Distal Femoral Varus Osteotomy for Lateral Compartment Osteoarthritis in the Valgus Knee. A Systematic Review of the Literature

Abstract

The primary objectives of this systematic review were to define the indications, functional outcomes, survivorship and complications associated with distal femoral varus osteotomy (DFVO).Cumulative survival with arthroplasty as the endpoint ranged from 64 to 82% at 10 years, and 45% at 15 years. The mean pre-operative HSS score ranged from 46 to 65 and this improved at latest follow up to means of between 72 and 88. Pooled results show an overall complication rate of 5.8% (5/86) for unanticipated re-operation due to a complication.Poor reporting of included studies and considerable heterogeneity between them precluded any statistical analysis. Further study is required to determine the precise indications for DFVO, optimum surgical technique, implant of choice and post-operative rehabilitation regimen as all of these factors may significantly affect the complication profile and outcomes of this procedure.DFVO is technically demanding and requires a significant period of rehabilitation for the patient. However, long-term survivorship and good function have been demonstrated and it remains a potential option for valgus osteoarthritis in carefully selected patients.

Expanding the indications: distal femoral osteotomy used successfully to treat recurrent knee effusion

“…A 2007 Cochrane review of knee osteotomies16 identified only 13 suitable papers, all of which concerned high tibial osteotomy. A 2012 systematic review of DFO6 was based on the evidence from only six case series. Cumulative survival using arthroplasty as an end point ranged from 64% to 82% at 10 years 6.…”

“…Accordingly the indications for distal femoral osteotomy (DFO) are yet to be clearly defined 6. DFO is appropriate in younger and more active patients, symptomatic from valgus lateral compartment knee arthritis, where arthroplasty is unlikely to meet aspirations for high activity 7.…”

Varus-Producing Lateral Distal Femoral Opening-Wedge Osteotomy

“…Good outcomes have been reported for varusproducing DFOs in patients with valgus malalignment, 12,21 as well as in those with congenital or developmental deformity resulting in valgus alignment and subsequent MCL laxity. 5 However, to determine the long-term effectiveness of restoring alignment and medial compartment stability, high-quality studies are needed.…”

“…[2][3][4] Recently, the indications for varus-producing DFOs have expanded to include the treatment of valgus malalignment in the setting of central or medial ligamentous instability or incompetence. [5][6][7][8][9][10][11][12][13][14] This is of particular importance and utility because several authors have also reported that healing of both the native and reconstructed medial collateral ligament (MCL) is impaired with persistent valgus deformity at the knee. 6 For this reason, many surgeons now choose to perform a DFO to correct the valgus deformity at the knee not only in the setting of isolated lateral compartment pathology but also in the setting of medial ligamentous incompetence.…”

Total knee arthroplasty after varus distal femoral osteotomy vs native knee: similar results in a case control study

“…Varus producing distal femoral osteotomy (VrDFO) is particularly indicated in constitutional valgus deformity where most of the deformity is situated in the distal femur. This procedure, technically demanding and subject to post-operative complications including stiffness and patellofemoral arthrosis [18], nonetheless demonstrates excellent longterm clinical and functional results [5,15,16]. Progression of arthrosis, however, is inescapable and secondary arthroplasty is not uncommon.…”