Varus and valgus knee deformity affect the alignment of the knee and distribution of biomechanical loads on the knee joint. When the knee is malaligned, the forces in the knee joint are not evenly distributed and may overload one compartment causing pain and possibly degeneration. An osteotomy is performed on the tibia or femur in order to properly realign the weight bearing line, restore the ideal mechanical environment, and aid in the unloading of concomitant procedures.

Knee

Procedure

Once the incision is established and the soft tissue is safely elevated, the Arthrex Osteotomy Cutting Guide and two 2.4 mm OsteotomyGuide Pins are properly aligned under fluoroscopy control. Specifically design retractors are then used to clear any soft tissue and the osteotomy is precisely performed preserving approximately 1 cm of the medial cortex. The desired amount of angular correction is achieved utilizing the Osteotome Jackor Osteotomy Wedge and the osteotomy site is packed with allograft or autograft bone void filler.

Distal Femoral Osteotomy 

OSferion is an osteoconductive bone graft substitute and bone void filler consisting of 100% beta-tricalcium phosphate (β-TCP). OSferion’s micro- and macroporous structure allows it to be resorbed and replaced by bone during the healing process. 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 chamfered wedge design of the OSferion implants corresponds to the shape of the osteotomy and can be easily trimmed to size using a rongeur.

OSferion Bone Void Filling

In situations where the lateral cortex or anteromedial cortex has been inadvertently fractured, the Two-Hole Osteotomy Support Plate Implant System can be utilized to help fixate these fractures. After proper soft tissue exposure and identification of the fracture it is recommended to close the prepared osteotomy before application of the plate. 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. After successful application of the plate and screws re-open the osteotomy allowing compression at the fracture site.

Distal Femoral Fracture Management

Titanium
Anatomically curved and low profile, ContourLock DFO plates are available in right and left orientations and multiple sizes, depending on the desired amount of correction. The toothless design facilitates greater flexibility through infinite correction potential up to 20 mm without compromising strength.
Titanium Femoral Opening Wedge Osteotomy Plates provide a straight-toothed option to aid in maintaining the osteotomy correction.
These plates are fixated to bone using titanium locking 6.5 mm cancellous and 4.5 mm cortical screws. Each screw can be angled to the proper anatomic orientation within a swiveling bushing before being locked.
Stainless Steel
Low-profile, stainless steel Femoral Opening Wedge Osteotomy Plates are available with a straight tooth to facilitate maintaining the osteotomy. These plates are optimal for unique anatomy that requires a customized fit with multiple bends. The plates are fixated using standard AO stainless steel 6.5 mm cancellous and 4.5 cortical screws.
All of the Femoral Opening Wedge Osteotomy Plates are designed to work in conjunction with the standard <a href="http://www.arthrex.com/knee/opening-wedge-osteotomy-instrument-set">Opening Wedge Osteotomy Instruments Sets.</a>

ContourLock™ Distal Femoral Osteotomy (DFO) Plates and Screws

Distal Femoral Osteotomy

The ContourLock™ distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. 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. 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.
In situations involving lateral unicompartmental arthritis unresponsive to conservative treatment options, the Distal Femoral Opening Wedge Osteotomy System is a safer, more reproducible alternative to traditional closing wedge distal femoral osteotomies. The system is designed to correct valgus malalignment through the knee joint and is carried out through a distal lateral femoral approach.
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. The osteotomy is supported by one in a series of Femoral Osteotomy Plates and secured with traditional proximal bicortical screw and distal cancellous screw fixation.
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.
*StimuBlast® is a registered trademark of AlloSource

Secondary (C)

After determining the angle of correction preoperatively, the medial exposure of the tibia is established and the anterior, medial, and posterior soft tissues are safely elevated. The tibial osteotomy then begins by placing the Arthrex® HTO Cutting Guide on the medial tibia and drilling two 2.4 mm guide pins to within approximately 1 cm of the lateral cortex under fluoroscopy control. The surgeon may also choose to use the Arthrex Biplanar Alignment Guide to set the height and align the osteotomy with the patient's native tibial slope. Once the desired Arthrex Cutting Guide and retractors are in place, the osteotomy is completed utilizing an osteotome or specific saw blade. The osteotomy is then opened to the desired amount of correction via the Arthrex iBalance® HTO Opening Jack, Osteotome Jack or Osteotomy Wedge.

Tibial Opening Wedge

Proximal Tibial Fracture Management

Proximal Tibial Osteotomy

In the treatment of lower extremity malalignment and osteoarthritis, high tibial osteotomy is a procedure that allows for the realignment of the lower extremity and thereby either shifts the weight-bearing access to the healthier portion of the knee or corrects the alignment deformity.
Osteotomies can be performed concomitantly with the ACL reconstruction and osteochondral and meniscal transplants among other soft tissue and cartilage restorative procedures. Protective correction of alignment has been shown to improve success and satisfaction of these conservative treatments in young active patients.

Limb Deformity

Distal Femoral Osteotomy

Proximal Tibial Osteotomy