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Introduction
Varising distal femoral osteotomy is a well-
described treatment for lateral compartment
arthrosis in the young, active patient. Distal
femoral varising osteotomy may be performed
using a lateral opening wedge or medial closing
wedge technique [1-2-3-4]. The most commonly
described technique is the medial closing wedge
[5-11]. In our center, the preferred method is the
lateral opening wedge. Little literature exists
regarding the results and complications of this
technique [12-15]. This treatment may poten
tially alter the length of the lower limb. The
objective of this study is to quantify the change
in leg length following lateral opening wedge
distal femoral osteotomy using a blade plate.
Materialand method
Between January 1998 and December 2011, we
treated twenty-seven patients (29 knees) with
symptomatic genu valgum with signs of lateral
compartment osteoarthritis, with or without
associated lateral patello-femoral degenerative
changes as seen on standard radiographs. All
patients underwent lateral opening wedge distal
femoral osteotomy. Two patients underwent
bilateral procedures. We excluded patients who
underwent combined high tibial osteotomy or
femoral rotational correction.
The mean age was 44.4 years. We used the
newly validated
Knee Society Score
(KSS),
French version. This measure gives an objective
score based on symptoms, range of movement
and axis, and a subjective score based on knee
function and patient satisfaction [16]. Patients
were reviewed two, six and twelve months
post-operatively. The mean follow-up was
80.2 months (23.1-198.7). The mean deformity
in the twenty-nine knees, as measured by the
femoro-tibial mechanical axis (mFTA) [17],
was 187.8° (183.0°-197.0°).
The aim of the osteotomy was to correct the
axis of the lower limb to a neutral alignment of
between 0° and 3° of varus, with a preference
for slight over-correction rather than under-
correction. Careful pre-operative planning was
used to determine the degree of correction and
magnitude of opening of the osteotomy.
A lateral incision, 15 to 18cm in length, was
used, and the bone approached in front of the
iliotibial band but behind the vastus lateralis.
Two guide wires were introduced using artery
forceps: one across the femoro-tibial joint and
one across the patello-femoral joint. These were
used to guide the orientation of the blade plate
and reduce the need for fluoroscopic control.
A horizontal osteotomy was used, at the
superior border of the lateral trochlea. The
The effect of lateral
opening wedge distal
femoral osteotomy
on leg length
V. Villa, A. Madelaine, T. Lording,
S. Lustig, E. Servien, P. Neyret