Journal articles: 'Distal femoral osteotomy'

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Rosso, Federica, and Fabrizio Margheritini. "Distal femoral osteotomy." Current Reviews in Musculoskeletal Medicine 7, no. 4 (August 22, 2014): 302–11. http://dx.doi.org/10.1007/s12178-014-9233-z.

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Yoo, Jae Doo, and Nam Ki Kim. "Distal Femoral Varization Osteotomy." Journal of the Korean Orthopaedic Association 49, no. 2 (2014): 118. http://dx.doi.org/10.4055/jkoa.2014.49.2.118.

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KASSIM, RIDA A., KHALED J. SALEH, PATRICK YOON, GEORGE S. MACARI, GREG BROWN, and STEVEN HAAS. "Varus Distal Femoral Osteotomy." Techniques in Knee Surgery 1, no. 1 (September 2002): 54–59. http://dx.doi.org/10.1097/00132588-200209000-00007.

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Kassim, Rida A., Khaled J. Saleh, Patrick Yoon, George S. Macari, Greg Brown, and Steven Haas. "Varus Distal Femoral Osteotomy." Techniques in Knee Surgery 11, no. 2 (June 2012): 78–82. http://dx.doi.org/10.1097/btk.0b013e3182555b33.

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Meloche, Alice T. "Distal Femoral Varus Osteotomy." AORN Journal 48, no. 1 (July 1988): 77–85. http://dx.doi.org/10.1016/s0001-2092(07)67442-0.

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Healy, W. L., J. O. Anglen, S. A. Wasilewski, and K. A. Krackow. "Distal femoral varus osteotomy." Journal of Bone & Joint Surgery 70, no. 1 (January 1988): 102–9. http://dx.doi.org/10.2106/00004623-198870010-00016.

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Horne, G. "Distal femoral varus osteotomy." Journal of Bone & Joint Surgery 70, no. 8 (September 1988): 1269–70. http://dx.doi.org/10.2106/00004623-198870080-00026.

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Cappellari, Fulvio, Matteo Olimpo, Lisa Piras, Robert Radasch, Antonio Ferretti, Bruno Peirone, and Enrico Panichi. "Distal femoral osteotomy using a novel deformity reduction device." Veterinary and Comparative Orthopaedics and Traumatology 29, no. 05 (September 2016): 426–32. http://dx.doi.org/10.3415/vcot-15-11-0186.

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SummaryDistal femoral osteotomy is a surgical procedure used to correct patellar luxation, secondary to a femoral deformity. A distal femoral osteotomy using the tibial plateau levelling osteotomy-jig to temporarily provide stability of the distal femoral osteotomy, maintaining limb alignment in the frontal and axial planes prior to internal plate fixation of the osteotomy, has been described. This report describes a novel jig named Deformity Reduction Device (DRD). This device was developed with the specific aim of increasing precision and predictability during corrective osteotomy execution in order to be consistent with the preoperative planning. The distal femoral osteotomy DRD-assisted procedure is described in detail, discussing the theoretical and practical principles of the application.

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Duethman, Nicholas C., Christopher D. Bernard, Christopher L. Camp, Aaron J. Krych, and Michael J. Stuart. "Medial Closing Wedge Distal Femoral Osteotomy." Clinics in Sports Medicine 38, no. 3 (July 2019): 361–73. http://dx.doi.org/10.1016/j.csm.2019.02.005.

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Mathew, Smitha E., Todd A. Milbrandt, and Megan L. Young. "Lateral Opening Wedge Osteotomy of the Distal Femur for Genu Valgum." Journal of the Pediatric Orthopaedic Society of North America 4, no. 3 (August 1, 2022): 1–11. http://dx.doi.org/10.55275/jposna-2022-0033.

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Genu valgum is a risk factor for patellofemoral maltracking and recurrent instability and may cause mechanical overload of the lateral compartment leading to early arthritic changes in some patients. In skeletally mature adolescents, a varus-producing distal femoral osteotomy will correct the valgus malalignment when the femur contributes to the overall lower extremity deformity. The goal of a distal femoral osteotomy is to correct the lateral distal femur joint angle and restore a neutral mechanical axis through the center of the knee joint. We aim to discuss the indications and contraindications, pros and cons, preoperative planning, osteotomy options, surgical techniques, and postoperative protocol for a distal femur corrective osteotomy.

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Zhang, Xinyuan, John Attenello, Marc R. Safran, and David W. Lowenberg. "Congenital internal rotation deformity of the distal femur presenting as patellofemoral instability and pain." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 4, no. 2 (March 2019): 93–97. http://dx.doi.org/10.1136/jisakos-2018-000260.

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ObjectivesFemoral antetorsion, defined as the angle of rotation of the femoral head and neck axis in relation to the transcondylar axis of the distal femur, is a cause for patellofemoral instability and anterior knee pain. Most clinical reports do not distinguish between antetorsion of the femur distal to the isthmus and anteversion of the proximal femur, which is another cause of femoral internal rotational deformity.MethodsThis retrospective observational case series evaluated four cases in three female patients who underwent evaluation of surgical intervention for chronic anterior knee pain since childhood. Physical examination and radiographic images supported the diagnosis of internal rotation deformity at the distal femora in all four cases. Distal femoral derotational osteotomy of 45°, 60° and 30° were performed, respectively. Kujala scoring system for patellofemoral pathology was used to assess the change in knee symptoms before and after the osteotomies.ResultsThis study demonstrated successful treatment of the resultant knee symptoms from femoral antetorsion with distal femur derotational osteotomy in all three patients.ConclusionsPatellofemoral syndrome is multifactorial, and the true anatomic reason for each patient’s individual pathology must be determined before surgery proceeds.Level of evidenceLevel V.

