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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.

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