Correction of Femoral Valgus Deformity

Abstract

In the past two decades, the insights in the causes and development of valgus leg deformities as well as the options for treatment with corrective osteotomies have dramatically changed. New definitions for deformity analysis and planning for corrections have better defined the patients suitable for femoral valgus deformity corrections. Biomechanical research on new osteotomy methods and stability of plate fixation have provided scientific background for the development of improved surgical techniques that are more accurate, safer, and provide for quicker rehabilitation and bone healing. This article provides an overview of the basic principles behind the correction of femoral valgus deformity. Both the analysis and planning of femoral valgus deformity correction as well as the results of systematic clinical reviews are provided. The current recommended surgical technique of biplanar medial closing-wedge supracondylar osteotomy is explained, and the first clinical results are reported. Finally, the authors describe some of the future directions and needs for treatment optimization of patients with femoral valgus deformity.

Eight respectively nine out of ten patients return to sport and work after distal femoral osteotomy

“…Therefore, DFO appears to show a functional benefit from retaining native knee kinematics, allowing demanding functional loading that would otherwise jeopardize the survival of a KA [6, 35]. In contrast, time to RTS might be somewhat longer after DFO due to the extended rehabilitation following knee osteotomy [10].…”

“…Therefore, knee osteotomy has regained interest from surgeons who are looking for joint preserving alternatives to KA, resulting in a considerable increase in knee osteotomy surgery in the last decade [11, 28]. In cases of early‐stage unicompartmental knee OA with a femoral deformity, distal femoral osteotomy (DFO) is considered the preferred treatment [10]. DFO is also a well‐accepted procedure for the treatment of symptomatic unicompartmental overload and congenital malformations, especially in younger and physically active patients [6, 10, 13, 14, 35].…”

Medial Closed Wedge Distal Femoral Osteotomy Using a Novel Plate With an Optimal Compression System

“…A biplanar MCWDFO 1 , 2 , 3 is performed under K-wire guidance with sufficient retraction ( Fig 4 B-F; Video 1 ). The method used to determine the osteotomy lines is listed in Table 2 .…”

“…The method used to determine the osteotomy lines is listed in Table 2 . Although the conventional hinge point 1 , 2 was usually set just proximal to the upper border of the lateral condyle, a slightly distal hinge is now recommended to prevent an unstable LHF. 6 We set the hinge point just distal to the upper border of the lateral condyle and in between the lateral cortex and the contour of the lateral condyle ( Fig 5 ).…”

“…Medial closed wedge distal femoral osteotomy (MCWDFO) is widely performed for valgus knee with lateral-compartment osteoarthritis when the deformity center is located at the distal femur. Although favorable short- to mid-term results have been reported since the development of a biplanar osteotomy with existing plates, 1 , 2 the following problems remain, especially in the Asian population, who have smaller femurs: (1) the straight shape of the plate, which sometimes requires bending; (2) an inappropriate distal screw direction, which sometimes interposes into the osteotomized site; (3) interference with the medial patellofemoral ligament (MPFL); (4) difficulty in inserting proximal screws, and (5) risk of lateral hinge fracture (LHF) during the application of compression to the osteotomized site using a lag screw. To improve these potential disadvantages, the authors have developed a newly designed MCWDFO-specific locking plate made of titanium alloy (TriS Medial DFO Plate [TriS-MDFO], Olympus Terumo Biomaterials, Tokyo, Japan).…”