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Wilson, Philip L., Henry B. Ellis, Marc Tompkins, Tyler J. Stavinoha, Charles W. Wyatt, Aaron J. Zynda, Parker Mitchell, Chan-Hee Jo, and Kevin Shea. "PHYSEAL-SPARING DISTAL FEMORAL TROCHLEOPLASTY: A TECHNIQUE ANALYSIS IN A PEDIATRIC CADAVERIC MODEL." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (March 1, 2019): 2325967119S0015. http://dx.doi.org/10.1177/2325967119s00159.

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Background: To describe the results and extra-physeal position of a pediatric distal femoral trochleoplasty in a pediatric cadaveric model. Methods: Eight pediatric cadaveric specimens (mean maturity: 7.75 years, range 4-11) were used to model a distal femoral anterolateral metaphyseal osteotomy immediately proximal to the physis. A standardized 4 mm wedge was placed at the distal end of an anterior cortical shingle; created by an osteotomy 3.25 mm below the anterior cortex (range 2.5 – 4.4), with a transverse corticotomy just proximal to the physis, and hinged 25.5 mm proximally (range 21.9-28.1). The specimens were evaluated with multi-planar micro-CT scans (0.67 mm) pre and post-osteotomy. Lateral cortical elevation, the pre and post sulcus angle of the anterior supra-trochlear metaphysis, distance from distal elevated margin of the osteotomy to the superior edge of the trochlear cartilage, and distance from the distal margin of the osteotomy to the superior edge of the physis were evaluated. Results: The supra-physeal trochleoplasty elevated the lateral cortex an average of 3.26 mm (range 2.8-3.9). The resultant mean angle of the supra-trochlear metaphyseal sulcus was changed by 15.25° (range 8° -21°) (p<0.001); with the central to lateral cortical angle along the anterior femoral surface changing from 173° (range 166°-178°) pre-trochleoplasty, to 157° (range 146°-166°) following the osteotomy. The magnitude of the change in angle was associated with age; with larger corrections in the younger specimens (p<0.05). The distal margin of the trochleoplasty was on average 9.56 mm (range 2.73-13.24) from the superior margin of the trochlear articular cartilage. The distance from the distal extent of the osteotomy to the superior margin of the physis was 5.54 mm (range 1.95-9.55). No fracture into the physis, or physeal deformity was demonstrated. Conclusion: A technique for an extra-physeal, metaphyseal, distal femoral trochleoplasty resulted in alterations to the anterior femoral cortex that may serve as deterrents to lateral patellar translation. Lateral cortical elevation immediately superior to the trochlea may serve as a guide for centralizing patellar motion during early flexion in the setting of patella alta and trochlear dysplasia that is not uncommon in pediatric lateral patellar instability. A pediatric cadaveric model demonstrated changes in close proximity to the superior entrance of the femoral trochlea, while avoiding injury to the distal femoral physis. Significance: A supra-trochlear, lateral metaphyseal elevating osteotomy may be feasible and merit further study as an option for the treatment of lateral patellar instability in the skeletally immature.

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Kim, Tae Woo, Myung Chul Lee, Jae Ho Cho, Jong Seop Kim, and Yong Seuk Lee. "The Ideal Location of the Lateral Hinge in Medial Closing Wedge Osteotomy of the Distal Femur: Analysis of Soft Tissue Coverage and Bone Density." American Journal of Sports Medicine 47, no. 12 (August 29, 2019): 2945–51. http://dx.doi.org/10.1177/0363546519869325.

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Background: Although an appropriate hinge position to prevent unstable lateral hinge fractures is well established in medial opening wedge high tibial osteotomy, the position during medial closing wedge distal femoral osteotomy has not been elucidated. Purpose/Hypothesis: The purpose was to evaluate the ideal hinge position that would prevent an unstable lateral hinge fracture during biplanar medial closing wedge distal femoral osteotomy based on soft tissue coverage and bone density around the hinge area. The hypothesis was that the ideal hinge position could be clarified by analyzing soft tissue coverage and bone density around the lateral hinge area. Study Design: Controlled laboratory study. Methods: In 20 cadaveric knees (mean age, 70.3 ± 19.2 years), the femoral attachment of the gastrocnemius lateral head was quantitatively analyzed as a soft tissue stabilizer using digital photography and fluoroscopy. Then, medial closing wedge distal femoral osteotomy was performed, locating the lateral hinge either inside (group 1) or outside (group 2) the femoral attachment of the gastrocnemius lateral head, and the incidence of unstable lateral hinge fractures was compared between the 2 groups. Cortical bone density around the lateral hinge was measured using Hounsfield units on 30 computed tomography scans and reconstructed as a 3-dimensional mapping model. The transitional zone with low bone density was regarded as the safe hinge position with an increased capacity for bone deformation. Results: The upper and lower margins of the femoral attachment of the gastrocnemius lateral head were 9.1 ± 0.9 mm above and 8.0 ± 1.4 mm below the upper border of the lateral femoral condyle, respectively, and the femoral attachment of the gastrocnemius lateral head was widest in the anteroposterior dimension 0.4 ± 1.7 mm above the upper border of the lateral femoral condyle. The incidence of unstable lateral hinge fractures during osteotomy was significantly decreased in group 1 compared with group 2 (group 1: 0/10; group 2: 5/10; P = .01). An isolated transitional zone with low bone density was observed in all 30 knees and located 1.3 ± 0.8 mm above the upper border of the lateral femoral condyle. Bone density of the transitional zone with low bone density was significantly lower than surrounding femoral cortices ( P < .001). Conclusion: Only the upper border of the lateral femoral condyle can be recommended as an ideal hinge position to prevent unstable lateral hinge fractures during biplanar medial closing wedge distal femoral osteotomy based on soft tissue coverage and bone density. Clinical Relevance: When the hinge is positioned at the upper border of the lateral femoral condyle during biplanar medial closing wedge distal femoral osteotomy, the risk of unstable hinge fractures can be minimized.

