Robert rozbruch of the limb lengthening and complex reconstruction service at hss shows how he performs a distal femoral osteotomy to correct knockknee deformity. In order to determine if a distal femoral ostetomy is an appropriate procedure for you your surgeon will obtain a. Distal femoral osteotomy system dfos the dfos system includes implants to correct several distal femoral conditions, such as flexion contractures and varusvalgus deformities. The described procedure is a minimally invasive single. A femoral osteotomy fo is a surgical procedure in which a surgeon cuts into the femur and repositions it before pinning it in place. Femoral opening wedge osteotomy surgical technique arthrex. Dewilde tr, dauw j, vandenneucker h, bellemans j 20 opening wedge distal femoral varus osteotomy using the puddu plate and calcium phosphate bone cement knee surg sports traumatol arthrosc 21. All questions begin with a number in front of it, like so. The aim of proximal femoral osteotomies pfo in children is to restore normal anatomy. Provincial health services authority phsa improves the health of british columbians by seeking provincewide solutions to specialized health care needs in. The instrumentation includes a pin guide and cut guides to assist with more precise osteotomies and implant placement.
The procedure is usually performed on patients who have developmental conditions such hip dysplasia, and who develop early arthritis of the hip joint. In this chapter, we focus on the long bones of the lower extremity. Proximal femoral osteotomy avascular necrosis of head of femur usually seen in younger age groups. Pediloc locking proximal femur plate system varus osteotomy of the proximal femur. Specifically designed femoral osteotomy plates take into account the anatomical differences between the distal femur and proximal tibia. Cartilage repair center tom minas, md, ms 850 boylston street, suite 112 andreas gomoll, md chestnut hill, ma 02467 courtney vanarsdale, pac p.
In case of a femoral neck pseudarthrosis, the aim is to convert shear stresses into compressive forces, increasing the likelihood of union. The best choice is to salvage the natural hip joint which. They play an important role in the treatment of neurological subluxations or dislocations of the hip. In this article, we describe our preferred operative technique for a lateral opening wedge varusproducing distal femoral osteotomy to correct mild to moderate valgus malalignment. Apr 27, 2018 proximal femoral osteotomy is currently commonly used for adults in the treatment of hip fracture nonunions and malunions and in cases of congenital and acquired hip deformities, as in the images below. Once used routinely, trochanteric osteotomy in total hip arthroplasty now is usually limited to difficult primary and revision cases. Provincial health services authority phsa improves the health of british columbians by seeking provincewide solutions to specialized health care needs in collaboration with bc health authorities and other partners. Proximal femoral osteotomy is currently commonly used for adults in the treatment of hip fracture nonunions and malunions and in cases of. Apr 01, 2014 femoral derotational osteotomy is an acceptable treatment for excessive femoral torsion. This creates better coverage of the acetabulum over the femoral head.
Varus and valgusproducing osteotomies were aimed at maximizing joint congruity and redistributing the weightbearing load across the femoral head to a less affected area. High tibial osteotomy hto deformity correction planning. Structural autologous bone grafting was performed in cases of unneglectable bone defects. Proximal femoral osteotomy was a technique used in adults in the early part of the. Advances in modern imaging and surgical techniques have improved.
Derotational osteotomy techniques are performed for excessive anteversion or retroversion, whereas varusvalgus correction of angulation. From posna on february 22nd, 2016 likes views comments. The proximal femoral osteotomy is an instrumental tool for hip deformity correction. It is commonly indicated for extraction of wellfixed femoral components either cemented or uncemented. A comprehensive plating system for stable fixation of osteotomies around the knee. The need for casting after proximal femoral osteotomy is determined by the stability of proximal femoral fixation, cooperativeness of the child, age of the child, or the need to stretch soft tissues that have been lengthened as an adjunctive procedure to the femoral osteotomy. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. Proximal femoral osteotomies in children using the richards. The dfos system includes implants to correct several distal femoral conditions, such as flexion contractures and varusvalgus deformities. Distal femoral osteotomy postop rehab protocol general rehabilitation guidelines and principles. Restoration of proximal femoral anatomy during total hip. Fragomen, md introduction osteotomy is a reconstructive surgery that involves cutting the bone to attain limb deformity correction andor limb length equalization.
