J Korean Orthop Assoc.  2014 Apr;49(2):118-125. 10.4055/jkoa.2014.49.2.118.

Distal Femoral Varization Osteotomy

• Yoo JD
• Kim NK

• KMID: 2185216
• DOI: http://doi.org/10.4055/jkoa.2014.49.2.118

Abstract

Distal femoral varization osteotomy is performed for treatment of lateral compartment osteoarthritis of the knee associated with valgus deformity for relief of pain and improvement of functional status. Careful selection of patients is the key to the success of this procedure. Distal femoral varus osteotomy is indicated for patients with isolated lateral compartment knee arthritis with a valgus deformity; candidates must have a range of motion arc of at least 90 degrees and less than 20 degrees of flexion-contracture. The indications of distal femoral varization osteotomy must be considered before surgery. Contraindications include patients with diffuse and nonspecific knee pain, primary complaint of patellofemoral pain, history of medial meniscectomy, and bicompartmental degeneratvie osteoarthritis. The success of an osteotomy is dependent on adequate correction of limb malalignment; therefore, accurate determination of the desired angle of correction is essential during preoperative planning. In recent years with the advent of new anatomical locking plate designs, medial closed wedge osteotomy has become popular. Compared to lateral opening wedge osteotomy, with medial closing wedge osteotomy, earlier union is expected and it provides stable fixation even with poor bone quality. Nevertheless, arthroplasty offers rapid pain relief and short-term rehabilitation period; however, risk of wear, difficulty and poor outcome of revision surgery, possible complication of infection or prosthetic failure in young and active patients, demanding high functional loading, is a cause for concern. Because this joint preserving procedure is not associated with prosthesis-related complication, it can be a good alternative option for young and active patients.

Keyword

gemu valgum; femur; osteoarthritis; osteotomy

MeSH Terms

Arthritis
Arthroplasty
Congenital Abnormalities
Extremities
Femur
Humans
Joints
Knee
Osteoarthritis
Osteotomy*
Range of Motion, Articular
Rehabilitation

Figure

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  Figure 1 Mechanical axes of the lower extremities: The mechanical axis of the right lower limb normally passes through the center of the knee; however, as shown, the mechanical axis of the left lower limb with genu valgum deformity passes through the lateral compartment of the knee.

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  Figure 2 Normal physiologic axes and angles of the lower extremities: The physiologic axes and angles have abnormal value in malalignment of the lower extremities. NSA, neck-shaft angle; aMPFA, anatomical medial proximal femoral angle; mLPFA, mechanical lateral proximal femoral angle; aLDFA, anatomical lateral distal femoral angle; mLDFA, mechanical lateral distal femoral angle; JLCA, joint line congruency angle; mMPTA, mechanical medial proximal tibial angle; mLDTA, mechanical lateral distal tibial angle; aPDFA, anatomical posterior distal femoral angle; aPPTA, anatomical posterior proximal tibial angle; aADTA, anatomical anterior distal tibial angle; MAD, mechanical axis deviation; SD, standard deviation.

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  Figure 3 Anteroposterior knee radiography shows the postoperative status of the knee after medial closing wedge osteotomy of the distal femur using a TomoFix medial distal femur (Synthes) plate.

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  Figure 4 Preoperative determination of the correctional angle: The mechanical axis of the left lower extremity passes through the lateral compartment of the knee in this pateint. A line is drawn from the center of the tibial plafond (A) through just medial to the medial tibial spine (C) to create a new mechanical axis line. This line is prolonged to a level of the femoral head (E). A hinge point (H) is chosen at the lateral cortex of the supracondylar region. An expected correctional angle (α) is measured at this level between two lines; One line is drawn from the center of the femoral head (D) to the hinge point, and the other line is drawn from the hinge point to the point (E) where the same level of the center of the femoral head. The angle α and the angle β have the same measurements.

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  Figure 5 Arthroscopic view shows severe degenerative change of the lateral compartment of the knee. The patient underwent a distal femoral varization osteotomy.

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  Figure 6 Biplanar osteotomy: Biplanar osteotomy was performed at the medial distal femur after anterior retraction of the vatus medilalis and the tendon of the adductor magnus.

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  Figure 7 Tomofix medial distal femur plate. (A) Anterior view. (B) Lateral view of the plate with locking screws inserted.

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