Opening- and Closing-Wedge Distal Femoral Osteotomy

Abstract

Background:Lateral compartment osteoarthritis of the knee can be a challenging pathology in the younger, active population due to limited treatment options and high patient expectations. Distal femoral osteotomy (DFO) has been reported to be a potential treatment option.Purpose:To perform a systematic review on the survival, outcomes, and complications of DFO for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Registry of Controlled Trials, PubMed, and MEDLINE from 1980 to present. Inclusion criteria were as follows: outcomes of opening- and closing-wedge DFOs performed for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee, English language, minimum 2-year follow-up, and human studies. Data abstracted from the selected studies included type of osteotomy (opening vs closing), survival rate, patient-reported and radiographic outcomes, and complications.Results:Fourteen studies met the inclusion criteria and were considered for the review. A total of 9 closing-wedge and 5 opening-wedge DFO studies were included. All were retrospective studies and reported good to excellent patient-reported outcomes after DFO. Survival decreased with increasing time from surgery, with 1 study reporting a 100% survival rate at 6.5 years, compared with 21.5% at 20 years in another study. A low rate of complications was reported throughout the review.Conclusion:Highly heterogeneous literature exists for both opening- and closing-wedge DFOs for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment. A mean survival rate of 80% at 10-year follow-up was reported, supporting that this procedure can be a viable treatment option to delay or reduce the need for joint arthroplasty. A low complication rate was observed, with symptomatic hardware being the most prevalent postoperative complication.

Distal Femoral Varus Osteotomy for Valgus Arthritis of the Knees: Systematic Review of Open versus Closed Wedge Osteotomy

“…Recently, a few systematic review articles have been published 31 , 32) . Saithna et al 32) included 6 case series and demonstrated poor reporting and heterogeneity among studies that precluded any statistical analysis.…”

“…Overall, they concluded that DFO is a potential option for valgus osteoarthritis considering the long-term survivorship and good function. Chahla et al 31) performed a systematic review that included 14 studies. All were retrospective studies with good to excellent patient-reported outcomes.…”

Case report: migration of a broken screw to the knee joint after hardware failure following closing wedge distal femoral osteotomy

“…Minor complications such as stiffness and postoperative pain also appeared in both groups. The common complications were plate prominence, discomfort, or irritation over the plate [ 5 ]. Nonunion or hardware failure is a generally a concern during opening wedge DFO due to the opened gap.…”

Total knee arthroplasty after distal femoral osteotomy: a systematic review and current concepts

“…Likewise, opening-wedge survival rate of 84%-100% was reported at 8-year follow-up. Hardware-related issues are the most prevalent complications of these surgical procedures [4,5].…”