Valgus sliding subtrochanteric osteotomy for neglected. Proximal femoral osteotomy is commonly used in the treatment of nonunions of hip fractures. To treat hip dysplasia, the doctor cuts through the femoral head and rotates it anteriorly or posteriorly to the front or to the back. The first planning step of a valgus osteotomy starts with the determination of the correction angle. Proximal femoral osteotomy is currently commonly used for adults in the treatment of hip fracture nonunions and malunions and in cases of congenital and acquired hip deformities, as in the images below. This is a simple technique to obtain significant varus correction with automatic shortening of the femoral neck in. In this deformity correction module we explain the method for proximal femoral osteotomy planning. The described procedure is a minimally invasive singleincision technique based on an intramedullary saw. A proximal tibial cut perpendicular to the tibial mechanical axis is undertaken using extramedullary instrumentation. Two previous studies 15, 17 have reported results of pfos using hip screws andor blade plates. Extended proximal femoral osteotomy the journal of arthroplasty. Femoral deformities in the sagittal and coronal planes can be corrected with an extended trochanteric osteotomy in combination with a reduction or. Apr 27, 2018 proximal femoral osteotomy was a technique used in adults in the early part of the 20th century for the treatment of hip dysplasia and osteoarthritis.
Lateral femoral sliding osteotomy semantic scholar. Jan 01, 2008 femoral deformities in the sagittal and coronal planes can be corrected with an extended trochanteric osteotomy in combination with a reduction or angular osteotomy. One of the most recent papers about the technique and results of supracondylar femoral derotation osteotomy in patients with patellofemoral instability. Distal femoral osteotomy system dfos orthopediatrics.
Proximal femoral osteotomies in children using the. These procedures are technically difficult, have limited indications, require meticulous preoperative planning, and involve prolonged postoperative care. The goal of a proximal femoral osteotomy is to return the. Surgical technique a lateral approach is used to perform a distal femoral osteotomy. Ten cadaveric lower extremities underwent femoral osteotomies. Some of the problems encountered during this procedure are gaining an accurate reduction in the osteotomized fragment and a stable reduction and fixation. Trochanteric osteotomy and fixation during total hip arthroplasty.
Femoral derotational osteotomy is an acceptable treatment for excessive femoral torsion. In a knee osteotomy, either the tibia shinbone or femur thighbone is cut and then reshaped to relieve pressure on the knee joint. Both femoral neck and intertrochanteric fracture nonunions respond positively to valgusproducing realignment osteotomies. Femoral derotational osteotomy level does not effect resulting torsion. Use for 24 weeks at 0120 degrees begin physical therapy within 3 days of surgery follow up with physician 1014 days after surgery.
The iliotibial band is split along its fibers and the vastus lateralis is elevated off the femur to expose the femoral shaft and metaphysis. Proximal femoral osteotomies in children sciencedirect. The distal femoral osteotomy system utilizes the same principles of design featured in the tibial osteotomy system. Femoral opening wedge osteotomy surgical technique youtube.
Mar 10, 2016 the first planning step of a valgus osteotomy starts with the determination of the correction angle. Orthopedic surgeons perform the operation, which involves cutting the bone, in order to realign it and restore a more normal anatomy, thereby addressing or preventing problems related. Oct 02, 2008 this is the largest reported series of proximal femoral osteotomies in children using the richards paediatric and intermediate hip screws. A hip osteotomy is a surgical procedure in which the hip bones are cut, realigned, and fixed in a new position. Varusproducing lateral distal femoral openingwedge osteotomy. Each has unique indications, fixation techniques, and complications. This surgery is used to treat a number of conditions, including congenital and acquired hip deformities. The resection is based on the medial tibial plateau. Extended femoral osteotomy and proximally coated prosthesis.
This is the largest reported series of proximal femoral osteotomies in children using the richards paediatric and intermediate hip screws. Femoral osteotomy is a surgical procedure that is performed to correct specific deformities of the femur the long bone in the upper leg and the hip joint. They have been done infrequently in the united states, but more. The locking proximal femur lpf plate system is designed for long bone fractures and osteotomies in children and adolescents, and is indicated for derotational and angular osteotomies, where a bone is cut to shorten, lengthen, or change its alignment. A femoral osteotomy fo is any surgical procedure that cuts through the femur to change its relationship to the hip or to the knee. It has been utilized since the early 20th century, and.
