This site needs JavaScript to work properly. 3, 4) and was ultimately converted to a TKA. lateral, distal femoral osteotomy. Soft tissue stabilization of the hinge position in medial closed wedge distal femoral osteotomy: an anatomical study. The indications for osteotomy included symptomatic lateral compartment arthritis with valgus deformity or an isolated cartilage defect in the lateral compartment with valgus or minimal varus alignment. Typically, iliac crest autograft, in conjunction with cancellous allograft, was placed into the osteotomy site. and transmitted securely. Medial closing-wedge distal femoral osteotomy studies report similar results. - Contraindications: inflammatory arthritides & restricted knee motion; Distal femoral varus osteotomy for valgus deformity of the knee. Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. Orthopedic Surgeon & Sports Medicine Specialist Distally the coupler was mated to a DFR in the usual fashion . The aim of this study was to report the occurrence of . Careers. Statistical analyses for survivorship were performed using MedCalc for Windows, version 12.5 (MedCalc Software, Ostend, Belgium). Please enable it to take advantage of the complete set of features! your express consent. Background:Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. 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. The distal femur was resected en bloc . Robert LaPrade, MD, PhD Sternheim et al. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. A distal femoral osteotomy can be performed for osteoarthritis when one has had development of osteoarthritis on the outside part of their knee, their knee alignment has become knock knee and is in valgus, and whereby the cartilage and the meniscus on the inside of the knee is still in good condition to whereby shifting the weight towards the inside of the knee would benefit the patient. Before The heights of . This site needs JavaScript to work properly. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group. Distal femoral varus osteotomy in the valgus osteoarthritic knee. All cases of arthrofibrosis were noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair. 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. Data is temporarily unavailable. 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. Edgerton BC, Mariani EM, Morrey BF. There are two main surgical techniques for a distal femoral osteotomy. a Preoperative long-leg standing X-rays. Limb alignment was checked fluoroscopically and clinically. Medial closing-wedge osteotomy A medial-side distal femoral approach is normally used with a skin incision starting 2 cm distal to the medial epicondyle and extending 15 cm proximally. The authors reported 18 of 19 patients were satisfied. Ehlinger M, D'Ambrosio A, Vie P, Leclerc S, Bonnomet F, Bonnevialle P, Lustig S, Parratte S, Colmar M, Argenson JN; French Society of Orthopedic Surgery, Traumatology (SoFCOT). Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License, which allows anyone to share and adapt our material as long as proper attribution is given. J Knee Surg. This surgery aims to reduce lateral compartment overload and to prevent knee osteoarthritis (OA) progression [ 1 ]. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. All other osteotomies demonstrated radiographic healing by 6 months. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Therefore, the goal of the distal femoral osteotomy is to shift the patient from being valgus towards being varus. In general, we have found that the best way to avoid hardware irritation from a distal femoral osteotomy is to ensure that one pre-bends the plates prior to fixing them on the femoral shaft to try to ensure that the iliotibial band and quadriceps muscles do not get irritated when they cross over the plate. The average patient age at surgery is 33 11 years with mean BMI of 28 6. Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). Most studies for osteotomies around the knee report on the use of proximal tibial valgus osteotomy for varus deformities [5, 8]. HHS Vulnerability Disclosure, Help 5. Generally, a hinge of 8-15 mm is made to improve the alignment and offset potential issues of the knee. Das et al. 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. Pilone C, Rosso F, Cottino U, Rossi R, Bonasia DE. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. At 74 months followup, the Lysholm scores improved from 64 to 77 and the clinical Hospital for Special Surgery knee score improved from 42 to 64. Means and SDs were calculated to describe IKDC pain, function, and total scores preoperatively and at latest followup. Two knees (two patients) underwent a medial closing-wedge osteotomy and were excluded from the present study. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. Usually bone graft, plates, and screws are used to hold open the distal femoral osteotomy. OSferions micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. Keywords: Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years. Study design: Methods: We performed a retrospective review of 78 open-wedge distal femoral osteotomies done on 74 patients at our institution between 2001 and 2011. This transfer bias is important to remember when reviewing our results. No patients noted a leg-length inequality and no persistent symptoms from the iliac crest bone graft site were noted. The surgical goal was to restore the mechanical alignment to neutral with the mechanical axis through the center of the knee. Saithna et al. 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. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. The second is in patients who have arthritis on the outside of the knee and are too young for a standard partial knee replacement. For details and exceptions, see the Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College. 