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Contractor, Dhruti, Richard Evanson, Nathan Marsh, Thomas DeBerardino, Michael Todd, and John Bojescul. "Simplified digital technique for distal femoral osteotomy." Current Orthopaedic Practice 25, no. 4 (2014): 392–96. http://dx.doi.org/10.1097/bco.0000000000000116.

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Puddu, Giancarlo, Vittorio Franco, Guglielmo Cerullo, and Massimo Cipolla. "Distal Femoral Osteotomy for Genu Valgus Correction." Techniques in Knee Surgery 8, no. 4 (December 2009): 257–64. http://dx.doi.org/10.1097/btk.0b013e3181c3b2a7.

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Puddu, Giancarlo, Vittorio Franco, Guglielmo Cerullo, and Massimo Cipolla. "Distal Femoral Osteotomy for Genu Valgus Correction." Techniques in Knee Surgery 11, no. 2 (June 2012): 83–90. http://dx.doi.org/10.1097/btk.0b013e3182555d36.

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Swarup, Ishaan, Osama Elattar, and S. Robert Rozbruch. "Patellar instability treated with distal femoral osteotomy." Knee 24, no. 3 (June 2017): 608–14. http://dx.doi.org/10.1016/j.knee.2017.02.004.

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Chahla, Jorge, Justin J. Mitchell, Daniel J. Liechti, Gilbert Moatshe, Travis J. Menge, Chase S. Dean, and Robert F. LaPrade. "Opening- and Closing-Wedge Distal Femoral Osteotomy." Orthopaedic Journal of Sports Medicine 4, no. 6 (June 6, 2016): 232596711664990. http://dx.doi.org/10.1177/2325967116649901.

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Thein, Rafael, Barak Haviv, Shlomo Bronak, and Ran Thein. "Distal femoral osteotomy for valgus arthritic knees." Journal of Orthopaedic Science 17, no. 6 (November 2012): 745–49. http://dx.doi.org/10.1007/s00776-012-0273-1.

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O'Malley, Michael P., Ayoosh Pareek, Patrick J. Reardon, Michael J. Stuart, and Aaron J. Krych. "Distal Femoral Osteotomy: Lateral Opening Wedge Technique." Arthroscopy Techniques 5, no. 4 (August 2016): e725-e730. http://dx.doi.org/10.1016/j.eats.2016.02.037.

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Cha, Myoung-Soo, Si-Young Song, Koo-Hyun Jung, and Young-Jin Seo. "Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity." Knee Surgery and Related Research 31, no. 1 (March 1, 2019): 61–66. http://dx.doi.org/10.5792/ksrr.18.023.

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Jagernauth, S., A. J. Tindall, S. Kohli, and P. Allen. "New Technique: A Novel Femoral Derotation Osteotomy for Malrotation following Intramedullary Nailing." Case Reports in Orthopedics 2012 (2012): 1–2. http://dx.doi.org/10.1155/2012/837325.

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A 19-year-old female patient sustained a closed spiral midshaft femoral fracture and subsequently underwent femoral intramedullary nail insertion. At followup she complained of difficulty in walking and was found to have a unilateral in-toeing gait. CT imaging revealed 30 degrees of internal rotation at the fracture site, which had healed. A circumferential osteotomy was performed distal to the united fracture site using a Gigli saw with the intramedullary femoral nail in situ. The static distal interlocking screws were removed and the malrotation was corrected. Two further static distal interlocking screws were inserted to secure the intramedullary nail in position. The osteotomy went on to union and her symptoms of pain, walking difficulty, and in-toeing resolved. Our paper is the first to describe a technique for derotation osteotomy following intramedullary malreduction that leaves the intramedullary nail in situ.

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Kariksiz, Mesut, and Ozgur Karakoyun. "Acute correction of distal femoral deformities by retrograde femoral nail using preoperative planning." Journal of Orthopaedic Surgery 30, no. 3 (September 2022): 102255362211435. http://dx.doi.org/10.1177/10225536221143552.

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Purpose This study presents the technique and results of acute correction of distal femoral deformities using retrograde femoral nailing based on preoperative planning without using a fixator. Methods Twenty-eight patients (34 limbs: 22 left-sided, 12 right-sided, mean age = 36 years) undergoing distal femoral deformity correction with retrograde femoral nailing between 2013 and 2020 were examined retrospectively. The osteotomy line, block screw location and number were identified by detailed preoperative planning. Osteotomy was performed using the percutaneous multiple drill method, and the retrograde femoral nail was placed. Results The average follow-up period was 62.7 months (range: 13–84 months). Postoperatively, the mean mechanical axis deviation was corrected to 6.8 mm (range: 0–8 mm) and the mean mechanical lateral distal femoral angle to 87.42° (range: 84–90°). The Association for the Study an Application of the Method of Ilizarov (ASAMI) score was excellent for all patients. None of the patients had fracture, infection, implant failure, or non-union. Conclusion Distal femoral deformities can be corrected acutely, without applying external fixators, with good preoperative planning and using the retrograde femoral nail. This technique is safe and effective, with a low complication rate.

