CORR Insights(®): Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5Years.

Abstract

T he information in the study by Cameron et al. [1] represents an excellent addition to the current literature on distal femoral osteotomies that is largely dominated by medial closing-wedge techniques. Currently, lateral opening-wedge and medial closing-wedge distal femoral osteotomies have been effectively used to provide substantial relief in painful knees with significant valgus (>10 to 15 between the anatomic and mechanical axes). While medial closing-wedge high tibial osteotomies have also been utilized in these patients, this approach has produced less reliable pain relief and may cause iatrogenic joint line obliquity and subsequent instability [2]. Fortunately, multiple studies have demonstrated good outcomes following varus-producing distal femoral osteotomies including TKA conversion rates of 6.1% at 10 years [4] and Knee Injury and Osteoarthritis Outcome Score improvements from 31 preoperatively to 69 postoperatively [3]. Controversy exists, however, regarding the most reliable approach to the varus-producing distal femoral osteotomy, specifically, medial closingwedge versus lateral opening-wedge. Prior data have suggested an increased rate of hardware irritation, delayed osteotomy healing and more meticulous preoperative planning with the lateral opening-wedge distal femoral osteotomy technique [3, 5]. However, the lateral opening-wedge distal femoral osteotomy may have advantages including a single osteotomy cut, possible reduced neurovascular risk, and improved correction control due to increased flexibility during intraoperative corrective degree adjustments. Other questions exist including: (1) What are the specific indications and subsequent outcomes of the varus-producing distal femoral osteotomy for joint restoration and valgus gonarthrosis? (2) Which distal femoral osteotomy technique (lateral opening-wedge versus medial closing-wedge) may optimize these outcomes?