osteotomy
Distal femoral varus osteotomy (DFVO)
Aetiology
Trauma
RA
Rickets / osteomalacia
Issues
Horizontal joint line important
- < 10° tilt acceptable
> 10o joint line tilt / due to femoral valgus
- continues to overload lateral compartment
Management
Management Summary
Stage 0
Natural history mixed
- depends on size of lesion and diagnosis
- treat if becomes asymptomatic
- may benefit from bisphosphonates
Stage 1 / Normal X-ray, abnormal MRI
Forage: 80% G/E
Bisphosphonates
Stage 2 / Abnormal X-ray with cysts and sclerosis
A: As for Stage I
Extra-articular Deformity
Causes of Deformity
Metabolic Bone Disease
Paget's
Fracture Malunion
Previous Osteotomy
Options
1. Intra-articular correction
2. Simultaneous osteotomy and TKR
3. Staged correction and TKR
1. Intra-articular correction
Indications
Femur
- draw line of mechanical axis of femur