Varus distal femoral osteotomy

The young patient with knee osteoarthritis (OA) presents a challenging treatment dilemma to the orthopedic surgeon. In the varus knee, delay of OA progression has been successfully performed with proximal tibial osteotomy; in the valgus knee, however, varus distal femoral osteotomy (VDFO) has usually had better results. VDFO is indicated in the physiologically young, active patient in whom conservative therapy for symptomatic lateral compartment arthritis in a stable knee without significant flexion deformity has failed. Meticulous preoperative planning is crucial and entails obtaining long-leg standing radiographs to determine the mechanical and anatomic axes. The medial closing wedge technique is the most common method of performing VDFO, although the lateral opening, dome osteotomy, and hemicallotasis techniques have all had their proponents. Proper pin placement is necessary to correctly make the osteotomy and to obtain the desired correction of deformity. The osteotomy is then stabilized with internal fixation, usu-ally a 90° blade plate. Postoperative weight-bearing is generally delayed for 6-8 weeks. Complications can include nonunion, failure of fixation, infection, loss of correction, and acceleration of medial compartment arthritis. With proper selection and careful attention to detail, VDFO can be successful in delaying the need for total knee arthroplasty (TKA), and it has been associated with 71%-83% good/excellent Hospital for Special Surgery scores at 4-8-year follow-up.