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Piras, Lisa, Bruno Peirone, Derek Fox, and Matteo Olimpo. "Comparison of osteotomy technique and jig type in completion of distal femoral osteotomies for correction of medial patellar luxation." Veterinary and Comparative Orthopaedics and Traumatology 30, no. 01 (2017): 28–36. http://dx.doi.org/10.3415/vcot-16-06-0086.

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SummaryObjectives: Femoral osteotomies are frequently completed to correct malalignment associated with patellar luxation. The objectives of this study were to compare the use of: 1) two different types of jig; and 2) different types of osteotomy in the realignment of canine femoral bone models which possessed various iterations of angular deformity.Methods: Models of canine femora possessing distal varus, external torsion and a combination of varus and torsion underwent correction utilizing two alignment jigs (Slocum jig and Deformity Reduction Device) and either a closing wedge ostectomy (CWO) or an opening wedge osteotomy (OWO). Post-correctional alignment was evaluated by radiographic assessment and compared between groups.Results: The use of the Slocum jig resulted in frontal plane overcorrection when used with CWO in models of femoral varus, and when used with OWO in models of femoral varus and external torsion when compared to other techniques. The Deformity Reduction Device tended to realign the frontal plane closer to the post-correction target value in all angulation types. The use of both jigs resulted in undercorrection in the transverse plane in models with varus and torsion.Clinical significance: Jig selection and osteotomy type may lead to different post-correctional alignment results when performing distal femoral osteotomies. Whereas OWO allows accurate correction when used with either jig to address frontal plane deformities, the Deformity Reduction Device can be utilized with both CWO and OWO to correct torsion-angulation femoral deformities to optimize frontal plane alignment.

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Shen, Quan-Hu, Ji-Woong Baik, and Ye-Yeon Won. "The Morphology of a Kinematically Aligned Distal Femoral Osteotomy Is Different from That Obtained with Mechanical Alignment and Could Have Implications for the Design of Total Knee Arthroplasty." Journal of Personalized Medicine 12, no. 3 (March 8, 2022): 422. http://dx.doi.org/10.3390/jpm12030422.

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Background: Kinematically aligned total knee arthroplasty (KA-TKA) may lead to a different pattern of osteotomy from mechanically aligned total knee arthroplasty (MA-TKA). This paper aims to analyze the effects of KA and MA on the morphology of the distal femoral osteotomy surface. Methods: Computed tomography scans of 80 TKA candidates were reconstructed into 3D models. The measurement of bone morphology was performed after the distal femur cut according to two different alignment techniques. The aspect ratio, trapezoidicity ratio, and asymmetry ratio of the distal femur were assessed. Results: The aspect ratio and the asymmetry ratio in the KA group was significantly lower than that in the MA group in the general population (p < 0.001). The trapezoidicity ratio in the KA group was significantly higher than that in the MA group in the general population (p < 0.001). Conclusions: It was found that KA-TKA and MA-TKA presented different morphologies of the distal femoral osteotomy surface, and this difference was also influenced by gender. The surgery pattern of KA-TKA and MA-TKA and gender should be considered when surgeons choose femoral prostheses.

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Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. "Survivorship and Complications of the Distal Femoral Osteotomy." Orthopaedic Journal of Sports Medicine 2, no. 7_suppl2 (July 2014): 2325967114S0005. http://dx.doi.org/10.1177/2325967114s00051.

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Puzzitiello, Richard N., Joseph N. Liu, Grant H. Garcia, Michael L. Redondo, Enrico M. Forlenza, Avinesh Agarwalla, Adam B. Yanke, and Brian J. Cole. "Return to Work After Distal Femoral Varus Osteotomy." Orthopaedic Journal of Sports Medicine 8, no. 12 (December 1, 2020): 232596712096596. http://dx.doi.org/10.1177/2325967120965966.

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Background: Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. There is a paucity of information available regarding patients’ ability to return to work (RTW) after DFVO. Purpose: To report the objective findings for RTW rates and times for patients receiving a DFVO for lateral compartment osteoarthritis secondary to valgus deformity of the knee. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective study of patients who received a lateral-wedge opening DFVO. Patients must have worked within 3 years before their operation to be included for analysis. Patients were contacted at a minimum of 2 years postoperatively for interview and questionnaire evaluation, including a subjective work questionnaire, visual analog scale (VAS) for pain, Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Results: Overall, 32 patients were contacted at a mean follow-up of 7.1 ± 4.1 years (range, 2.2-13.3 years). The mean ± SD age at the time of surgery was 30.8 ± 8.8 years (range, 17.2-46.5 years), and 65.6% of patients were female. Eleven patients (34.4%) received a concomitant meniscal allograft transplant, and 12 (37.5%) received a cartilage grafting procedure. The average VAS pain score decreased significantly from 6.1 preoperatively to 3.2 postoperatively ( P = .03). All patients were able to RTW, at a mean time of 6.0 ± 13.2 months postoperatively (range, 0-72 months). When stratified by work intensity, the average time to return was 13.8, 3.1, 2.7, and 2.9 months for high, moderate, light, and sedentary occupations, respectively. There was no significant difference between these RTW times ( P = .16), although this analysis may have been limited by the small sample size. Four patients whose work was classified as heavy work (50%) and 3 whose work was classified as moderate work (18.8%) either switched jobs or kept the same job with lighter physical duties as a result of their procedures. Conclusion: In a young and active population, DFVO for valgus deformity reliably afforded the ability to RTW within a relatively short time for patients with sedentary, light, and moderate occupational demands. However, patients with moderate- to high-intensity occupational demands may be unable to RTW at their preoperative level.

