Distal femoral osteotomy is an operation to realign the lower end of the thighbone to correct a knock-knee (valgus) deformity. It shifts weight-bearing away from the damaged outer compartment of the knee.
An incision is made on the inner side of the lower thigh. A wedge of bone is removed (closing wedge) or the bone is cut and opened (opening wedge) to correct the alignment. The osteotomy is fixed with a plate and screws. The operation takes one to two hours.
Distal femoral osteotomy is recommended for younger, active patients with unicompartmental knee arthritis affecting the lateral (outer) compartment due to valgus malalignment. It preserves the native knee joint.
Physiotherapy, weight management, lateral wedge insoles, activity modification, injections. Total or partial knee replacement are surgical alternatives.
Long-leg alignment X-rays and CT scan for planning.
Pain relief by offloading the damaged compartment. Delay or avoidance of knee replacement. Most patients achieve good results lasting 10+ years.
Temporary loss of knee flexion.
Thigh and knee swelling.
The plate may be palpable on the inner thigh.
Risk approximately 5%.
Imperfect correction of alignment.
Through the osteotomy site.
DVT.
Peroneal nerve and popliteal vessels at risk.
General or spinal anaesthesia.
Partial weight-bearing for six to eight weeks. Knee exercises begin immediately. Full weight-bearing by three months. Return to sport at six to nine months.
X-rays at six weeks, three months, and six months.
For younger, active patients with lateral compartment arthritis and valgus alignment, osteotomy preserves the natural knee and allows continued high-level activity. It delays the need for replacement.