Ostéotomie fémorale de valgisation par fermeture latérale dans le Genu varum d’origine fémorale

The conventional approach to bow-leg deformity (genu varum) often treats the tibial side; however, when the deformity originates in the distal femur (or is mixed femoro-tibial), tibial correction alone may lead to non-anatomical alignment, joint line obliquity and abnormal cartilage loading. This study describes a lateral femoral closing wedge osteotomy (FCW-DFO) designed specifically for femoral or combined-origin varus deformities. 

How the surgical technique was designed and implemented

The authors present a step-by-step method for a lateral closing wedge distal femoral osteotomy:

• Pre-operative planning identifies femoral deformity via mechanical lateral distal femoral angle (mLDFA) analysis.
  
• A biplanar osteotomy is performed laterally with removal of a bone wedge and preservation of a lateral cortical hinge to maintain stability and reduce hinge fracture risk.
  
• Fixation is achieved with locking plate and screws, allowing early mobilisation under controlled weight-bearing.
  
• The approach is indicated when femoral origin deformity is clear, or when a tibial osteotomy has already been used and femoral component remains.

Key observations and outcomes of the technique

According to the published abstract:

• The technique is described as feasible and safe in femoral or mixed-origin varus knees.
  
• The authors highlight that correcting only through the tibia in femoral-based deformity may cause a “non-anatomic morphology” with undesirable shear stresses on cartilage.
  
• The methodology emphasises hinge preservation and improved post-operative morphology.

Implications for surgical planning and deformity correction

This paper reinforces that surgeons must localise the deformity origin (femur vs tibia vs combined) rather than assuming all varus deformities can be managed via tibial osteotomy. For femoral-dominant deformity, a lateral closing wedge femoral osteotomy offers a more anatomically logical correction, helps preserve joint line orientation, and reduces risk of inducing secondary deformity or obliquity. Surgeons should invest in full-length imaging, segmental analysis, hinge planning and appropriate fixation strategy.

Key take-away messages

1. A closing-wedge distal femoral osteotomy is a valid and anatomically sound option when genu varum originates in the femur.
   
2. Surgical technique must prioritise hinge integrity, biplanar cuts, and stable fixation to minimise complications.
   
3. Pre-operative localisation of the deformity origin is critical to avoid non-anatomical correction and joint line obliquity.
   
4. While the study focuses on surgical technique rather than large-scale outcomes, it underscores the importance of matching osteotomy site to deformity source.
   

Link to full paper: Ostéotomie fémorale de valgisation par fermeture latérale dans le Genu varum d’origine fémorale

Sources used in report overview:

1. https://www.sciencedirect.com/article/abs/pii/S1877051721002471 (ScienceDirect)
2. https://pubmed.ncbi.nlm.nih.gov/34144255/ (PubMed)

https://www.em-consulte.com/article/1455088/osteotomie-femorale-de-valgisation-par-fermeture-laterale-dans-le-genu-varum?id=1455088 (EM Consulte)