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Heidari, K. Soraya, Nathanael Heckmann, William Pannell, J. Ryan Hill, Braden McKnight, C. Thomas Vangsness, and George Hatch. "Distal Femoral Osteotomy Survivorship: a Population-based Study." Arthroscopy: The Journal of Arthroscopic & Related Surgery 33, no. 6 (June 2017): e36. http://dx.doi.org/10.1016/j.arthro.2017.04.106.

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Leong, Natalie L., Taylor M. Southworth, and Brian J. Cole. "Distal Femoral Osteotomy and Lateral Meniscus Allograft Transplant." Clinics in Sports Medicine 38, no. 3 (July 2019): 387–99. http://dx.doi.org/10.1016/j.csm.2019.02.007.

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Heidari, K. Soraya, Nathanael Heckmann, William C. Pannell, J. Ryan Hill, Braden Michael McKnight, C. Thomas Vangsness, and George F. Rick Hatch. "Distal Femoral Osteotomy Survivorship: A Population-based Study." Orthopaedic Journal of Sports Medicine 5, no. 7_suppl6 (July 2017): 2325967117S0029. http://dx.doi.org/10.1177/2325967117s00293.

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Mitchell, Justin J., Chase S. Dean, Jorge Chahla, Gilbert Moatshe, Tyler R. Cram, and Robert F. LaPrade. "Varus-Producing Lateral Distal Femoral Opening-Wedge Osteotomy." Arthroscopy Techniques 5, no. 4 (August 2016): e799-e807. http://dx.doi.org/10.1016/j.eats.2016.03.009.

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Luceri, Francesco, Jacopo Tamini, Paolo Ferrua, Damiano Ricci, Cécile Batailler, Sébastien Lustig, Elvire Servien, Pietro Simone Randelli, and Giuseppe Maria Peretti. "Total knee arthroplasty after distal femoral osteotomy: a systematic review and current concepts." SICOT-J 6 (2020): 35. http://dx.doi.org/10.1051/sicotj/2020033.

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Introduction: Distal Femoral Osteotomy (DFO) is a common procedure for correcting lower limb valgus deformity and lateral compartment overload. Low 20-year survivorship rate was reported with a consequent need for total knee arthroplasty (TKA). This study aims to review literature and to analyse the influence of a previous distal femoral osteotomy on outcomes of patients undergoing TKA. Methods: A systematic literature review was performed in PubMed/Medline and Embase in May 2020. Papers were selected based on the following criteria: patient with a previous distal femoral osteotomy; total knee replacement; Pre- and Postoperative outcomes; surgical outcomes: clinical scores, range of motion, radiographic evaluation and revisions for any cause; case series, retrospective studies, observational studies, open-label studies, randomized clinical trials; systematic reviews and meta-analyses were included to extract primitive studies. Results: 306 articles were found, of which five papers were considered eligible for this review. In every study included, postoperative clinical outcomes (Knee Society Score or Hospital for Special Surgery score) statistically improved from the preoperative. Complications were not uncommon; implant survivorship at the available follow-up seems to be similar to primary TKA, although being too short to draw any conclusions. Conclusions: Limited and highly heterogeneous evidence is currently available on the influence of DFO on outcomes after TKA. Knee replacement improves clinical middle-term outcomes in patients with previous distal femoral osteotomy. In this complex surgery, the use of technical tips and tricks could help surgeons to obtain an accurate knee balancing and better long-term results.

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Wang, Zhibing, Xingwang Cheng, Yuan Zhang, Xia Zhang, and Yue Zhou. "Restoration of Constitutional Alignment in TKA with a Novel Osteotomy Technique." Journal of Knee Surgery 33, no. 02 (January 16, 2019): 190–99. http://dx.doi.org/10.1055/s-0038-1677508.

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AbstractMany studies have shown that restoration of the preoperative constitutional varus may lead to a normal knee status in total knee arthroplasty (TKA). It is also known that coronal femoral lateral bowing contributes to constitutional varus of the femoral shaft, and bilateral femoral lateral bowing (BFLB) can decelerate medial knee osteoarthritis progression. In this sense, the BFLB should be reserved in TKA. To date, no study has yet reported the technique to reserve BFLB in TKA. Our study showed that the proximal and distal femur had no significant geometric difference between patients with varus knees and BFLB (> 5°) and volunteers with healthy knees and straight femoral shaft. So, the virtual center of femoral head fell on the distal femoral mechanical axis (DMA) after accurate correction of the bowing, indicating that the DMA should be the femoral original constitutional mechanical axis (CA). Subsequently, the distal femoral osteotomy was performed perpendicular to DMA in TKA, and the postoperative angle formed by DMA and tibial mechanical axis (TMA) was measured to assess whether CA was restored successfully. In this study, the gap balance was achieved without medial collateral ligaments release, and the patient's CA was successfully restored (range of DMA–TMA angle 178.2°–179.9°). This study provides a novel technique to restore preoperative CA in patients with varus knees and BFLB. It is found that the distal femur should be cut perpendicular to DMA, so the lower limb alignment and soft tissue strains can be restored to the preoperative state, and the knees would be stable and in a natural status after TKA.