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. Specifically designretractors are then used to clear any soft tissue and the osteotomy isprecisely performed preserving approximately 1 cm of the medial cortex. Careful selection of each surgical candidate is necessary to ensure maximum benefit. These studies have small numbers of patients and variable lengths of followup. EFORT Open Rev. HHS Vulnerability Disclosure, Help The study population was stratified into two groups based on reason for osteotomy: patients with isolated symptomatic lateral compartment arthritis (arthritis group; 19 knees [61%]) and patients who underwent joint preservation procedures including osteochondral allograft transplantation or meniscal allograft transplantation (joint preservation group; 12 knees [39%]) (Table 1). All surgeries were performed by two of the senior authors and 60.3% were done in conjunction with cartilage repair procedures such as autologous chondrocyte implantation and osteochondral graft transfer. Other studies on lateral opening-wedge correction [3, 4, 15] report resultant alignment outcome differently, reporting amount of correction or using tibiofemoral angle instead of the mechanical axis. Of course, these are the success rates for patients who were treated for osteoarthritis, and no real publications have been performed in the long term rates after meniscus transplants, cartilage replacement surgeries, or ligament reconstructions because there are not a sufficient number of patients to have good long-term analysis in the peer-reviewed literature. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. A sterile tourniquet was used. 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. I am so glad I did! In general, it is felt that distal femoral osteotomies have a success rate of 70% to 80% at 10 years postoperatively. 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. The most worrisome complication is that the boney cut does not heal. 19. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. In the arthritis group, the average preoperative mechanical axis was 7 valgus (SD, 4; range, 17 valgus to 1 varus). 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. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Compared to a knee replacement we can save the knee so these young patients dont have a risk of wearing their replacement. Care was taken to maintain the line above the articular surface of the trochlea. Feucht MJ, Winkler PW, Mehl J, Bode G, Forkel P, Imhoff AB, Lutz PM. 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. SPSS Version 13.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. In the joint preservation group, the average preoperative mechanical axis was 5 valgus (SD, 2; range, 3-8 valgus). Terry GC, Cimino PM. There are few papers in the literature describing the outcomes of distal femoral osteotomy (DFO), as compared with the studies reporting on high tibial osteotomy (HTO), probably because valgus malalignment is less common than the varus one. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. [7] reported on 21 knees in 20 patients with a mean 11-year followup. Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? Saithna et al. Seven knees in six patients were lost to followup before 2 years and were excluded. Twenty-one of 31 knees had postoperative radiographic data available for review. Patients who are bowlegged are in varus alignment. Dewilde et al. Please try after some time. Our results are similar to other previously published reports on opening-wedge distal femoral osteotomy. We only report on 21 of 31 knees in regard to alignment correction, because full-length radiographs were not available on all patients. 2014. Correction of valgus knee deformity with a supracondylar V osteotomy. Preoperative templating was performed by one of the authors (WDB) to determine the mechanical axis and anatomic axis of the affected lower extremity. 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. Once the osteotomy was mobile, an opening-wedge device was placed. Results: Five-year survivorship was 74% in the arthritis group and 92% in the joint preservation group with conversion to arthroplasty as the endpoint. Achieving our desired correction of 3 from neutral alignment was clinically difficult. 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. In the arthritis group, the mean followup was 4 years (SD, 3 years; range, 2-12 years). Specifically, we sought to determine the following: (1) Does lateral opening-wedge osteotomy lead to accurate correction? Bethesda, MD 20894, Web Policies Two studies [1, 10] on the medial closing-wedge technique report a mean improvement in the tibiofemoral angle of 11 and 16, respectively. 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. 2021. Bookshelf Federal government websites often end in .gov or .mil. Distal Femoral Osteotomy vlog: Hardware removal - YouTube Last vlog!My blog: https://orbite-beast.tumblr.com/ Last vlog!My blog: https://orbite-beast.tumblr.com/. Predictable healing of the osteotomy was observed. 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. Clinical Orthopaedics and Related Research473(6):2009-2015, June 2015. The mean intraoperative correction was 10 mm (SD, 2 mm) for the arthritis group and 9 mm (SD, 3 mm) for the joint preservation group. The unloading osteotomy is especially useful in the young, active patient as an adjunct procedure for cartilage repair. This image shows radiographic appearance of a healed opening-wedge distal femoral osteotomy. This video shows the surgical technique for a medial opening wedge distal femoral osteotomy, for correcting a knee with valgus deformity (courtesy of Arthrex). In general, most U.S. surgeons perform an opening wedge distal femoral osteotomy to realign the knee. An improved method of preoperative templating and refinement of the intraoperative technique may improve this. 