Skip to main content

Advertisement

SpringerLink
Log in

Distal femoral osteotomy

  • Modern Techniques in Lower Limb Realignment (DE Bonasia and P Phisitkul, Section Editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Osteotomies around the knee are well-recognized treatments for unloading the affected compartment in cases of lower limb malalignment. 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. There is still debate as to what the correct indication is and which surgical techniques lead to the best outcomes in performing a DFO. Besides, it is still controversial whether patellofemoral arthritis should be considered as a contraindication to performing a DFO, as well as in HTO. In this article, we will summarize the indications for DFO, the surgical techniques reported in the literature, and their outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Saithna A, Kundra R, Modi CS, Getgood A, Spalding T. Distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. A systematic review of the literature. Open Orthop J. 2012;6:313–9. doi:10.2174/1874325001206010313. This is a systematic review about DFO, reporting some of the papers we analyzed in this article.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee: prognostic factors. Am J Sports Med. 2014;42(3):690–8. doi:10.1177/0363546513516577. This paper is about HTO, but it is really interesting on the analysis of prognostic factors.

    Article  PubMed  Google Scholar 

  3. Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg. 2011;19(10):590–9.

    PubMed  Google Scholar 

  4. Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J. 2010;30:131–40.

    PubMed  PubMed Central  Google Scholar 

  5. Shoji H, Insall J. High tibial osteotomy for osteoarthritis of the knee with valgus deformity. J Bone Joint Surg Am. 1973;55(5):963–73.

    PubMed  CAS  Google Scholar 

  6. Coventry MB. Proximal tibial varus osteotomy for osteoarthritis of the lateral compartment of the knee. J Bone Joint Surg Am. 1987;69(1):32–8.

    PubMed  CAS  Google Scholar 

  7. McDermott AG, Finklestein JA, Farine I, Boynton EL, MacIntosh DL, Gross A. Distal femoral varus osteotomy for valgus deformity of the knee. J Bone Joint Surg Am. 1988;70(1):110–6. This is an old paper, but it described the original technique to perform a closing wedge DFO.

    PubMed  CAS  Google Scholar 

  8. Bouillet H VGP. Knee arthritis. Pathogenesis and treatment. L’arthrose du genou. Etude pathogenique et traitement. . Acta Orthop Belg. 1961(27):6.

  9. Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg Am. 1973;55(1):23–48.

    PubMed  CAS  Google Scholar 

  10. Backstein D, Morag G, Hanna S, Safir O, Gross A. Long-term follow-up of distal femoral varus osteotomy of the knee. J Arthroplasty. 2007;22(4 Suppl 1):2–6. doi:10.1016/j.arth.2007.01.026.

    Article  PubMed  Google Scholar 

  11. Jacobi M, Wahl P, Bouaicha S, Jakob RP, Gautier E. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique. Arch Orthop Trauma Surg. 2011;131(6):725–8. doi:10.1007/s00402-010-1193-1. This paper analyzes the results with open wedge DFO, and it is the only report describing unacceptable healing time with this technique.

    Article  PubMed  Google Scholar 

  12. Dewilde TR, Dauw J, Vandenneucker H, Bellemans J. Opening wedge distal femoral varus osteotomy using the puddu plate and calcium phosphate bone cement. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):249–54. doi:10.1007/s00167-012-2156-6. One of the most recent papers about opening wedge DFO and using of syntethic substitutes.

    Article  PubMed  CAS  Google Scholar 

  13. Closkey RF, Windsor RE. Alterations in the patella after a high tibial or distal femoral osteotomy. Clin Orthop Relat Res. 2001;389:51–6.

    Article  PubMed  Google Scholar 

  14. Purushothaman B, Agarwal A, Dawson M. Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction. Orthopedics. 2012;35(11):e1668–72. doi:10.3928/01477447-20121023-30.

    Article  PubMed  Google Scholar 

  15. Kwon JH, Kim JI, Seo DH, Kang KW, Nam JH, Nha KW. Patellar dislocation with genu valgum treated by DFO. Orthopedics. 2013;36(6):840–3. doi:10.3928/01477447-20130523-35.