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Yuan, Liang, Bin Yang, Xiaohua Wang, Bin Sun, Ke Zhang, Yichen Yan, Jie Liu, and Jie Yao. "The Bony Resection Accuracy with Patient-Specific Instruments during Total Knee Arthroplasty: A Retrospective Case Series Study." BioMed Research International 2021 (February 15, 2021): 1–9. http://dx.doi.org/10.1155/2021/8674847.

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Purpose. Bony resection is the primary step during total knee arthroplasty. The accuracy of bony resection was highly addressed because it was deemed to have a good relationship with mechanical line. Patient-specific instruments (PSI) were invented to copy the bony resection references from the preoperative surgical plan during a total knee arthroplasty (TKA); however, the accuracy still remains controversial. This study was aimed at finding out the accuracy of the bony resection during PSI-assisted TKA. Methods. Forty-two PSI-assisted TKAs (based on full-length leg CT images) were analyzed retrospectively. Resected bones of every patient were given a CT scan, and three-dimensional radiographs were reconstructed. The thickness of each bony resection was measured with the three-dimensional radiographs and recorded. The saw blade thickness (1.27 mm) was added to the measurements, and the results represented intraoperative bone resection thickness. A comparison between intraoperative bone resection thickness and preoperatively planned thickness was conducted. The differences were calculated, and the outliers were defined as >3 mm. Results. The distal femoral condyle had the most accurate bone cuts with the smallest difference (median, 1.0 mm at the distal medial femoral condyle and 0.8 mm at the distal lateral femoral condyle) and the least outliers (none at the distal medial femoral condyle and 1 (2.4%) at the distal lateral femoral condyle). The tibial plateau came in second (median difference, 0.8 mm at the medial tibial plateau and 1.4 mm at the lateral tibial plateau; outliers, none at the medial tibial plateau and 1 (2.6%) at the lateral tibial plateau). Regardless of whether the threshold was set to >2 mm (14 (17.9%) at the tibial plateau vs. 12 (14.6%) at the distal femoral condyle, p > 0.05 ) or >3 mm (1 (1.3%) at the tibial plateau vs. 1 (1.2%) at the distal femoral condyle, p > 0.05 ), the accuracy of tibial plateau osteotomy was similar to that of the distal femoral condyle. Osteotomy accuracy at the posterior femoral condyle and the anterior femoral condyle were the worst. Outliers were up to 6 (15.0%) at the posterior medial femoral condyle, 5 (12.2%) at the posterior lateral femoral condyle, and 6 (15.8%) at the anterior femoral condyle. The percentages of overcut and undercut tended to 50% in most parts except the lateral tibial plateau. At the lateral tibial plateau, the undercut percentage was twice that of the overcut. Conclusion. The tibial plateau and the distal femoral condyle share a similar accuracy of osteotomy with PSI. PSI have a generally good accuracy during the femur and tibia bone resection in TKA. PSI could be a kind of user-friendly tool which can simplify TKA with good accuracy. Level of Evidence. This is a Level IV case series with no comparison group.

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Tan, Si Heng Sharon, Si Jian Hui, Chintan Doshi, Keng Lin Wong, Andrew Kean Seng Lim, and James Hoipo Hui. "The Outcomes of Distal Femoral Varus Osteotomy in Patellofemoral Instability: A Systematic Review and Meta-Analysis." Journal of Knee Surgery 33, no. 05 (March 1, 2019): 504–12. http://dx.doi.org/10.1055/s-0039-1681043.

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AbstractDistal femoral varus osteotomies have been novelly described in the recent years to be successful in the management of patellofemoral instability with genu valgum. However, these publications are limited to case reports and small case series and no published literature have attempted to analyze them in totality. The current review aims to pool together these small case series to evaluate the outcomes and complications of distal varus femoral osteotomies when performed for patellofemoral instability. The review was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. All studies that reported the outcomes of distal femoral varus osteotomy for patellofemoral instability were included. A total of five publications were included in the review, which included a total of 73 patients. All of the studies reported improvement in the radiological outcomes for genu valgum correction and patellofemoral instability. One study using opening wedge osteotomy reported a decrease in Caton–Deschamps index postoperatively, while another study using closing wedge osteotomy reported maintenance of the Caton–Deschamps index postoperatively. Second look arthroscopy showed an improvement in the status of the chondral lesions of the medial facet of the patellar undersurface, the lateral facet of the patellar undersurface and the trochlear groove 2 years postoperatively. All studies also reported a decrease in the risk of recurrence of patellofemoral instability, reduction in pain, and an improvement in all the clinical outcomes knee scores. Distal femoral varus osteotomy is promising and useful in the management of patellofemoral instability with genu valgum. The procedure can allow for radiological correction of the genu valgum and patellofemoral instability, reduction in the risk of recurrence of patellofemoral instability, reduction in pain, improvement in clinical knee outcome scores, and improvement in the status of the chondral lesions in the patellofemoral joint. It is highly versatile and could accommodate varying degrees of correction. These improvements in radiological and clinical outcomes can be seen in studies for both closing wedge and opening wedge distal femoral osteotomies. However, opening wedge osteotomies appear to decrease the patellar height as compared with closing wedge osteotomies which maintain the patellar height; therefore, the patellar height should be assessed preoperatively prior to deciding whether to perform an opening wedge or closing wedge distal femoral varus osteotomy. The Level of Evidence for this study is IV.

