Distal Femoral Osteotomy

synonyms: DFO, distal femoral osteotomy

Distal Femoral Osteotomy CPT

Distal Femoral Osteotomy Anatomy

• Varus-producing distal femoral osteotomy produces a horizontal joint line and is therefore prefered to a varus-producing high tibial osteotomy which produces an oblique joint line. (Distal femoral osteotomies unload the lateral compartment only in extension. HTO's unload in both flexion and extension.) (Chambat P, Oper Tech Sports Med 2000;8:44)

Distal Femoral Osteotomy Indications

• Isolated lateral compartment osteoarthritis with associated valgus tibiofemoral alignment.

Distal Femoral Osteotomy Contraindications

• Inflammatory arthritis (rheumatoid)
• Inadequate motion

Distal Femoral Osteotomy Alternatives

• Arthroscopic debridement-indicated for pt with ,1yr symptoms, nl alignment, mechanical symptoms.
• Unicompartmental knee - indications flexion cont <15, ROM >90, age >60, sedentary: rehab easier, costs less, quicker ROM, preserves ligamants/proprioception,  92% last 10yr, 15yrs  = 60% working.  Creates bone defect which often must be filed with allograft
• TKA
• High Tibial osteotomy
• Arthodesis-indicated for infection, failed TKA, young active patients, soft tissue defects, absent extensor mechanism, neuropathic joint disease.  fusion in 10-15 flexion and 0-7 valgus. complications=infection, non/malunion, pain.successful in 80-90% of failed condylar components, 55% of failed hinged prosthesis.

Distal Femoral Osteotomy Pre-op Planning

Distal Femoral Osteotomy Technique

• Sign operative site.
• Pre-operative antibiotics, +/- regional block.
• General endotracheal anesthesia
• position. All bony prominences well padded.
• Examination under anesthesia.
• Prep and drape in standard sterile fashion.
• Irrigate.
• Close in layers.

Distal Femoral Osteotomy Complications

Distal Femoral Osteotomy Follow-up care

• Post-op:
• 7-10 Days:
• 6 Weeks:
• 3 Months:
• 6 Months:
• 1Yr:

Distal Femoral Osteotomy Outcomes

• 83% good to excellent result. Average pre-op deformity = 18 degrees valgus, corrected to an average 2 degrees valgus. (Healy WL, JBJS 1988;70A:102)
• 83% satisfactory result; 87% cumulative ten-year survival rate with TKA as end-point (Wang JW, JBJS 2006;88A:100).

Distal Femoral Osteotomy Review References

• Mathews J, Orthopedics 1998;21:437
• Cameron HU, Can J Surg 1997;40:114
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