Medial Closed Wedge Distal Femoral Osteotomy Using a Novel Plate With an Optimal Compression System

Abstract

Medial closed wedge distal femoral osteotomy (MCWDFO) has been widely performed for lateral-compartment osteoarthritis since the development of a biplanar osteotomy technique using existing MCWDFO-specific plates. To further improve this system and the technique, we have developed a newly designed MCWDFO plate (TriS-MDFO; Olympus Terumo Biomaterials). The improved shape of the plate consists of a larger headeshaft angle to fit the distal femur after MCWDFO, more distally oriented distal screws to enable longer screw insertion, and a diamond-shaped plate head to avoid interference with the medial patellofemoral ligament. Technically, to overcome the difficulty in inserting proximal screws through the vastus medialis muscle, a cannulated screw system was employed. This system can prevent difficulties in removing the screw due to cross-threading when plate removal is required. Furthermore, we designed a novel compression hook device with a bulb-shaped head to hook on a screw hole to apply a compressive force to the osteotomized site. On the plate side, a characteristic 1.5 mm-thickness stopper is installed to prevent slippage of the hook device. This optimal compression system can minimize the risk of lateral hinge fracture during the compression procedure. These improvements in the TriS-MDFO may increase the ease and safety of MCWDFO.

Ankle-Angle-Adjusting Fibular Osteotomy in Closed Wedge High Tibial Osteotomy

“…During distal femoral osteotomy, relaxation of the hamstring muscles makes it easier to retract the posterior structures, including neurovascular structures. 9 However, the muscle relaxation position during fibular osteotomy has been largely ignored.…”

Femoral-varus tibial-valgus osteotomy (FVTVO) for neutrally-aligned knee osteoarthritis with severe joint line obliquity enables return to sports activities: A case series study

“…For the femur, biplanar medial closed wedge DFO 9 was chosen in all cases, and a lateral opening DFO was not performed to prevent complications. 22 For the tibia, our first choice was OWHTO using a pes-preserving technique, 3 and when the patient had moderate to severe patellofemoral osteoarthritis and/or flexion contracture ≥5°, hybrid CWHTO (HCWHTO) 5-7) was indicated.…”

“…High tibial osteotomy (HTO), including medial open-wedge HTO (OWHTO) 1 , 2 , 3 , 4 and lateral closed wedge HTO (CWHTO), 5 , 6 , 7 for medial compartmental osteoarthritis in varus knee has become a widely accepted surgery. Currently, medial closed wedge distal femoral osteotomy (DFO) 8 , 9 for valgus knees and lateral closed wedge DFO combined with medial OWHTO or lateral CWHTO; i.e. , double-level osteotomy 10 , 11 , 12 for severe varus knees are also becoming more common since the launch of various around-knee osteotomy (AKO)-specific locking plates.…”

Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity

“…The TomoFix MDF anatomical plate (DePuy Synthes, Solothurn, Switzerland) originally designed for the contralateral side was used for fixation and bent according to the individual’s anatomy. In May 2018, the fixation device was changed to a TriS LDFO plate (Olympus, Tokyo, Japan) [ 25 ]. After LCW-DFO, osteotomy was completed with OWHTO.…”