The Journal of Bone and Joint Surgery (American). 2005;87:127-133.
doi:10.2106/JBJS.C.01559
© 2005 The Journal of Bone and Joint Surgery, Inc.
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 Adult Knee Reconstruction Test 8: Spring 2005
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Distal Femoral Varus Osteotomy for Osteoarthritis of the Knee

Jun-Wen Wang, MD1 and Chia-Chen Hsu, MD1

1 Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan, Republic of China. E-mail address for J.-W. Wang: lee415{at}adm.cgmh.org.tw

Investigation performed at the Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Distal femoral varus osteotomy is a procedure that is performed for the treatment of lateral-compartment osteoarthritis of the knee as well as for correction of the associated valgus deformity. However, its role remains controversial and its efficacy in the treatment of associated patellofemoral arthritis has not been well studied. The purpose of the present study was to evaluate the outcome after distal femoral osteotomy performed for the treatment of painful genu valgum and to assess the influence of patellofemoral arthritis on the results.

Methods: Thirty patients (thirty knees) were managed with distal femoral varus osteotomy for the treatment of noninflammatory lateral-compartment arthritis of the knee associated with a valgus deformity. Twelve knees had isolated lateral-compartment arthritis, ten had mild-to-moderate degenerative changes in the other two compartments, and eight knees had severe patellofemoral arthritis in addition to lateral-compartment disease. The osteotomy site was fixed with a 90° blade-plate. After a mean duration of follow-up of ninety-nine months, all patients were evaluated with use of the Hospital for Special Surgery knee-rating system and a physical examination.

Results: At the time of the most recent follow-up, twenty-five patients (83%) had a satisfactory result and two had a fair result according to the Hospital for Special Surgery rating system. The remaining three patients had had a conversion to a total knee arthroplasty. With conversion to total knee arthroplasty as the end point, the cumulative ten-year survival rate for all patients was 87% (95% confidence interval, 69% to 100%). Improvement in patellar tracking, which persisted at the time of the latest follow-up, was observed in seven of the eight knees with associated severe patellofemoral arthritis.

Conclusions: Distal femoral varus osteotomy with blade-plate fixation can be a reliable procedure for the treatment of lateral-compartment osteoarthritis of the knee associated with valgus deformity. The result of the osteotomy does not appear to be affected by the presence of severe patellofemoral arthritis.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Related articles in JBJS:

Distal Femoral Varus Osteotomy for Osteoarthritis of the Knee • J.-W. Wang and C.-C. Hsu reply:
Ronald P. Grelsamer, Jun-Wen Wang, and Chia-Chen Hsu
JBJS 2005 87: 1886-1887. [Extract] [Full Text]  

Distal Femoral Varus Osteotomy for Osteoarthritis of the Knee
Jun-Wen Wang and Chia-Chen Hsu
JBJS 2006 88: 100-108. [Abstract] [Full Text]  



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Letters to the Editor:

Read all Letters to the Editor

Dangerous indications for femoral osteotomies?
Ronald P. Grelsamer
JBJS Online, 2 Feb 2005 [Full text]
Drs. Wang and Hsu respond to Dr. Grelsamer
Jun-Wen Wang, et al.
JBJS Online, 2 Feb 2005 [Full text]