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DISTAL FEMORAL OSTEOTOMY FOR A DEFORMITY OF THE LEG AXIS

Method
Varus-producing medial closing osteotomy of the thigh bone
Duration
about 90 minutes
Recovery time
4 to 6 months

The distal femoral osteotomy corrects a deformity of the leg axis that has its origin in the thigh bone. With knock knees (genu valgum) a large part of the load runs through the outer part of the joint. The correction shifts it back towards the middle of the knee and so takes the load off the damaged compartment.

It is an option where there is cartilage damage or early wear in the outer compartment of the knee, and likewise with an unstable kneecap and a valgus axis. Whether the deformity comes from the thigh or from the lower leg is shown by a full-length standing X-ray of the leg – from that it follows whether the correction is made at the thigh bone, at the upper tibia, or at both.

How the operation proceeds

The correction is planned beforehand on the full-length standing X-ray with calibrated software: the angle of correction and the implant are settled before the procedure. The osteotomy itself is carried out under fluoroscopic control on the inner side of the thigh bone, just above the knee joint.

There a wedge-shaped piece of bone is removed and the gap closed, which corrects the leg axis inwards (into varus). It is fixed with a locking plate. Depending on the findings, the osteotomy can also be adjusted rotationally or combined with further procedures – for instance an MPFL reconstruction where the kneecap is unstable.

Rehabilitation

Aftercare proceeds step by step and is guided by the consolidation of the bone and by the restoration of loading along the leg axis. Mobilisation accompanied by physiotherapy is decisive for the functional result.

Phase I (0-6 weeks): partial weight-bearing and protection
  • Partial weight-bearing with forearm crutches (about 15-20 kg)
  • Orthosis to control movement, thrombosis prophylaxis where needed
  • Cooling, elevation, lymphatic drainage
  • Passive mobilisation exercises, CPM splint
Phase II (6-12 weeks): increasing load
  • Transition to full weight-bearing depending on the X-ray check
  • Strengthening the thigh and hip muscles
  • Increasing active movement, co-ordination training
Phase III (from week 12): everyday life and sport
  • Stability and load training
  • Sport-specific build-up training (from about 4-6 months)
  • Return to activity after clinical and radiological checks