Pdf proximal femoral osteotomies in children researchgate. Proximal femoral osteotomy is currently commonly used for adults in the treatment of hip fracture nonunions and malunions and in cases of congenital and acquired hip deformities. Apr 06, 2020 a femoral osteotomy fo is a surgical procedure in which a surgeon cuts into the femur and repositions it before pinning it in place. Extended proximal femoral osteotomy is a wellestablished technique in complex primary and revision hip surgery. Depuy synthes trauma image intensifier control table of contents introduction. Technique of intersubtrochanteric osteotomy with the.
Orthopedic surgeons perform the operation, which involves cutting the bone, in order to realign it and restore a more normal anatomy, thereby addressing or preventing problems related to the deformity. Mar 15, 20 the purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion. After completing the proximal femoral osteotomy, the proximal fragment was distracted laterally and proximally for an easier soft tissue dissection and adequate exposure of the acetabulum. These report remarkably similar overall complication rates of 9% and 8. Restoration of the anatomical hip center was attempted. Osteotomies of the proximal femur can be performed either on the inter or subtrochanteric level.
Femoral opening wedge osteotomy surgical technique promedon s. Trochanteric osteotomy and fixation during total hip. The aim of proximal femoral osteotomies pfo in children is to restore normal anatomy and optimal joint congruency to prevent medium and longterms degenerative deterioration of the hip. Since the strong valgus deformation was the main component and the parents refused a pelvic osteotomy, the indication was set for a varisation and derotation intertrochanteric osteotomy.
An osteotomy technique for removal of distally fixed cemented and cementless femoral components is described. Femoral osteotomy is a surgical procedure in which a cut is made in the proximal femur, allowing the necrotic segment of bone to be rotated away from the weightbearing area of the acetabulum. Gmrs proximal femoral surgical protocol acknowledgements stryker would like to thank all of the surgeons for their contributions in developing the global modular replacement system gmrs. Osteotomy means cutting of the bone and so femoral osteotomy means cutting of the femur bone. Osteotomies can be used to correct a variety of problems but here we will focus on relieving arthritic pain and as an alternative to a hip replacement.
The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion. The major advantage of intertrochanteric osteotomies is the possibility to additionally correct varusvalgus and flexionextension deformity. The indications and contraindications for distal femoral osteotomy are similar to those for high tibial osteotomy. Periacetabular osteotomy is an effective technique for treating. Proximal femoral osteotomy deformity correction planning. Lateral distal femoral opening wedge osteotomy using the peekpower ldfo plate. Apr 14, 2015 extended proximal femoral osteotomy is a wellestablished technique in complex primary and revision hip surgery. Click to view the posna content provider agreement. Proximal femoral osteotomy was a technique used in adults in the early part of the 20th century for the treatment of hip dysplasia and osteoarthritis. T he distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. The posterior condylar line is used as the sole rotational reference. Relative neck lengthening and intracapital osteotomy for. Jul 11, 2016 the lateral opening wedge distal femoral osteotomy is a reproducible technique for limb alignment correction in patients with valgus malalignment. May 23, 20 femoral opening wedge osteotomy surgical technique promedon s.
Knee osteotomy is used when a patient has earlystage osteoarthritis that has damaged just one side of the knee joint. Proximal femoral osteotomies pfo play an important role in the treatment of numerous hip disorders in children. I realize that i am fairly old for this surgery usually done at 15 year old and younger and that a femoral osteotomy on a patient with a retroversion is rare. Proximal femoral osteotomy protocol open procedure, with. Proximal femoral osteotomy avascular necrosis of head of. Through a lateral approach to the proximal femur, the fascia lata and vastus lateralis muscle are split close to the intermuscular septum. Percutaneous femoral derotational osteotomy for excessive. Lateral distal femoral opening wedge osteotomy using the. The most common indication for intertrochanteric osteotomies has been hip dysplasia. A distal femoral osteotomy can be used alone as treatment for lateral compartment osteoarthritis or to correct alignment in conjunction with other cartilage repair procedures. Proximal femoral osteotomy protocol open procedure, with plate and hardware to reduce rotation of femur dr.
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