Ostéotomie fémorale de valgisation par fermeture latérale dans le Genu varum

Clinical importance: when a varus knee needs femoral correction

In patients with genu varum (bow-leg deformity) where the deformity originates from the distal femur (or is mixed femoral + tibial), simply performing a tibial osteotomy may lead to suboptimal alignment and increased joint line obliquity. 

This paper presents a lateral femoral closing-wedge osteotomy intended to restore alignment in femoral-based varus and preserve a more physiological joint line. 

Technique overview: planning and surgical execution

The authors describe the key steps:

• Identification of femoral origin via full-length standing radiographs and measurement of mechanical lateral distal femoral angle (mLDFA).
  
• Lateral closing-wedge osteotomy with a biplanar cut, preserving a lateral cortical hinge, designed to limit hinge fracture and improve stability.
  
• Osteosynthesis using plate and screws after wedge removal and closure.
  
• Rehabilitation with early mobilisation, protected weight bearing, and monitoring of hinge integrity.

Key observations: feasibility and early results

• The technique is described as feasible and safe in the context of femoral-origin genu varum.
  
• By correcting the femoral component, the authors argue a better restoration of mechanical axis and joint line geometry, avoiding an excessive tibial correction and consequent joint line tilt.
  
• The paper emphasises that limiting hinge fracture risk and ensuring a stable fixation are critical for success.

Implications for practice: selecting the right level and technique

• Surgeons should carefully determine the location of deformity (femur vs tibia vs both) rather than defaulting to tibial correction in varus cases.
  
• For femoral-dominant or combined deformity, the lateral femoral closing wedge offers a targeted correction, preserving joint line and potentially avoiding over-correction of tibia.
  
• Precision in planning (wedge size, hinge placement, plate fixation) and execution (biplanar cuts, hinge integrity) is essential.
  
• Early safe weight bearing and hinge monitoring may improve outcomes and reduce complications.

Essential take-aways

1. A closing-wedge femoral osteotomy is a valid option for genu varum driven by the distal femur.
   
2. This technique helps maintain favourable joint line orientation and avoids inducing abnormal tilt from tibial correction alone.
   
3. Accurate planning and meticulous surgical execution are required to achieve optimal results.
   
4. While early results are promising, larger outcome-series and longer-term follow-up are still required.

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

Sources used in report overview:

1. https://www.sciencedirect.com/article/pii/S1877051721002471 (ScienceDirect)
2. https://www.sciencedirect.com/article/pii/S187705682100222X (ScienceDirect)

https://www.em-consulte.com/article/1455088/osteotomie-femorale-de-valgisation-par-fermeture-l (EM Consulte)