- 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.