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Terry, Glenn C., and Peter M. Cimino. "DISTAL FEMORAL OSTEOTOMY FOR VALGUS DEFORMITY OF THE KNEE." Orthopedics 15, no. 11 (November 1992): 1283–90. http://dx.doi.org/10.3928/0147-7447-19921101-07.

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Wang, J. W., and C. C. Hsu. "Distal Femoral Varus Osteotomy for Osteoarthritis of the Knee." JBJS Essential Surgical Techniques os-88, no. 1_suppl_1 (March 1, 2006): 100–108. http://dx.doi.org/10.2106/jbjs.e.00827.

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WANG, JUN-WEN, and CHIA-CHEN HSU. "DISTAL FEMORAL VARUS OSTEOTOMY FOR OSTEOARTHRITIS OF THE KNEE." Journal of Bone and Joint Surgery-American Volume 87, no. 1 (January 2005): 127–33. http://dx.doi.org/10.2106/00004623-200501000-00018.

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Grelsamer, Ronald P. "Distal Femoral Varus Osteotomy for Osteoarthritis of the Knee." Journal of Bone and Joint Surgery-American Volume 87, no. 8 (August 2005): 1886. http://dx.doi.org/10.2106/00004623-200508000-00041.

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Wang, Jun-Wen, and Chia-Chen Hsu. "Distal Femoral Varus Osteotomy for Osteoarthritis of the Knee." Journal of Bone and Joint Surgery-American Volume 87, no. 8 (August 2005): 1887. http://dx.doi.org/10.2106/00004623-200508000-00042.

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WANG, JUN-WEN, and CHIA-CHEN HSU. "Distal Femoral Varus Osteotomy for Osteoarthritis of the Knee." Journal of Bone and Joint Surgery-American Volume 88 (March 2006): 100–108. http://dx.doi.org/10.2106/00004623-200603001-00010.

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Wang, Jun-Wen, and Chia-Chen Hsu. "Distal Femoral Varus Osteotomy for Osteoarthritis of the Knee." Journal of Bone & Joint Surgery 87, no. 1 (January 2005): 127–33. http://dx.doi.org/10.2106/jbjs.c.01559.

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Voleti, Pramod B., Isabella T. Wu, Ryan M. Degen, Danielle M. Tetreault, Aaron J. Krych, and Riley J. Williams. "Successful Return to Sport Following Distal Femoral Varus Osteotomy." CARTILAGE 10, no. 1 (December 21, 2017): 19–25. http://dx.doi.org/10.1177/1947603517743545.

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Objective Distal femoral varus osteotomy (DFVO) is an effective treatment for unloading valgus knee malalignment; however, there is limited evidence on the ability for patients to return to athletics following this procedure. The purpose of this study is to report the functional outcomes and rate of return to sport for athletes that underwent DFVO. Design A consecutive series of athletes that had undergone DFVO were retrospectively reviewed. Radiographs were assessed to determine preoperative and postoperative alignment. Institutional registries were used to collect preoperative and postoperative Marx Activity Scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form scores, and return to sport. Results Thirteen patients (8 males, 5 females) with a mean age of 24 years (range 17-35 years) and a mean follow-up of 43 months (range 24-74 months) were included in the study. Six patients underwent medial closing wedge DFVO versus 7 patients who underwent lateral opening wedge DFVO. Nine of 13 had concomitant chondral, meniscal, or ligamentous procedures performed. The mean alignment correction was 8° (range 5°-13°). All patients were able to successfully return to sport at a mean of 11 months (range 9-13 months). Furthermore, all 13 patients demonstrated an improvement in both Marx Activity Scale (4-11; P < 0.01) and IKDC scores (53-89; P < 0.01) after surgery. Conclusions Correction of valgus knee malalignment through DFVO—either medial closing wedge or lateral opening wedge—can reliably result in improvement in function and return to sport. Concomitant chondral, meniscal, and ligamentous pathology should be addressed.

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Dietrick, Todd B., and William D. Bugbee. "Distal Femoral Osteotomy Utilizing a Lateral Opening-Wedge Technique." Techniques in Knee Surgery 4, no. 3 (September 2005): 186–92. http://dx.doi.org/10.1097/01.btk.0000175881.99745.78.

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Healy, William L., Stephen A. Wasilewski, and Kenneth A. Krackow. "Distal femoral varus osteotomy for the painful valgus knee." Techniques in Orthopaedics 4, no. 1 (April 1989): 47–52. http://dx.doi.org/10.1097/00013611-198904000-00010.

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Voleti, Pramod Babu, Ryan Degen, Danielle Tetreault, Aaron John Krych, and Riley J. Williams. "Successful Return to Sport Following Distal Femoral Varus Osteotomy." Orthopaedic Journal of Sports Medicine 4, no. 7_suppl4 (July 18, 2016): 2325967116S0013. http://dx.doi.org/10.1177/2325967116s00132.

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Seah, K. T. Matthew, Raheel Shafi, Austin T. Fragomen, and S. Robert Rozbruch. "Distal Femoral Osteotomy: Is Internal Fixation Better than External?" Clinical Orthopaedics and Related Research® 469, no. 7 (January 6, 2011): 2003–11. http://dx.doi.org/10.1007/s11999-010-1755-0.

