The Closing Wedge Distal Femoral Osteotomy: A Series of 19 Cases for the Management of Genu Valgum and Genu Varum.
Academic Article
Overview
abstract
BACKGROUND: Distal femoral osteotomy (DFO) represents an important intervention for addressing valgus and varus deformity about the knee. Closing wedge DFO (CWDFO) is less used and documented than opening wedge DFO for correcting coronal-plane knee deformities. This study evaluates the safety and efficacy of lateral CWDFO (LCWDFO) and medial CWDFO (MCWDFO) by analyzing complication rates and clinical, radiographic, and patient-reported outcome measures. METHODS: A retrospective review was done of 19 patients (average age: 42.2 years; range 23-75) who underwent CWDFO between January 2016 and December 2021, with follow-up through at least 1 year or implant removal. The primary outcome was adverse events including delayed or nonunion, iatrogenic injury, or unplanned surgery. The secondary goal was to report patient clinical performance and patient-reported outcome measures: time to full weight bearing (FWB), passive knee range of motion change, and preoperative and postoperative scores on the Limb Deformity-modified Scoliosis Research Society (LD-SRS) survey. The tertiary goal was to report radiographic outcomes: mechanical tibiofemoral angle, mechanical axis deviation, and mechanical lateral distal femoral angle. RESULTS: Fifteen patients underwent LCWDFO and four underwent MCWDFO, with mean follow-up of 23.1 ± 17.3 months. Two infections occurred and resolved with antibiotics; no iatrogenic injuries or unplanned surgeries occurred. Patients achieved FWB at 6.48 ± 2.59 (0.14 to 11.43) week and knee motion remained unchanged. The LD-SRS composite score significantly improved (3.4 ± 0.7 vs. 4.2 ± 0.5, P = 0.019), as did three of four subscores: function/activity score (3.3 ± 0.8 vs. 4.1 ± 0.5, P = 0.026), pain score (3.3 ± 0.8 vs. 4.3 ± 0.4, P = 0.006), and self-image score (3.1 ± 0.9 vs. 4.1 ± 0.6, P = 0.014). All radiographic measures collected markedly improved postoperatively. CONCLUSION: LCWDFO and MCWDFO both seem safe and effective surgical interventions for improving coronal plane deformity about the knee.