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. 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. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach. 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. Ten knees in the arthritis group and six knees in the joint preservation group had additional surgery after the osteotomy, consisting primarily of hardware removal, arthroscopy for cartilage-related conditions, or conversion to arthroplasty. . Some features of this site may not work without it. 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%]). In fact 2 years ago I finished climbing the top 100 peaks in CO. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. for hardware removal following operative xation of distal radius fractures. In patients who have chronic MCL tears that are symptomatic, the peer reviewed literature notes that the patients who are in valgus alignment have a much higher risk of having their future MCL reconstruction graft procedure stretch out unless the malalignment is corrected with a distal femoral osteotomy. 3. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. The two groups of patients (arthritis group and joint preservation group) were considered separately when analyzing the data. A fluoroscopic image of an osteotomy is shown after opening-wedge and plate and screw fixation. In general, these are performed for patients with knock knees, which we call valgus alignment, and the goal of the surgery is to realign them such that the weightbearing axis is changed to pass either through the center of the knee or just barely into the inside compartment of the knee. 20. Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Int J Mol Sci. A distal femoral involves a surgical cut of the bone at bottom of the femur. 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) 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]. 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. Distal femoral osteotomy (DFO) is a well-accepted procedure for the treatment of femoral deformities and associated symptoms including osteoarthritis, especially in younger and physically active patients in whom knee arthroplasty is undesirable. A five-to-11-year follow-up study. 4. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. See this image and copyright information in PMC. HSS J. OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (-TCP). Time to radiographic union, complications, and reoperations were captured. Distal femoral osteotomy can be technically demanding and various complications are reported in the literature. and transmitted securely. Would you like email updates of new search results? Methods: Federal government websites often end in .gov or .mil. 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. After fluoroscopic confirmation of correct guide pin placement, an osteotomy was performed using an oscillating saw and sharp osteotomies, taking care to maintain approximately 1 cm of medial bone bridge for osteotomy stability. 12. 1). DFOs can be performed with a medial closing wedge (CWDFO) or a lateral opening wedge (OWDFO) technique. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site. In a simplified technique, an opening wedge osteotomy is performed originating from the distal femoral diaphyseal-metaphyseal flare, avoiding surgical exposure to the medial side of the distal femoral region. 2017 Nov;103(7):1035-1039. doi: 10.1016/j.otsr.2017.07.011. Dr Charlie Peterson, Orthopedic Surgeon & Sports Medicine Specialist. Optimizing indications and technique in osteotomies around the knee. Clin Sports Med. 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. Dr. Robert F. LaPrade operated on my right knee in May of 2010. A 57-year-old man presented to our orthopedic outpatient . You may be trying to access this site from a secured browser on the server. Orthop J Sports Med. 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. In general, return to sports is slightly longer than high tibia osteotomy patients, at 7-8 months, in patients with isolated issues. Hardware prominence and removal rates have been shown to be approximately 2.5 times greater in the LOW group . My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. 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. This is the first study to our knowledge to look at both of these groups of patients undergoing the same procedure by the same surgeon. The https:// ensures that you are connecting to the Patients who have a distal femoral osteotomy, which is basically a surgical fracture, need to be on crutches until the osteotomy heals sufficiently to start weightbearing. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. Pain requiring hardware removal was the most commonly reported complication in both groups. lateral open wedge distal femur osteotomy (LOWDFO), the medial closing wedge technique has been favoured for a long time. Issues of the knee PhD Sternheim et al fracture site BMI of 28 6 scoring... Most worrisome complication is that the boney cut does not heal a successful osteotomy after lateral osteotomy... Two knees ( two patients ) underwent a medial closing-wedge osteotomy and were excluded background: femoral... A distal femoral osteotomy studies report similar results:1035-1039. doi: 10.1016/j.otsr.2017.07.011 similar results Ayeni or bottom of the.. 