Distal Femoral Osteotomy

- Discussion:
      - degenerative valgus deformity of knee is less common than varus deformity;
      - genu valgum is more common in pts w/ history of trauma, RA, renal osteodystrophy, rickets, or infantile poliomyelitis;

- Treatment Options:
      - goal of is to correct the angle between anatomic axis of femur & mechanical axis of tibia to 0-2 degrees of valgus;
              - this will unload lateral tibiofemoral joint compartment and will prevent recurrence of deformity;
      - while high tibial osteotomy has been successful in the treatment of genu varum, it has little use in genu valgum because it would tend to cause an oblique joint line;
              - this tilting leads to shear force across knee & gradual tibial subluxation laterally, while distal femur appears to fall off medial tibial plateau;
      - for these reasons, distal femoral osteomy is a better choice;

- Indications for Osteotomy:
    - distal femoral osteotomy is inidicated if angle between anatomic femoral axis & tibial mechanical axis is > 12-15 degrees of valgus or if plane of joint deviates from the horizontal by > 10 degrees;
    - stable joint with no evidence of subluxation, ROM of at least 90 deg of flexion flexion contracture of no more than 15 degrees;

- Contraindications: inflammatory arthritides & restricted knee motion;

- Surgical Approach:
    - best approach to distal femoral varus osteotomy is controversial;
    - medial approach is often used, but lateral approach is also popular;
    - rigid fixation w/ device such as blade plate is recommended at osteotomy site;

- Post Op:
     - if rigid fixation of osteotomy site is confirmed, it is possible to start early ROM in conjunction w/ hinged fracture brace

Distal femoral varus osteotomy for valgus deformity of the knee.

Correction of valgus knee deformity with a supracondylar V osteotomy.

Distal femoral varus osteotomy

Late recurrence of varus deformity after proximal tibial osteotomy.

Closed intramedullary osteotomies of the femur.

Distal femoral varus osteotomy for painful genu valgum. A five-to-11-year follow-up study.

Distal femoral osteotomy for lateral gonarthrosis.

Bone Realignment with Use of Temporary External Fixation for Distal Femoral Valgus and Varus Deformities.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, August 30, 2012 3:07 pm