distal femoral osteotomy hardware removal

Further x-rays are obtained at that point to verify healing. Methods: In the arthritis group, the mean IKDC total score improved from 47 (SD, 15) preoperatively to 67 (SD, 10) postoperatively. Das et al. An official website of the United States government. No postoperative infections, nerve palsies, or wound complications occurred. Delva ML, Samuel LT, Roth A, Yalin S, Kamath AF. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. This AP radiograph demonstrates a healed nonunion (left). Eur J Radiol Open. Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, http://dx.doi.org/10.1007/s11999-015-4159-3, Articles in PubMed by James I. Cameron, MD, Articles in Google Scholar by James I. Cameron, MD, Other articles in this journal by James I. Cameron, MD, Privacy Policy (Updated December 15, 2022). For arthritis patients usually with more than 5 degrees of knock-kneed or valgus a knee correction is needed. 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 . 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. Its combination with various cartilage repair procedures has been shown to further improve outcomes. The distal femur is the preferred site of osteotomy for surgical correction of genu valgum deformity. The iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral intermuscular septum to expose the femoral shaft. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. Preoperative planning on long-leg x-rays., Preoperative planning on long-leg x-rays. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Its combination with various cartilage repair procedures has been shown to further improve outcomes. 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. The use of varus-producing osteotomies for valgus knee deformity is less common and limited clinical studies have been published [1, 2, 6, 7, 10, 12, 13, 15, 16, 20]. Knee Surg Sports Traumatol Arthrosc. This website uses cookies. Additionally, compared to knee replacement patients are allowed to participate in much more rigorous activities. 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. Seven knees in six patients were lost to followup before 2 years and were excluded. 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. . Some error has occurred while processing your request. Find top doctors who perform Knee Osteotomy near you in Vallejo, CA. If patients have knock kneed knees and arthritis this can be a very effective surgery and delay the need for a knee replacement. A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. Distal femoral varus osteotomy for osteoarthritis of the knee. 8600 Rockville Pike There are a number of different indications for a distal femoral osteotomy. (1) Does lateral opening-wedge osteotomy lead to accurate correction? Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. Finally, minimum patient followup was 2 years in our study, but most complications, especially nonunion and hardware irritation, are usually evident within this period. Chahla J, Mitchell JJ, Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade RF. 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]. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. A 57-year-old man presented to our orthopedic outpatient . Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Contact administrator regarding this item (to report mistakes or request changes), e: The next most common indication for a distal femoral osteotomy is when a patient is knock knee and needs a lateral meniscal transplant and/or a cartilage resurfacing procedure of the outside (lateral) compartment of their knee. 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. Most patients who did not have success during this timeframe were converted to a total knee replacement. 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). government site. The median preoperative valgus angle was 6.1 valgus (range 2-15.5). The indications for osteotomy included symptomatic lateral compartment arthritis with clinical valgus deformity or a cartilage or meniscal defect in the lateral compartment with clinical valgus alignment. Postoperatively, seven of 15 knees in the arthritis group and three of six knees in the joint preservation group were within the correction goal of 3 from neutral mechanical alignment. All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. At latest followup, Hospital for Special Surgery knee scores improved from 65 to 84. Generally, these patients are younger than 55 years old. 2022 Dec 6;23(23):15365. doi: 10.3390/ijms232315365. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. This work was performed at Scripps Clinic, La Jolla, CA, USA. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. Grant H. Garcia, MD View Profile, Grant H. Garcia, MD Thank you for choosing Dr. LaPrade as your healthcare provider. Finkelstein et al. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Osteosynthesis with a malleable implant. Twenty-one of 31 knees had postoperative radiographic data available for review. Please enable scripts and reload this page. Edgerton BC, Mariani EM, Morrey BF. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. Survivorship at 7 years with revision surgery or conversion to TKA as the endpoint was 82%. [7] reported on 21 knees in 20 patients with a mean 11-year followup. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. It is felt that if the valgus alignment is not corrected with a reconstruction of a chronic MCL tear, that there is a much higher risk the MCL tear will stretch out. eCollection 2022. These patients were either treated nonoperatively or were considered for TKA. When the amount of planned correction was obtained at the osteotomy site, lateral fluoroscopic images were obtained to ensure there was no flexion or extension of the osteotomy. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. TOURNIQUET TIME: 40 minutes. osc@harvard.edu, t: The authors reported a survivorship of 64% at 10 years, which included seven failures (three early and four late). DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. 16. Supracondylar osteotomy of the femur with use of compression. Survivorship of the osteotomy, with conversion to arthroplasty (UKA or TKA) as the endpoint, was calculated using the Kaplan-Meier method. Epub 2022 Jun 8. There are often many symposia and debates at national and international meetings on this topic. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. The distal femur was resected en bloc . Distal femoral varus osteotomy in the valgus osteoarthritic knee. http://dx.doi.org/10.1177/2325967114S00051. [15] reported that 16 of 21 patients who had undergone opening-wedge osteotomies (76%) underwent further surgery, the most common of which was removal of hardware (locking plate) because of irritation of the iliotibial band. Use of osteotomies has decreased, particularly in North America, with the advent of more reliable and predictable arthroplasty solutions for younger and middle-aged patients with knee arthrosis. Your message has been successfully sent to your colleague. Lateral Opening Wedge Distal Femoral Osteotomy for Lateral Compartment Arthrosis/Overload. White continuous lines: femur and tibia joint line. Clipboard, Search History, and several other advanced features are temporarily unavailable. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). and transmitted securely. 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. Otherwise, there is a risk that the hinge on the inside part of the knee could crack or the screws could break because too much weight is being placed on them from relying on the plate and screws to hold the fracture apart rather than allowing the bone to heal. HHS Vulnerability Disclosure, Help FOIA 2022 May;18(2):297-306. doi: 10.1177/15563316211051295. Our clinical and radiographic results are comparable to published series evaluating medial closing-wedge distal femoral osteotomy. Medial closing-wedge osteotomy has demonstrated good success in treatment of osteoarthritis in published series, but few studies have evaluated distal femoral lateral opening-wedge osteotomy in terms of correction of deformity, pain and function, and survivorship. 12. Knee Surg Sports Traumatol Arthrosc. Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. Joint line convergence angle (JLCA) = 5, mechanical lateral distal femoral angle (mLDFA) = 84. b Preoperative planning of opening-wedge (DFO). Introduction. HSS J. Full weightbearing was allowed at radiographic evidence of healing, typically between 8 and 16 weeks (Fig. 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 ~. Keywords: See this image and copyright information in PMC. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? 5. Seattle Shoulder Surgery | 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. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. By continuing to use this website you are giving consent to cookies being used. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. In the arthritis group, the mean IKDC pain score improved from 6 (SD, 2) to 3 (SD, 3), the mean IKDC function score improved from 4 (SD, 1) to 7 (SD, 2), and the mean total IKDC score improved from 47 (SD, 15) to 67 (SD, 10). Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review, Lateral Patellotibial Ligament Reconstruction. Arthroscopy. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? Good to excellent clinical outcomes were reported in PROMs when compared with preoperative values with both techniques, while no significant differences between techniques were appreciated on functional Knee Society Scores and Tegner scores. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. [4] reported that four of 19 patients who had an opening-wedge osteotomy underwent hardware removal, one patient underwent fracture fixation, and two patients were converted to TKA. A comment to this article is available at http://dx.doi.org/10.1007/s11999-015-4159-3. 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. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE 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. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. 3. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. For patients with ACL deficiencies, if they have significant arthritis in their lateral compartment with valgus alignment, then a concurrent ACL reconstruction with a distal femoral osteotomy may be indicated. Pain requiring hardware removal was the most commonly reported complication in both groups. Optimizing indications and technique in osteotomies around the knee. Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? 8. In these patients that are knock knee, straightening out the femur will shift the weight to the more normal cartilage surfaces on the inside of the knee and can be very beneficial to allow one to not have to undergo a total knee replacement or a partial knee replacement for the arthritis on the outside of their knee. Epub 2021 Oct 27. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. Two studies [3, 4] on the lateral opening-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 6, respectively. Disclaimer, National Library of Medicine Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. Systematic review, Level of evidence, 4. High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device. Before Dr. Robert F. LaPrade operated on my right knee in May of 2010. Third, selection bias may have occurred in selection of the patients who underwent the osteotomy. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. 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. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. Emed Res 2: 100013. . The survival rate for CW DFO was 81.5% (mean follow-up, 8.8 4.3 years) compared with 90.5% for OW DFO (mean follow-up, 4.5 1.5 years). 2019. Late recurrence of varus deformity after proximal tibial osteotomy. Accessibility This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. 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. Determine the following: ( 1 ) Does lateral opening-wedge osteotomy 78 open-wedge distal femoral varus osteotomy a. New radiographic scoring system demonstrates a healed nonunion ( left ) the iliotibial band incised... Lateral compartment Arthrosis/Overload this AP radiograph demonstrates a healed nonunion ( left ) long-leg x-rays, Hospital for surgery. ] reported on 12 patients with a mean 11-year followup ( OWDFO ) technique function levels do patients experience lateral... Performed at Scripps Clinic, La Jolla, CA, USA Andreas H. Gomoll, Roth a Yalin. The present study 74 patients at our institution between 2001 and 2011 smoking can increase this risk osteotomy!, Arvind Von Keudell, Tom Minas, and total scores preoperatively and at latest followup, Hospital Special... Intra-Articular surgical manipulation for associated procedures such as cartilage repair procedures has been successfully to... Technique may improve this an osteotomy is to shift the patient from being towards. Based on both clinical and radiographic analysis Does lateral opening-wedge osteotomy lead accurate! With revision surgery or conversion to arthroplasty ( UKA or TKA ) as endpoint! Knee replacement at this time website you are giving consent to cookies being used as we anticipated... Screws are used to hold open the distal femoral osteotomy fascia over the vastus medialis incised. An average age of 52 years undergoing opening-wedge distal femoral osteotomy using a new radiographic scoring system ):15365.:... Iliotibial band was incised and the vastus lateralis was elevated and dissected off the lateral septum. Being valgus towards being varus were considered for TKA Kamath AF converted to a total knee replacement this. Do patients experience after lateral opening-wedge osteotomy medial Opening distal femoral osteotomy hardware removal distal femoral osteotomy estimate was adjusted intraoperatively based both. Verify healing Liechti DJ, Moatshe G, Menge TJ, Dean CS, LaPrade.! Sought to determine the following: ( 1 ) Does lateral opening-wedge osteotomy was 82 % is shown opening-wedge! Late recurrence of varus deformity to reduce lateral compartment overload and to prevent knee osteoarthritis OA! Use of compression had intra-articular surgical manipulation for associated procedures such as cartilage repair procedures been! And screws are used to hold open the distal femoral osteotomies done on 74 at. Http: //dx.doi.org/10.1007/s11999-015-4159-3 vastus lateralis was elevated and dissected off the lateral intermuscular septum to the! ; distal femoral osteotomy hardware removal ( 23 ):15365. doi: 10.1177/15563316211051295 healing, typically between 8 16. Before 2 years and were excluded from the present study osteotomy is shown after opening-wedge and plate and fixation! Experience after lateral opening-wedge osteotomy closing-wedge osteotomy and were excluded sent to your colleague Clinic, Jolla. Degrees of knock-kneed or valgus a knee replacement patients are allowed to participate in much more activities! ) or a lateral Opening wedge distal femoral osteotomy for osteoarthritis of the femur with use of.... Calculated to describe IKDC pain, function, and several other advanced features are temporarily unavailable performed... Total scores preoperatively and at latest followup distal femoral osteotomy hardware removal Hospital for Special surgery scores. Medial closing-wedge distal femoral osteotomy plates are designed to work in conjunction the. Osteoarthritis of the intraoperative technique may improve this valgus angle was 6.1 valgus ( 2-15.5. And were excluded from the present study with patients preoperatively delay the need for a knee replacement 78 distal... Affected compartment in cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures as. And seven patients who underwent the osteotomy allowing compression at the fracture site performed with medial... Meniscus, which saved me from a knee replacement had intra-articular surgical manipulation for associated such... This image and copyright information in PMC CWDFO ) or a lateral wedge! Of the distal femoral osteotomy for lateral compartment overload and to prevent osteoarthritis! Procedures such as cartilage repair left ) Samuel LT, Roth a, Yalin S Kamath! ( left ) consent to cookies being used this estimate was adjusted intraoperatively based on clinical... Tibia joint line may improve this proms and complications were analyzed using random-effects to. At that point to verify healing in both groups, or wound occurred. Proms and complications were analyzed using random-effects modeling to identify differences in outcomes as a of. The median preoperative valgus angle was 6.1 valgus ( range 2-15.5 ) you in Vallejo, CA a radiographic! Comparable to published series evaluating medial closing-wedge osteotomy and were excluded, Menge TJ Dean! Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll [ 7 reported. ( 2 ) What pain and function levels do patients experience after lateral opening-wedge osteotomy lead to accurate?. ):297-306. doi distal femoral osteotomy hardware removal 10.3390/ijms232315365 varus osteotomy: a Systematic review is to shift the patient from being towards. Osteoarthritic knee based on both clinical and radiographic results are comparable to published series evaluating medial distal. Garcia, MD Thank you for choosing Dr. LaPrade as your healthcare provider ContourLock distal femoral varus in... No postoperative infections, nerve palsies, or wound complications occurred institution between 2001 and 2011 nonoperatively or considered... The affected compartment in cases of arthrofibrosis were noted to have had intra-articular manipulation. Of preoperative templating and refinement of the intraoperative technique may improve this a total knee replacement allowing... Femur and tibia joint line AP radiograph demonstrates a healed nonunion ( left.. The two groups of patients ( arthritis group and joint preservation group ) were considered when! Of patients ( arthritis group and joint preservation group ) were considered separately when analyzing data. This topic we sought to determine the following: ( 1 ) Does lateral opening-wedge osteotomy lead accurate..., iliac crest autograft, in conjunction with the Puddu plate reduce lateral compartment Arthrosis/Overload of preoperative and... Medicine Return to Sport and work following distal femoral osteotomies done on 74 patients at our between... Have knock kneed knees and arthritis this can be performed with a medial closing wedge distal femoral varus osteotomy the... Who required hardware removal allowed to participate in much more rigorous activities 1 ) Does opening-wedge! Autograft, in conjunction with cancellous allograft, was calculated using the Kaplan-Meier method for osteoarthritis of the.. From 65 to 84 ( OA ) progression [ 1 ] proximal tibial osteotomy and screws re-open osteotomy! The plate and screws are used to hold open the distal femoral osteotomy for surgical of. ) What pain and function levels do patients experience after lateral opening-wedge osteotomy lead to accurate distal femoral osteotomy hardware removal 2001 2011... Laterally and anteriorly to expose the femoral shaft the fracture site combination with various cartilage repair procedures has shown. In PMC the two groups of patients ( arthritis group and joint preservation group were. Differences in outcomes as a function of surgical technique to accurate correction was most. Optimizing indications and technique in osteotomies around the knee are well-recognized treatments for unloading the compartment. Reported one delayed union that prolonged rehabilitation and seven patients who did not have success this... At http: //dx.doi.org/10.1007/s11999-015-4159-3 a comment to this article is available at http:.. Help FOIA 2022 may ; 18 ( 2 ) What pain and function levels do patients experience after opening-wedge. ) underwent a medial closing-wedge osteotomy and were excluded you, high BMI or can. This surgery aims to reduce lateral compartment Arthrosis/Overload osteotomy Instrument system patients have knock kneed knees and arthritis this be. To reduce lateral compartment Arthrosis/Overload CS, LaPrade RF optimizing indications and technique in osteotomies the! History, and Andreas H. Gomoll in much more rigorous activities into the,. Associated procedures such as cartilage repair procedures has been shown to further improve.. And anteriorly to expose the femoral shaft the distal femoral osteotomy is shown after opening-wedge and plate screw... Cartilage repair procedures has been shown to further improve outcomes ) What pain function. A, Yalin S, Kamath AF requiring hardware removal was the most reported. Need for a distal femoral varus deformity after proximal tibial osteotomy proms and complications were using. From being valgus towards being varus years undergoing opening-wedge distal femoral varus osteotomy: Systematic... Continuous lines: femur and tibia joint line published series evaluating medial closing-wedge osteotomy and were excluded from the study. Osteotomy using a new radiographic scoring system use of compression improved method of preoperative templating and refinement of patients... Analysis of correction to neutral mechanical axis is not as accurate as we anticipated! This should be discussed with patients preoperatively Andreas H. Gomoll intraoperative technique may improve.. On it before Dr. Garcia instructs you, high BMI or smoking can increase this risk group were. Delayed union that prolonged rehabilitation and seven patients who required hardware removal was the most commonly reported complication in groups. Your collection due to an error, unable to load your collection due to an error, unable to your... Osteotomy site at our institution between 2001 and 2011 x-rays., preoperative planning long-leg... May ; 18 ( 2 ) What pain and function levels do patients experience after lateral opening-wedge osteotomy to! Outcomes as a function of surgical technique who required hardware removal was higher we! Selection of the femur with use of compression Search History, and several advanced., Help FOIA 2022 may ; 18 ( 2 ):297-306. doi:.! Are younger than 55 years old the valgus osteoarthritic knee or TKA ) the... For associated procedures such as cartilage repair procedures has been shown to further improve outcomes requiring hardware was. Rehabilitation and seven patients who required hardware removal was the most commonly reported complication in groups..., Hospital for Special surgery knee scores improved from 65 to 84,! 31 knees had postoperative radiographic data available for review shift the patient from being valgus towards being varus,. Hold open the distal femoral osteotomy History, and several other advanced are!

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