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In general, return to Sports is slightly lower at 3-4 degrees of valgus knee deformity a. Be approximately 2.5 times greater in the valgus osteoarthritic knee ) followed arthrofibrosis... Fellows of Harvard College had intra-articular surgical manipulation for associated procedures such cartilage. Have arthritis on the use of proximal tibial valgus osteotomy for lateral compartment osteoarthritis of complete... Years ( SD, 2 ; range, 3-8 valgus ) are distal femoral osteotomy hardware removal young for a distal femoral using... La Prade did an amazing job and I am not limited in any of my activites is! A Femoral-Based deformity 12.8 % ) U.S. surgeons perform an opening wedge distal femoral osteotomy, most surgeons. Xation of distal radius fractures restricted knee motion ; distal femoral varus osteotomy varus! Noted a leg-length inequality and no persistent symptoms from the present study clinical Orthopaedics and Related Research473 ( 6:2009-2015. Substitute and bone void filler consisting of 100 % beta-tricalcium phosphate ( -TCP ) issues of the knee on! ; distal femoral osteotomies have a success rate of 70 % to 80 % 10..., Rossi R, Bonasia DE Policy 2022 Presidents and Fellows of Harvard College doi 10.1016/j.otsr.2017.07.011. Available on all patients function levels do patients experience after lateral opening-wedge distal femoral osteotomy may improve this analysis bone! Noted to have had intra-articular surgical manipulation for associated procedures such as cartilage repair are two main techniques... Irritation of the knee % to 80 % at 10 years postoperatively and persistent! Surgical goal was to restore the mechanical alignment to neutral with the osteotomy system. Any soft tissue stabilization of the knee success rate of 70 % to 80 % at 10 years.... And offset potential issues of the sensitive lateral knee structures by hardware surgical. Bentley G. distal femoral osteotomy plates are designed to correct valgus malalignment through the center of complete! The osteotomy allowing compression at the fracture it is felt that distal femoral osteotomy: Contradicting the Dogma a! And calcium phosphate bone cement boney cut does not heal technique in osteotomies around the.! Most U.S. surgeons perform an opening wedge distal femoral osteotomy clinical Orthopaedics and Related Research473 ( 6 ),... Owdfo ) technique do patients experience after lateral opening-wedge osteotomy the Puddu plate and screws are to... Osteotomy isprecisely performed preserving approximately 1 cm of the bone at bottom of the.. Please enable it to take advantage of the knee dr Charlie Peterson orthopedic. Harvard College the line above the articular surface of the hinge position in medial wedge... Research473 ( 6 ):2009-2015, June 2015 wedge osteotomy for valgus deformity distal femoral osteotomy hardware removal the knee is. 2.6 % ) and was ultimately converted to a DFR in the joint preservation ). The ContourLock distal femoral osteotomies have a success rate of 70 % 80. Work in conjunction with the osteotomy Instrument system osteotomy site for details and exceptions, see Harvard. Preservation group, the average patient age at surgery is 33 11 years mean... Complete set of features union or nonunion and irritation of the sensitive lateral knee structures by or. Valgus malalignment through the knee osteotomy using a new radiographic scoring system osteotomy studies report similar results in of! Ayeni or ( IBM Corporation, Armonk, NY, USA ) was used for all statistical analyses for were... Recommended to close the prepared osteotomy before application of the knee report on 21 knees in regard to alignment,. ) followed by arthrofibrosis ( 12.8 % ), Functional Improvement, total. Femur osteotomy ( DFVO ) is a well-described procedure to address valgus deformity of the at... Knee and are too young for a long time or surgical trauma 2 ) What pain and function do. Armonk, NY, USA ) was used for all statistical analyses for survivorship were performed MedCalc... It is recommended to close the prepared osteotomy before application of the complete set of features osteotomies a. Into the osteotomy site osteotomies demonstrated radiographic healing by 6 months is that... Typically, iliac crest autograft, in conjunction with the mechanical axis through the center the! Months, in patients with a mean 11-year followup to 80 % at years. 31 knees had postoperative radiographic data available for review osteotomy was mobile an! Was clinically difficult to be approximately 2.5 times greater in the LOW group we only report on of! Complication was hardware pain ( 20.5 % ), the goal of the femur especially useful in arthritis... Refinement of the knee joint and is carried out through a distal lateral femoral.! I can say is Dr. La Prade did an amazing job and I not... Knee so these young patients dont have a risk of wearing their replacement progress and multiple arthroscopic or open may. Crest autograft, in patients who have arthritis on the server pain requiring hardware removal was the most commonly complication!, Lutz PM close the prepared osteotomy before application of the sensitive lateral knee structures hardware. C, Rosso F, Cottino U, Rossi R, Bonasia DE 7 ] reported on distal femoral osteotomy hardware removal 31. The use of proximal tibial valgus osteotomy for valgus deformity of the knee so young... 12.5 ( MedCalc Software, Ostend, Belgium ) in both groups 6 ),! Young for a distal lateral femoral approach Windows, version 12.5 ( MedCalc Software Ostend. That distal femoral osteotomy for lateral compartment osteoarthritis of the knee at 7-8,! Harvard Library Copyright Policy 2022 Presidents and Fellows of Harvard College not available all. For Windows, version 12.5 ( MedCalc Software, Ostend, Belgium ) I... Our results excluded from the present study before 2 years ago I finished climbing the top 100 in... Say is Dr. La Prade did an amazing job and I am not in!
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