Name:
Distal Femur Osteotomy to Correct (Knock-Knee) Deformity
Description:
Distal Femur Osteotomy to Correct (Knock-Knee) Deformity
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/a890c4e6-2dcc-4741-aca1-bfbad82d03c0/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H06M16S
Embed URL:
https://stream.cadmore.media/player/a890c4e6-2dcc-4741-aca1-bfbad82d03c0
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/a890c4e6-2dcc-4741-aca1-bfbad82d03c0/6_ Distal Femur Osteotomy to Correct (Knock-Knee) Deformity-.mov?sv=2019-02-02&sr=c&sig=jYwrHiKS6iTSxXrgrb3cVoBPZJ%2FEXYcJB58huLnYArI%3D&st=2024-11-21T18%3A02%3A50Z&se=2024-11-21T20%3A07%3A50Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
S. ROBERT ROZBRUCH: Hi, my name is Dr. Rob Rozbruch and I'm the Chief of Limb Lengthening and Complex Reconstruction Service. This is a video that is going to illustrate distal femoral osteotomy to correct valgus or knock knee deformity. The patient is a 25-year-old female who has 9 degrees of left sided valgus deformity. She is presenting with lateral left knee pain related to overloading of the lateral side of the knee.
S. ROBERT ROZBRUCH: And having a valgus deformity is a risk factor for developing lateral knee arthritis and progressive valgus deformity. The surgical plan is distal femoral osteotomy and the goal is full correction of the left lower extremity valgus deformity and realignment of the mechanical axis. Long x-ray shows that the mechanical axis line on the left is 26 millimeters lateral to the midline.
S. ROBERT ROZBRUCH: Joint orientation angles show that the source of the deformity is coming from the femur and particularly the distal femur. Surgical planning shows that there is 9 degrees of distal femur valgus deformity. The plan is an osteotomy of 9 degrees with an opening wedge technique. Drawing the opening wedge shows that the base of the wedge needs to be 8 millimeters.
S. ROBERT ROZBRUCH: A 6 inch lateral skin incision is made to sections carried down to the deep fascia, which is incised. This exposed the vastus lateralis. The vastus lateralis is elevated off of the lateral aspect of the distal femur and the lateral aspect of the femur is exposed. Perforating vessels are cauterized,
S. ROBERT ROZBRUCH: and the distal femur is well exposed. The distal femur plate is used as a template to figure out exactly the optimal location of the plate and the osteotomy. So I temporarily place it, and take an x-ray to make sure it is well located. I have a cluster of screws distal and proximal and I know where I want to make my osteotomy. I've marked my osteotomy location and I'm clearing the tissue anterior and distal at the osteotomy site.
S. ROBERT ROZBRUCH: Hohmann retractors are placed. The wire is then inserted to determine the exact orientation of the osteotomy and x-ray is used for this purpose. It's an oblique orientation and it should be parallel to the floor. You'll notice on the x-ray that it is pointed towards the metaphyseal bone. It's important not to make a transverse osteotomy, and it's important not to hinge too proximally in order not to fracture the medial cortex.
S. ROBERT ROZBRUCH: I cut the k-wire so that I can saw along the side of the wire. This is a micro sagittal saw that is 40 millimeters in length. The anterior cortex, the posterior cortex and the lateral cortex are cut, the medial cortex is not cut. Irrigation is used to prevent thermal necrosis. An osteotome is then used to further mobilize the osteotomy,
S. ROBERT ROZBRUCH: and I've marked my location so as not to penetrate too deeply. Lamina spreaders are then used posteriorly and anteriorly to then distract the osteotomy 8 millimeters as per the preoperative planning. A wedge can be used to determine and confirm the size of the osteotomy. At this point, an x-ray is taken to visualize the osteotomy.
S. ROBERT ROZBRUCH: The plate is applied, Lamina spreaders are placed so as not to obstruct the insertion of the plate, and the plate is provisionally fixed with a couple of screws. Before I get in too far, I will check the alignment, as you'll see in a moment. The plate is inserted so that a cluster of five screws is going to be available distal to the osteotomy and a cluster of four or five screws is going to be available proximal to the osteotomy.
S. ROBERT ROZBRUCH: These are locking screws. This can be done using a titanium plate or in this case, a carbon plate is shown. Intra operatively, the alignment is checked with a line between the hip and the ankle. Here you see a Bovie Core technique used for this purpose. The fluoroscopy unit centers at the hip and then the ankle and then looks at where the line is,
S. ROBERT ROZBRUCH: and it confirms that the mechanical axis falls directly through the center of the knee. At this point, the rest of the screws are then inserted, placed after drilling with a 4.3 millimeter drill. These are 5 millimeter locked screws. You can see the vastus lateralis is easily retracted. Now, at this point, you can see the opening wedge is very stable.
S. ROBERT ROZBRUCH: This is an x-ray showing the opening wedge. Now, again, we'll confirm alignment, this time with a more rigid rod. This is a line from the center of the hip to the center of the ankle, and it confirms that the mechanical axis falls directly through the center of the knee. Next, the open wedge osteotomy is grafted with a combination of freeze dried allograft chips and de mineralized bone matrix putty.
S. ROBERT ROZBRUCH: This area has high healing potential. The graft is placed anterior and then posterior. The freeze dried allograft chips provide a very nice scaffold for bone end growth and this is supplemented with the putty. Closure is performed in layers using zero vicryl for the deep fascia and then subcutaneous and the skin are closed accordingly. This is an x-ray three months later showing incorporation of the distal femoral osteotomy, the lateral x-ray.
S. ROBERT ROZBRUCH: It's basically healed at this point, and a long x-ray is showing the mechanical axis on the left side directly through the center of the knee. I appreciate your attention. Thank you.
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