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Putra, Pande Putu Agung Willa Kesawa, and Anak Agung Ngurah Ronny Kesuma. "Right femur malunion treated with open osteotomy and open reduction with internal fixation percutaneous surgery (ORIF PS): A case report." Intisari Sains Medis 13, no. 3 (November 2, 2022): 608–11. http://dx.doi.org/10.15562/ism.v13i3.1519.

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Introduction: Fracture femur distal third is a common orthopedic problem in patients of all ages. Malunion is common due to neglected conditions; an osteotomy plus ORIF PS procedure is required in the management. Surgery is currently the treatment of choice for distal femoral malunion fractures. Malunion requires deep fixation of compression using lag screws, cortical screws or cancellous screws depending on the type of fracture. Patients with distal femoral malunion are also treated with grafting using bone graft, allograft, autograft, synthetic graft and blade plate with screws in combination with a safe quadriceps approach. Case description: A 16-year-old female patient complained of unbalanced walking and cramps in the right leg for the last 3 months. The patient had a history of traffic accidents and then suffered femur fracture 9 months ago, debridement and a plaster cast. The physical examination found that the right leg was shorter than the left, and the AVN and active ROM distal right leg were still good. Then X-Ray examination obtained the results of his Malunion fracture of the middle 1/3 right femur and then decided to do an osteotomy + ORIF PS. The patient returned home in good condition and then controlled through the outpatient polyclinic. Conclusion: In most malunion patients, osteotomy and PS ORIF are surgical methods. Corrective osteotomy with ORIF PS should be regarded as a salvage procedure for treating distal third malunion.

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Sigwalt, Loic, Brice Rubens-Duval, Billy Chedal-Bornu, Regis Pailhe, and Dominique Saragaglia. "Concept of Combined Femoral and Tibial Osteotomies." Journal of Knee Surgery 30, no. 08 (June 14, 2017): 756–63. http://dx.doi.org/10.1055/s-0037-1603640.

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AbstractMedial knee osteoarthritis is not uncommon, and high tibial osteotomy (HTO) for some surgeons is a unique treatment option for young and active patients. However, the deformity is not always located at the level of proximal part of the tibia and the overcorrection needed to achieve a lasting functional result can lead to an oblique joint line. To avoid this undesirable effect to the joint line, a double-level osteotomy (DLO), one at the distal part of the femur and another one at the proximal part of the tibia, is a viable option. The aim of this article is to present the preoperative radiological assessment, the operative procedure, the indications of HTO, distal femoral osteotomy (DFO), and DLO presenting the rationale behind the treatment options. Long-leg radiographs are mandatory to measure the hip–knee–ankle angle, and the femoral and tibial mechanical axes to plan the location of the osteotomy. The best indication for DLO is a severe varus knee deformity with femoral and tibial mechanical axes in varus. This argument can be applied to a genu valgum deformity, especially when the femur is in valgus as well as the tibia, which is not rare. Although the operative technique is demanding, the biggest challenge is not the procedure itself but rather how to reach the exact degree of overcorrection. Computer-assisted surgery is a good alternative and can improve the accuracy of the surgery.

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Eberbach, Helge, Julian Mehl, Matthias J. Feucht, Gerrit Bode, Norbert P. Südkamp, and Philipp Niemeyer. "Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity." American Journal of Sports Medicine 45, no. 4 (December 21, 2016): 909–14. http://dx.doi.org/10.1177/0363546516676266.

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Background: Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. Purpose: The purposes of this study were (1) to analyze the coronal geometry of patients with valgus malalignment and identify the location of the underlying deformity and (2) to investigate the proportion of cases that require realignment osteotomy at the tibia, the femur, or both locations to avoid an oblique joint line. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The analysis included 420 standing full-leg radiographs of patients with valgus malalignment (mechanical femorotibial angle [mFTA], ≥4°). A systematic analysis of the coronal leg geometry was performed including the mFTA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). The localization of the deformity was determined according to the malalignment test described by Paley, and patients were assigned to 1 of 4 groups: femoral-based valgus deformity, tibial-based valgus deformity, femoral- and tibial-based valgus deformity, or intra-articular/ligamentary–based valgus deformity. Subsequently, the ideal osteotomy site was identified with the goal of a postoperative change of the joint line of two different maximum values, ±2° and ±4°, from its physiological varus position of 3°. Results: Measurements of the coronal alignment revealed a mean (±SD) mFTA of 7.4° ± 4.3° (range, 4°-28.2°). The mean mLDFA and mean mMPTA were 84.8° ± 2.4° and 90.9° ± 2.6°, respectively. The mean JLCA was 1.2° ± 3.1°. The majority (41.0%) of valgus deformities were tibial based, 23.6% were femoral based, 26.9% were femoral and tibial based, and 8.6% were intra-articular/ligamentary based. To achieve a straight-leg axis and an anatomic postoperative joint line with a tolerance of ±4°, the ideal site of a corrective osteotomy was tibial in 55.2% of cases and femoral in 19.5% of cases. A double-level osteotomy would be necessary in 25.2% of cases. With a tolerance of ±2°, the ideal osteotomy site was the proximal tibia in 41.0% of cases and the distal femur in 13.6% of cases; a double-level osteotomy would be necessary in 45.5% of cases. Conclusion: In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.

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Journal articles on the topic 'Distal femoral osteotomy'

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