    Article  PubMed  Google Scholar 

  16. Preston CF, Fulkerson EW, Meislin R, Di Cesare PE. Osteotomy about the knee: applications, techniques, and results. J Knee Surg. 2005;18(4):258–72.

    PubMed  Google Scholar 

  17. Lustig S, Khiami F, Boyer P, Catonne Y, Deschamps G, Massin P, et al. Post-traumatic knee osteoarthritis treated by osteotomy only. Orthop Traumatol Surg Res. 2010;96(8):856–60. doi:10.1016/j.otsr.2010.06.012.

    Article  PubMed  CAS  Google Scholar 

  18. Puddu GCM, Cerullo G, Franco V, Giannì E. Which osteotomy for a valgus knee? Int Orthop. 2010;34(2):239–47. The original technique about opening wedge DFO performed with the Puddu Plate®.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Coventry MBID, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of 87 cases. J Bone Joint Surg Am. 1993;75:196–201.

    PubMed  CAS  Google Scholar 

  20. Zarrouk A, Bouzidi R, Karray B, Kammoun S, Mourali S, Kooli M. Distal femoral varus osteotomy outcome: is associated femoropatellar osteoarthritis consequential? Orthop Traumatol Surg Res. 2010;96(6):632–6. doi:10.1016/j.otsr.2010.04.009. One of the most complete papers regarding the role of DFO in treating associated patellofemoral osteoarthritis.

    Article  PubMed  CAS  Google Scholar 

  21. Wang JW, Hsu CC. Distal femoral varus osteotomy for osteoarthritis of the knee. J Bone Joint Surg Am. 2005;87(1):127–33. doi:10.2106/JBJS.C.01559.

    Article  PubMed  Google Scholar 

  22. Drexler M, Gross A, Dwyer T, Safir O, Backstein D, Chaudhry H, et al. Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2014. doi:10.1007/s00167-013-2828-x.

    Google Scholar 

  23. Bonasia DE, Amendola A. Combined medial meniscal transplantation and high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2010;18(7):870–3. doi:10.1007/s00167-009-0999-2.

    Article  PubMed  Google Scholar 

  24. Phisitkul P, Wolf BR, Amendola A. Role of high tibial and distal femoral osteotomies in the treatment of lateral-posterolateral and medial instabilities of the knee. Sports Med Arthrosc. 2006;14(2):96–104. doi:10.1097/01.jsa.0000212306.47323.83. One of the papers reporting on DFO performed to treat medial collateral ligament instability.

    Article  PubMed  Google Scholar 

  25. Cameron JC, Saha S. Management of medial collateral ligament laxity. Orthop Clin North Am. 1994;25(3):527–32.

    PubMed  CAS  Google Scholar 

  26. Paley D, Bhatnagar J, Herzenberg JE, Bhave A. New procedures for tightening knee collateral ligaments in conjunction with knee realignment osteotomy. Orthop Clin North Am. 1994;25(3):533–55.

    PubMed  CAS  Google Scholar 

  27. Hetsroni I, Lyman S, Pearle AD, Marx RG. The effect of lateral opening wedge distal femoral osteotomy on medial knee opening: clinical and biomechanical factors. Knee Surg Sports Traumatol Arthrosc. 2013. doi:10.1007/s00167-013-2405-3.

    Google Scholar 

  28. Amendola A, Bonasia DE. Results of high tibial osteotomy: review of the literature. Int Orthop. 2010;34(2):155–60. doi:10.1007/s00264-009-0889-8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am. 1994;25(3):425–65.

    PubMed  CAS  Google Scholar 

  30. Fabricant PD, Camara JM, Rozbruch SR. Femoral deformity planning: intentional placement of the apex of deformity. Orthopedics. 2013;36(5):e533–7. doi:10.3928/01477447-20130426-11.

    Article  PubMed  Google Scholar 

  31. Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM. The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am. 1988;70(10):1479–83.

    PubMed  CAS  Google Scholar 

  32. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res. 1992;274:248–64.

    PubMed  Google Scholar 

  33. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. A survivorship analysis. J Bone Joint Surg Am. 1996;78(9):1348–52.

