and Development (OSHPD) Registry

Mayfield

Bolia

Mayer

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Malalignment of the lower extremity can lead to early functional impairment and degenerative changes. Distal femoral osteotomy (DFO) can be performed with arthroscopic surgery to correct lower extremity malalignment while addressing intra-articular abnormalities or to help patients with knee osteoarthritis (OA) changes due to alignment deformities. Purpose: To examine survivorship after DFO and identify the predictors for failure. Study Design: Case series; Level of evidence, 4. Methods: Data from the California Office of Statewide Health Planning and Development, a statewide discharge database, were utilized to identify patients between the ages of 18 and 40 years who underwent DFO from 2000 to 2014. Patients with a history of lower extremity trauma, infectious arthritis, rheumatological disease, skeletal dysplasia, congenital deformities, malignancy, or concurrent arthroplasty were excluded. Failure was defined as conversion to total or unicompartmental knee arthroplasty, and the identified cohort was stratified based on whether they went on to fail. Age, sex, race, diagnoses, concurrent procedures, and comorbidities were recorded for each admission. Statistically significant differences between patients who required arthroplasty and those who did not were identified using the Student t test for continuous variables and a chi-square test for categorical variables. Kaplan-Meier survivorship curves were constructed to estimate 5- and 10-year survival rates. A Cox proportional hazards model was used to analyze the risk for conversion to arthroplasty. Results: A total of 420 procedures were included for analysis. Overall, 53 knees were converted to arthroplasty. The mean follow-up time was 4.8 years (range, 0.0-14.7 years). The 5-year survivorship was 90.2% (range, 85.7%-93.4%), and the 10-year survivorship was 73.2% (range, 64.7%-79.9%). The mean time to failure was 5.9 years (range, 0.4-13.9 years). Survivorship significantly decreased with increasing age ( P = .004). Hypertension and a primary diagnosis of osteoarthrosis were significant risk factors for conversion to arthroplasty (odds ratio [OR], 3.12 [95% CI, 1.38-7.03]; P = .006, and OR, 2.42 [95% CI, 1.02-5.77]; P = .045, respectively), along with a primary diagnosis of traumatic arthropathy (OR, 10.19 [95% CI, 1.71-60.65]; P = .01) and a comorbid diagnosis of asthma (OR, 2.88 [95% CI, 1.23-6.78]; P = .02). Patients with Medicaid were less likely (OR, 0.11 [95% CI, 0.01-0.88]; P = .04) to undergo arthroplasty compared with patients with private insurance, while patients with workers’ compensation were 3.1 times more likely (OR, 3.08 [95% CI, 1.21-7.82]; P = .02). Conclusion: Older age was an independent risk factor for conversion to arthroplasty after DFO in patients ≥18 years but ≤60 years. Hypertension, asthma, and a diagnosis of osteoarthrosis or traumatic arthropathy at the time of surgery were predictors associated with failure, reinforcing the need for careful patient selection. The high survivorship rate of DFO in this analysis supports this procedure as a reasonable alternative to arthroplasty in younger patients with valgus deformities about the knee and symptomatic unicompartmental OA.

show abstract

“…Although several studies suggested the time point for delayed union after opening wedge distal femoral osteotomy, it ranged from 6 to 12 months between studies. 4,16 Moreover, finding the criteria for classifying a delayed union after closing wedge distal femoral osteotomy was difficult. In this study, delayed union was defined as the lack of complete osseous consolidation for up to 12 months, as described by Liska et al 16 However, the results of the study may be altered depending on the time point used for classifying delayed union.…”

Section: Discussionmentioning

confidence: 99%

“…20 Delayed union was defined as the lack of complete osseous consolidation and the presence of a radiolucent line in the previous osteotomy site after 12 months, although asymptomatic and not requiring revision surgery. 16 However, nonunion was evaluated on radiographs along with clinical symptoms according to the following findings: a radiological evidence of nonunion, which could be hypertrophic, oliotrophic, or atrophic; pain; no radiological progress in bony healing on serial radiographs; and subsequent need for revision surgery. 16 The cases in which nonunion, delayed union, or loss of correction were identified on follow-up radiographs were classified as problematic bone healing in this study.…”

Section: |mentioning

confidence: 99%

Detection of Lateral Hinge Fractures After Medial Closing Wedge Distal Femoral Osteotomy: Computed Tomography Versus Plain Radiography

et al. 2021

View full text Add to dashboard Cite

Background: Limited evidence exists in the literature regarding the detection rates of lateral hinge fracture (LHF) on computed tomography (CT) after medial closing wedge distal femoral osteotomy (MCDFO). Moreover, the effect of LHF on bone healing after MCDFO remains unclear. Hypothesis: The detection rates of LHF after MCDFO would be higher on CT than on plain radiography. The incidence of problematic bone healing would be higher in the knees with LHF than in those without LHF. Study Design: Cohort study (diagnosis), Level of evidence, 3. Methods: Patients who underwent MCDFO between May 2009 and July 2019 were retrospectively evaluated. The presence of LHF was evaluated using immediate postoperative plain radiography and CT. The detection rates of LHF on plain radiography and CT were compared. The incidence of problematic bone healing (nonunion, delayed union, and loss of correction) was also compared between the knees with LHF and those without LHF. Results: A total of 55 knees of 43 patients (mean age, 37.7 ± 16.7 years) were included in the study. Although 33 LHFs were detected on CT, only 19 LHFs were detected on plain radiography. The detection rate of LHF was significantly higher on CT than on plain radiography (60% vs 34.5%; P = .008). At 1-year follow-up, 10 cases of problematic bone healing (1 nonunion, 4 delayed unions, and 5 losses of correction) were identified. The incidence of problematic bone healing was significantly higher in the knees with LHF than in those without LHF as shown on plain radiography (36.8% vs 8.3%; P = .001) and CT (30.3% vs 0%; P = .004). Conclusion: LHF can be detected better on CT than on plain radiography and has a negative effect on bone healing after MCDFO. For patients with LHF detected on either plain radiography or CT, careful rehabilitation with close follow-up is recommended.

show abstract

Nonunion and delayed union in lateral open wedge distal femoral osteotomies—a legitimate concern?

Cited by 24 publications

References 32 publications

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting

Factors Associated With Distal Femoral Osteotomy Survivorship: Data From the California Office of Statewide Health Planning and Development (OSHPD) Registry

Detection of Lateral Hinge Fractures After Medial Closing Wedge Distal Femoral Osteotomy: Computed Tomography Versus Plain Radiography

Contact Info

Product

Resources

About