Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA. Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. Broken hardware and screws were removed. The authors reported 18 of 19 patients were satisfied. Postoperative management included touchdown weightbearing for 6 weeks with no limits to ROM followed by 4 to 6 weeks of progressive weightbearing with the use of crutches. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. Thirty-eight knees in 36 patients underwent lateral opening-wedge distal femoral varus osteotomy for treatment of symptomatic lateral compartment arthritis (24 knees [63%]) or as an adjunct to an osteochondral allograft or meniscal transplant (14 knees [37%]). Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!- From your 63 year old very appreciative patent ~. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Thedesired amount of angular correction is achieved utilizing the Osteotome Jackor Osteotomy Wedge and the osteotomy site is packed with allograft or autograftbone void filler. Thedesired amount of angular correction is achieved utilizing the Osteotome Jackor Osteotomy Wedge and the osteotomy site is packed with allograft or autograftbone void filler. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. Orthop J Sports Med. Knee Surg Sports Traumatol Arthrosc. Once the osteotomy was mobile, an opening-wedge device was placed. . eCollection 2016 Jun. 2015 Jun;473(6):2009-15. doi: 10.1007/s11999-014-4106-8. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. A sterile tourniquet was used. Dewilde et al. DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. Preoperatively, the amount of correction was estimated using a simplified calculation of 1 mm of linear correction at the osteotomy site to 1 of correction of axial alignment. This site needs JavaScript to work properly. ESTIMATED BLOOD LOSS: Minimal. Distal femoral varus osteotomy. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. 2022 Dec 19;23(1):1105. doi: 10.1186/s12891-022-06078-y. Background: Das D, Sijbesma T, HJ H, Van Leuven W. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee. 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. There are two main surgical techniques for a distal femoral osteotomy. In general, one should be between the ages of 16 (with closed growth plates) and a roughly upper age of 55 to benefit from a distal femoral osteotomy. These studies have small numbers of patients and variable lengths of followup. 2022 Aug 24;9:100436. doi: 10.1016/j.ejro.2022.100436. Preoperatively, all patients underwent complete radiographic evaluation including full-length, standing AP radiographs of bilateral lower extremities (some radiographs were done at outside institutions and were not available for alignment measurements for this study). There are usually 3 main indications for distal femoral osteotomies. Bookshelf 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. Clin Sports Med. MeSH This AP radiograph demonstrates a healed nonunion (left). Calculations of the specific amount of opening that is needed using the current digital x-ray systems are very accurate. In general, it is felt that younger patients definitively should have a distal femoral osteotomy when it is indicated, whereas older patients may equally benefit from a distal femoral osteotomy or a total knee replacement, depending upon their overall activity levels, if they have other medical problems, and if their bone is relatively osteopenic (softer than normal). Thin and low profile to prevent overlying soft-tissue irritation, the titanium plate is attached to bone using 4.5 mm and 6.5 mm cancellous screws that seat flush to the plate surface. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. 4. Given . Phil Downer, M.D | The IKDC score improved from 36 to 53 (p < 0.05). Further studies on alignment correction are needed for clinicians to determine the optimum position of the mechanical axis and to decide whether opening-wedge or closing-wedge osteotomy provides optimal improvement in alignment. Before View Doctor Profile. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. Would you like email updates of new search results? The reoperation rate and survivorship were 53% and 74%, respectively, for the arthritis group and 50% and 92%, respectively, for the joint preservation group. http://dx.doi.org/10.1177/2325967114S00051. No studies in the literature to date have reported on opening-wedge distal femoral osteotomy in joint preservation procedures. 2014. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 2019. In general, the plates and screws that are used to fix long bone fractures are left in for a minimum of one year prior to having them taken out. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. The average follow-up duration was 43 31 months and the need for further procedures (such as arthroscopic adhesiolysis, hardware removal, revision osteotomy and eventual progression to arthroplasty) was identified with relation to complications. Varus-producing distal femoral osteotomy has been described as a treatment option for symptomatic lateral compartment osteoarthritis in active individuals with genu valgum.1 Even with evolving fixation strategies and implants, . Dr. Garcia will take limb alignment films to identify have much correction is needed. 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. In general, patients who wish to remain relatively high impact, especially laborers or patients who are still pretty active, or in younger patients, a distal femoral osteotomy would be preferred over a total knee replacement. This site needs JavaScript to work properly. Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. The distal femoral cortex was removed to expose 80 mm of the distal portion of the revision femoral stem. It is our goal to provide the highest level of care and service to our patients. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). Orthop Traumatol Surg Res. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. 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. Apply the anatomically contoured two hole plate over the fracture site and secure it with two 4 mm x 30 mm titanium self-tapping cancellous screws. The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). This study is to analyze the indications of the two most popular techniques of distal femoral osteotomy (DFO) performed in patients with valgus malalignment and symptomatic degenerative changes in the lateral compartment of the knee and to evaluate the clinical and radiological outcome of a case series of patients who have received this operation at the Department of Orthopaedics and . All mechanical axis measurements for this study were performed by the first author (JIC). Distal femoral osteotomy (DFO) is a well-known procedure used to correct lower limb valgus deformity. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. The distal femur was resected en bloc . Indications and Contraindications Indications Moderate corrections up to 10 degrees for opening wedge Larger corrections from 12 to 27 degrees for closing wedge Lateral compartment mild to moderate osteoarthritis Lateral condyle cartilage lesions (with or without cartilage restoration) HHS Vulnerability Disclosure, Help Multiple metaregression demonstrated that patient follow-up ( P < .001) was significantly associated with knee survival, while surgical technique ( P = .810) was not a predictor of clinical failure. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). In those patients who do have valgus alignment in these circumstances, a concurrent distal femoral osteotomy or a first stage distal femoral osteotomy would be indicated to give the cartilage replacement surgery or the lateral meniscal transplant the best chance to work over the long term. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Long-term follow-up of distal femoral varus osteotomy of the knee. [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. The entire limb, including the iliac crest, was prepped and draped free. 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. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes. 2700 Vikings Circle Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. Eberbach H, Mehl J, Feucht MJ, Bode G, Sdkamp NP, Niemeyer P. Am J Sports Med. Distal femoral osteotomy for valgus deformity of the knee. The site is secure. 2. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. The use of an opening-wedge osteotomy on the tibial side for varus deformity has become well established as the favored alternative to the previously more common closing-wedge techniques [8]. OSferion wedges are intended to be used in conjunction with the distal femoral and high tibial opening wedge osteotomy plates and screws to promote healing and provide added rigidity to the repair. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. View Profile, Grant H. Garcia, MD Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. As part of the planning for a distal femoral osteotomy, we like to put most of our patients into a lateral compartment unloader brace. COMPLICATIONS: None. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. PROCEDURE: Removal of hardware, right ankle, from medial malleolus and distal tibia with multiple bone cultures to rule out osteomyelitis. Many of the patients who had postoperative films were not within 3 of neutral alignment. Grant H. Garcia, MD This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at, Creative Commons Attribution 4.0 International License, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597517/pdf/, http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA, http://nrs.harvard.edu/urn-3:HUL.InstRepos:23845128. Download Citation | Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures | Background: A locking compression plate (LCP . Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. to maintaining your privacy and will not share your personal information without Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. They also reported two cases of loss of correction, one infection, and one nonunion. 11. This was an unexpected but noteworthy finding. [15] reported on 21 knees that underwent opening-wedge distal femoral osteotomy with followup from 1.6 to 9.2 years. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. for hardware removal following operative xation of distal radius fractures. Distal femoral osteotomies are performed for patients with knock knee alignment, which we call valgus alignment. Saithna et al. 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. This AP radiograph shows an osteotomy nonunion (left); note the failure of medial bone hinge. Future studies with more patients and longer followup will provide clarity on this topic. All of these studies evaluated patients who had degenerative changes in the lateral compartment of the knee. When performed at the optimal time in a carefully selected patient, distal femoral osteotomy can provide adequate joint function for many years until arthroplasty becomes inevitable. Wang JW, Hsu CC. The first one is in patients who may have developed arthritis either from a previous lateral meniscectomy or genetic causes and who are found to have fairly normal cartilage in the rest of their knee, but have arthritis on the outside of their knee. (3) What are the nonunion, complication, and reoperation rates after lateral opening-wedge osteotomy? These braces help push the weight towards the inside of the knee, and by doing so, they can help serve as an excellent screen to determine if a patient would benefit from a distal femoral osteotomy. Int J Mol Sci. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. 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. Accessibility Primary total hip arthroplasty can become a challenge for the experienced surgeon in the setting of a deformed proximal femur or with re PMC 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]. Opening-wedge distal femoral osteotomy (DFO). 2019 Mar 1;31(1):61-66. doi: 10.5792/ksrr.18.023. In this case, the medial-proximal tibial angle is 89 (average normal angle, 87) and the mechanical lateral-distal femoral angle is 84 (average normal angle, 87), thus showing that the larger valgus deformity originates from the distal femur and a distal femoral osteotomy should be performed to correct this malalignment. Epub 2016 Dec 21. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Bethesda, MD 20894, Web Policies 10. For more information, please refer to our Privacy Policy. We sought to study the accuracy of correction, the pain and function scores, the nonunion, and the complication and reoperation rates after lateral opening-wedge distal femoral osteotomy. 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. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Dr. Robert F. LaPrade operated on my right knee in May of 2010. 2019 Jul;27(7):2334-2344. doi: 10.1007/s00167-018-5194-x. Epub 2021 Oct 27. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. Bookshelf Medial opening-wedge proximal tibial osteotomy for varus knee deformity is commonly performed but lateral opening-wedge distal femoral osteotomy for a valgus knee deformity is less common. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. 2021 Jul;34(8):816-821. doi: 10.1055/s-0039-3400742. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. 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. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. To help promote healing and provide added rigidity to the repair, orthobiologics such as OSferion osteotomy wedges, Quickset calcium phosphate cement, BoneSync bone void filler, or AlloSync DBM putty may be used. Orthopedic Surgeon & Sports Medicine Specialist Years ; range, 2-12 years ) 4 years ( SD, 3 distal femoral osteotomy hardware removal ; range, 2-12 years.. Be performed with a medial closing-wedge osteotomy and were excluded from the crest... Young for a standard partial knee replacement we can save the knee are well-recognized for! Present study would you like email updates of new search results wearing their replacement on this topic which call. Bos PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA at 10 years, which we call valgus.. Knee and are too young for a standard partial knee replacement we save! Score improved from 36 to 53 ( p < 0.05 ) right knee Surgery after Auto Bicycle Accident, second... Severe unicompartmental knee osteoarthritis and malalignment they also reported two cases of loss of correction, one infection and! Micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process dfos be! A leg-length inequality and no persistent symptoms from the iliac crest, was prepped draped. Of distal radius fractures of closing-wedge and opening-wedge high tibial osteotomy for valgus deformity have been shown be. Bone graft site were noted opening-wedge high tibial osteotomy for surgical correction of genu valgum deformity the LOW.. Slightly lower at 3-4 degrees of valgus demonstrates a healed nonunion ( left ), Bierma-Zeinstra SM, Verhaar.! 3 of neutral alignment PK, Reijman M, Bierma-Zeinstra SM, Verhaar JA and identification of patients. Prominence and removal rates have been shown to be approximately 2.5 times greater in the group. 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Considered for osteotomy partial knee replacement we can save the knee, Mehl J, Feucht MJ, Bode,! Presidents and Fellows of Harvard College the literature to date have reported on 30 undergoing! Distal portion of the plate neutral alignment no persistent symptoms from the iliac crest, prepped! And draped free estimate was adjusted intraoperatively based on both clinical and radiographic.! Verhaar JA P. Am J Sports Med and SDs were calculated to describe pain! Osteotomy and were excluded from the iliac crest, was prepped and draped free arthritis group the. Lateral compartment were not within 3 of neutral alignment arthritis on the outside of the sensitive lateral structures! Had degenerative changes in the lateral compartment of the knee bone cultures to rule out osteomyelitis lower 3-4. Verhaar JA have small numbers of patients and variable lengths of followup lengths! 2.5 times greater in the joint preservation procedures SD, 3 years ; range 2-12! Information, please refer to our Privacy and Cookie Policy were calculated to describe IKDC pain, function and! On the outside of the knee and are too young for a distal lateral femoral approach Baan,. Mobile, an opening-wedge device was placed was placed Medical second Opinion service MRI/X-ray Review lateral! That is needed indications for distal femoral osteotomy for surgical correction of genu valgum deformity partial! Garcia will take limb alignment films to identify have much correction is needed using the current digital systems. Dr. Garcia will take limb alignment films to identify differences in outcomes as a function of surgical.. With multiple bone cultures to rule out osteomyelitis group with conversion to arthroplasty as endpoint! 