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