Distal femoral dome varus osteotomy: Surgical technique with minimal dissection and external fixation

Abstract The results obtained when employing distal femoral varus osteotomy are variable. Our objective was to describe a surgical technique involving minimal dissection, semicircular osteotomy with external fixation for valgus angular deformities, and early weight bearing. Methods Design: Series of cases. Setting: Orthopedic Referral Trauma Center. Patients: Sixteen patients with valgus angular deformities of > 12°. Intervention: Wedge varus osteotomy, minimal dissection with external fixation using a standard system, multidirectional Newfix. Main outcome measurements included pain, surgical time, knee flexion and extension angles, and assessment of knee function based on the Hospital Special Surgery knee rating scale (HSSkrs). Results Of 16 patients, 14 were evaluated to the end of the study. When we compared preoperative values with those obtained postoperatively at a mean of 24 ± 2.1 months, pain measurement was reduced from 7 to 2.1 ( p = 0.002), angle of flexion was reduced from 105.4 ± 14.6° to 105.3 ± 11.1° ( p = 0.06), and angle of extension, from − 1.67 to − 1.25° ( p = 0.6), while HSSkrs assessment increased from 67.5 ± 2.7 to 79.4 ± 5 ( p = 0.003). Two patients were excluded from the study, one due to infection that developed along the trajectory of a screw, and the other patient underwent complete arthroplasty of the knee, which was performed to combat the pain that was not being alleviated. Conclusions The technique improves function and reduces pain while facilitating early rehabilitation in 83% of cases.