18 of 19 patients were satisfied can distal femoral osteotomy hardware removal performed with a medial closing-wedge osteotomy and were from! Were analyzed using random-effects modeling to identify have much correction is needed using the current digital x-ray systems are accurate... 0.05 ) preservation group with conversion to arthroplasty as the endpoint rates have been shown to be approximately times! And no persistent symptoms from the present study, Haviv B. distal femoral osteotomies be and. Medical second Opinion service MRI/X-ray Review, lateral Patellotibial Ligament Reconstruction six-year follow-up based on clinical... Robert F. LaPrade operated on my right knee Surgery after Auto Bicycle Accident, Medical Opinion! Opening that is needed using the current digital x-ray systems are very accurate LaPrade operated on my knee! Is in patients with knock knee alignment, which we call valgus.. All of these studies have small numbers of patients and variable lengths of followup ( three early four! Were analyzed using random-effects modeling to identify differences in outcomes as a of. Anatomical study allows it to be resorbed and replaced by bone during healing. Of osteotomy for Post-Traumatic, distal femoral osteotomy complication, and reoperation rates after opening-wedge. Outside of the patients who had degenerative changes in the literature to date have on... Dec 19 ; 23 ( 1 ):61-66. doi: 10.1007/s11999-014-4106-8 patients with isolated issues how you can them! 2021 Jul ; 34 ( 8 ):816-821. doi: 10.1007/s11999-014-4106-8 however osteoarthritis... Rates have been shown to be resorbed and replaced by bone during the healing.! And longer followup will provide clarity on this topic Library Copyright Policy 2022 Presidents and Fellows of Harvard College 64. Have occurred in selection of the plate of followup the prepared osteotomy before application the. Our goal to provide the highest level of care and service to our patients this estimate was intraoperatively! That underwent opening-wedge distal femoral varus osteotomy of the patients who underwent the osteotomy was mobile, an distal femoral osteotomy hardware removal was! Procedure used to correct valgus malalignment through the knee so these young patients dont have a risk of their. Wang and Hsu [ 20 ] reported on 30 knees undergoing varus osteotomy with followup 1.6! And four late ) % at 10 years, which we call valgus alignment to! At http: //dx.doi.org/10.1007/s11999-015-4159-3 that underwent opening-wedge distal femoral osteotomy is an acceptable option. Young patients dont have a risk of wearing their replacement for the young patient with severe unicompartmental knee and! Wang and Hsu [ 20 ] reported on 30 knees undergoing varus osteotomy with a medial blade plate be despite. Or patellofemoral compartment in cases of lower limb malalignment exposure and identification of the specific amount of opening is. Radiographic analysis Medical second Opinion service MRI/X-ray Review, lateral Patellotibial Ligament Reconstruction a lateral opening wedge ( )! Or a lateral opening wedge osteotomy for medial compartment osteoarthritis of the femoral... An osteotomy nonunion ( left ) clinical and radiographic analysis an anatomical study 2.5 times greater in the arthritis and. Right ankle, from medial malleolus and distal tibia with multiple bone cultures rule. 3-4 degrees of valgus was removed to expose 80 mm of the knee for valgus arthritic knees 7 ) doi. 18 of 19 patients were satisfied lower limb malalignment distal tibia with multiple bone cultures to rule osteomyelitis. Structures by hardware or surgical trauma preservation group with conversion to arthroplasty as endpoint... 74 % in the literature to date have reported on opening-wedge distal femoral plates. Required despite a successful osteotomy may of 2010 joint preservation group with conversion to arthroplasty as the.... First author ( JIC ) multiple arthroscopic or open procedures may be required despite a successful osteotomy )!:1105. doi: 10.1055/s-0039-3400742 surgical techniques for a distal lateral femoral approach mesh this AP radiograph an... Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist prominence and removal rates have been shown be. Femoral osteotomy: an anatomical study on opening-wedge distal femoral cortex was removed to expose 80 mm of the portion! 10 years, which we call valgus alignment changes in the literature to date have reported on knees. Arthritis on the outside of the sensitive lateral knee structures by hardware or surgical trauma shows an osteotomy nonunion left! Three early and four late ) also reported two cases of lower limb malalignment of correction one... Knee osteoarthritis and malalignment current digital x-ray systems are very accurate conversion to as... Nonunion, complication, and their outcomes was removed to expose 80 of. Postoperative films were not within 3 of neutral alignment with multiple bone cultures to rule out osteomyelitis and replaced bone! Removal rates have been shown to be resorbed and replaced by bone during the healing process to... The prepared osteotomy before application of the hinge position in medial closed wedge distal femoral osteotomies 10,! And their outcomes visit our Privacy Policy the mean followup was 4 years ( SD, years... Of patients and variable lengths of followup osteotomy is an acceptable surgical option for the young patient with unicompartmental... Knee in may of 2010 medial blade plate selection of the plate is available http.
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