    PubMed  CAS  Google Scholar 

  34. Omidi-Kashani F, Hasankhani IG, Mazlumi M, Ebrahimzadeh MH. Varus distal femoral osteotomy in young adults with valgus knee. J Orthop Surg Res. 2009;4:15. doi:10.1186/1749-799X-4-15.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Aglietti P, Menchetti PP. Distal femoral varus osteotomy in the valgus osteoarthritic knee. Am J Knee Surg. 2000;13(2):89–95.

    PubMed  CAS  Google Scholar 

  36. Edgerton BC, Mariani EM, Morrey BF. Distal femoral varus osteotomy for painful genu valgum. A five-to-11-year follow-up study. Clin Orthop Relat Res. 1993;288:263–9.

    PubMed  Google Scholar 

  37. Marin Morales LA, Gomez Navalon LA, Zorrilla Ribot P, Salido Valle JA. Treatment of osteoarthritis of the knee with valgus deformity by means of varus osteotomy. Acta Orthop Belg. 2000;66(3):272–8.

    PubMed  CAS  Google Scholar 

  38. Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Int Orthop. 2010;34(2):249–54. doi:10.1007/s00264-009-0807-0.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Forkel P, Achtnich A, Metzlaff S, Zantop T, Petersen W. Midterm results following medial closed wedge distal femoral osteotomy stabilized with a locking internal fixation device. Knee Surg Sports Traumatol Arthrosc. 2014. doi:10.1007/s00167-014-2953-1.

    Google Scholar 

  40. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Distal femoral varus osteotomy. J Bone Joint Surg Am. 1988;70(1):102–9.

    PubMed  CAS  Google Scholar 

  41. Learmonth ID. A simple technique for varus supracondylar osteotomy in genu valgum. J Bone Joint Surg (Br). 1990;72(2):235–7.

    CAS  Google Scholar 

  42. Mathews J, Cobb AG, Richardson S, Bentley G. Distal femoral osteotomy for lateral compartment osteoarthritis of the knee. Orthopedics. 1998;21(4):437–40.

    PubMed  CAS  Google Scholar 

  43. Stahelin T, Hardegger F, Ward JC. Supracondylar osteotomy of the femur with use of compression. Osteosynthesis with a malleable implant. J Bone Joint Surg Am. 2000;82(5):712–22.

    PubMed  CAS  Google Scholar 

  44. Thein R, Bronak S, Thein R, Haviv B. Distal femoral osteotomy for valgus arthritic knees. J Orthop Sci. 2012;17(6):745–9. doi:10.1007/s00776-012-0273-1.

    Article  PubMed  CAS  Google Scholar 

  45. Staubli AE, De Simoni C, Babst R, Lobenhoffer P. TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia–early results in 92 cases. Injury. 2003;34 Suppl 2:B55–62.

    Article  PubMed  Google Scholar 

  46. Jacobi MJR. Open wedge osteotomy in the treatmen of medial osteoarthritis of the knee. Tech Knee Surg. 2005;4(2):70–8.

    Article  Google Scholar 

  47. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. Knee. 2014;21(1):172–5. doi:10.1016/j.knee.2013.08.014. The most recent paper describing results from opening wedge DFO.

    Article  PubMed  CAS  Google Scholar 

  48. Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: biomechanical investigation of the modified arthrex osteotomy plate (puddu plate) and the TomoFix plate. Clin Biomech (Bristol, Avon). 2004;19(9):944–50. doi:10.1016/j.clinbiomech.2004.06.007. The only paper comparing two different fixation methods for opening wedge DFO.

    Article  Google Scholar 

  49. Gaasbeek RD, Toonen HG, van Heerwaarden RJ, Buma P. Mechanism of bone incorporation of beta-TCP bone substitute in open wedge tibial osteotomy in patients. Biomaterials. 2005;26(33):6713–9. doi:10.1016/j.biomaterials.2005.04.056.

    Article  PubMed  CAS  Google Scholar 

  50. Aryee S, Imhoff AB, Rose T, Tischer T. Do we need synthetic osteotomy augmentation materials for opening-wedge high tibial osteotomy. Biomaterials. 2008;29(26):3497–502. doi:10.1016/j.biomaterials.2008.05.027.

