Rotational Femoral Osteotomy

Abstract

Skeletal alignment in all three planes has a great influence on patellar tracking and loading. The source of patellofemoral loading is extraarticular; this is the reason that operations limited to the knee joint frequently fail if this is not recognized. The treatment of skeletal malalignment requires the correct bony operation. If there is genu valgum because of a short lateral femoral condyle, a femoral varus osteotomy is indicated. If the genu valgum is the result of a valgus bow to the tibia then a varus osteotomy of the tibia near the deformity is indicated. Genu varum with medial trochlear degeneration should be treated with tibial valgus osteotomy. Inward pointing knees with secondary lateral subluxation should be treated with external rotation femoral osteotomy if it is caused by increased femoral anteversion; internal rotation tibial osteotomy if it is caused by increased external tibial torsion. Combined deformities are not uncommon and the type of osteotomy and location depends on the deformity.