Context and Rationale: when varus stems from the femur
Genu varum (bow-leg deformity) is often attributed to the tibia, but a significant proportion of cases originate partially or entirely in the distal femur. When this segmental deformity is overlooked, tibial osteotomy alone may lead to inadequate correction and introduce excessive joint line obliquity (JLO).
This study outlines the indications, technique and rationale behind a lateral femoral closing wedge osteotomy (FCW-DFO) for appropriately selected varus knees.
Study Description: anatomical focus and operative method
This work presents a technical overview and early clinical insights related to FCW-DFO in patients with femoral or mixed-origin varus malalignment.
Key elements include:
• Identification of deformity origin using full-length radiographs
• Use of a lateral closing wedge to correct the mechanical lateral distal femoral angle (mLDFA)
• Biplanar cuts for rotational control and improved stability
• Fixation methods designed to support reliable healing
The paper primarily serves as a technical note with supportive early experience, rather than a large cohort outcome analysis.
Observations and Findings: feasibility, correction quality and joint line impact
The authors report the following early-phase insights:
- FCW-DFO is highly feasible when deformity is correctly localised to the femur.
- The technique allows for accurate correction while maintaining a more physiologic joint line orientation compared with tibial-only correction in femoral-origin varus.
- Early healing and complication rates were acceptable, with stable hinge management when principles of biplanar osteotomy were applied.
- The method demonstrates promise for improving biomechanics in younger or active patients.
Clinical Implications: when to choose femoral correction
- Proper deformity analysis is essential—surgeons must determine whether varus arises from femur, tibia, or both.
- In femoral-dominant deformity, FCW-DFO prevents excessive tibial correction and abnormal JLO.
- This approach may reduce risks of post-operative imbalance, shear forces, or long-term cartilage overload.
- The technique is particularly relevant in precise joint-preservation strategies, especially in physically active or younger individuals.
Summary Insights for Clinical Application
- Femoral closing wedge osteotomy is an effective option when genu varum originates in the distal femur.
- Correcting at the femur helps maintain a balanced, horizontal joint line, improving biomechanical restoration.
- Pre-operative planning using long-leg imaging is crucial to determine the correct segment for intervention.
- The procedure shows favourable early outcomes, though broader long-term data remain needed.