    Article  PubMed  CAS  Google Scholar 

  51. Dallari D, Savarino L, Stagni C, Cenni E, Cenacchi A, Fornasari PM, et al. Enhanced tibial osteotomy healing with use of bone grafts supplemented with platelet gel or platelet gel and bone marrow stromal cells. J Bone Joint Surg Am. 2007;89(11):2413–20. doi:10.2106/JBJS.F.01026.

    Article  PubMed  CAS  Google Scholar 

  52. Gugenheim Jr JJ, Brinker MR. Bone realignment with use of temporary external fixation for distal femoral valgus and varus deformities. J Bone Joint Surg Am. 2003;85-A(7):1229–37.

    PubMed  Google Scholar 

  53. Luna-Pizarro D, Moreno-Delgado F, De la Fuente-Zuno JC, Meraz-Lares G. Distal femoral dome varus osteotomy: surgical technique with minimal dissection and external fixation. Knee. 2012;19(2):99–102. doi:10.1016/j.knee.2011.01.005.

    Article  PubMed  Google Scholar 

  54. Yoo MJ, Yoo JS, Lee JY, Hwang CH. Deformity correction by femoral supracondylar dome osteotomy with retrograde intramedullary nailing in varus deformity of the distal femur after pathologic fracture of giant cell tumor. Knee Surg Relat Res. 2013;25(4):220–4. doi:10.5792/ksrr.2013.25.4.220.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Brinkman JM, Hurschler C, Staubli AE, van Heerwaarden RJ. Axial and torsional stability of an improved single-plane and a new bi-plane osteotomy technique for supracondylar femur osteotomies. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1090–8. doi:10.1007/s00167-010-1349-0.

    Article  PubMed  Google Scholar 

  56. Koyonos L, Slenker N, Cohen S. Complications in brief: osteotomy for lower extremity malalignment. Clin Orthop Relat Res. 2012;470(12):3630–6. doi:10.1007/s11999-012-2392-6.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Visser J, Brinkman JM, Bleys RL, Castelein RM, van Heerwaarden RJ. The safety and feasibility of a less invasive distal femur closing wedge osteotomy technique: a cadaveric dissection study of the medial aspect of the distal femur. Knee Surg Sports Traumatol Arthrosc. 2013;21(1):220–7. doi:10.1007/s00167-012-2133-0.

    Article  PubMed  CAS  Google Scholar 

  58. Willey M, Wolf BR, Kocaglu B, Amendola A. Complications associated with realignment osteotomy of the knee performed simultaneously with additional reconstructive procedures. Iowa Orthop J. 2010;30:55–60.

    PubMed  PubMed Central  Google Scholar 

  59. Seah KT, Shafi R, Fragomen AT, Rozbruch SR. Distal femoral osteotomy: is internal fixation better than external? Clin Orthop Relat Res. 2011;469(7):2003–11. doi:10.1007/s11999-010-1755-0.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Conflict of interest

Federica Rosso declares that she has no conflict of interest.

Fabrizio Margheritini declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

ᅟ

No human or animal studies performed by the authors

This article does not contain any studies with human or animal subjects performed by any of the authors.

Human studies done by authors (but no animal studies)

This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

Animal studies done by authors (but no human studies)

This article does not contain any studies with human subjects performed by any of the authors.

With regard to the authors’ research cited in this paper, all institutional and national guidelines for the care and use of laboratory animals were followed.

Author information

Authors and Affiliations

  1. University of Study of Torino, AO Mauriziano Umberto I. Largo Turati 62, 10128, Torino, Italy

    Federica Rosso

  2. Department of Health Science, Unit of Orthopaedic and Sports Traumatology, University of Rome “Foro Italico”, Piazza Lauro de Bosis 6, 00135, Rome, Italy

    Fabrizio Margheritini

Authors
  1. Federica Rosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabrizio Margheritini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Federica Rosso.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosso, F., Margheritini, F. Distal femoral osteotomy. Curr Rev Musculoskelet Med 7, 302–311 (2014). https://doi.org/10.1007/s12178-014-9233-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-014-9233-z

Keywords

Search

Navigation