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.
- Generally younger than age 50.
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 Arthroplasty- 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
- 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.
- Close in layers.
Distal Femoral Osteotomy Complications
Distal Femoral Osteotomy Follow-up care
- 7-10 Days:
- 6 Weeks:
- 3 Months:
- 6 Months:
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).
- Functional scores significantly deteriorate after 10-years with overall 15-yearl failure rate of 48.5%.
Distal Femoral Osteotomy Review References
- Mathews J, Orthopedics 1998;21:437
- Cameron HU, Can J Surg 1997;40:114
- Backstein D, Morag G, Hanna S, Safir O, Gross A. Long-term follow-up of distal femoral varus osteotomy of the knee. J Arthroplasty. 2007 Jun;22(4 Suppl 1):2-6.
- Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: a minimum ten-year follow-up. Int Orthop. 2010 Feb;34(2):249-54. doi: 10.1007/s00264-009-0807-0. Epub 2009 May 26.
- Kosashvili Y, Gross AE, Zywiel MG, Safir O, Lakstein D, Backstein D. Total knee arthroplasty after failed distal femoral varus osteotomy using selectively stemmed posterior stabilized components. J Arthroplasty. 2011 Aug;26(5):738-43. doi: 10.1016/j.arth.2010.06.008. Epub 2010 Aug 31.