Lateral Opening Wedge Osteotomy of the Distal Femur for Genu Valgum

Abstract

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. Key Concepts: • Valgus malalignment can be associated with patellofemoral symptoms of pain, instability, or lateral compartment overload. • A distal femur varus producing osteotomy improves patellar maltracking and reduces symptomatic patellar instability in some patients. • The goal of a distal femur varus producing osteotomy is to restore a neutral mechanical alignment of the lower extremity and even the weight distribution across the joint. • Mild limb length shortening can be addressed with a lateral opening wedge osteotomy as this procedure will lengthen the limb.