Lateral Opening Wedge Distal Femoral Osteotomy

Coronal malalignment of the lower limb is associated with altered joint forces, contributing to cartilage damage and progression of knee osteoarthritis over time. In patients with valgus malalignment, the lateral compartment of the knee is overloaded, leading to accelerated chondral wear. Distal femur varizating osteotomy is a joint-sparing surgery aimed at correcting valgus malalignment, thus off-loading the lateral compartment. It can be performed as a lateral opening wedge or a medial closing wedge osteotomy. The ideal candidate for lateral opening wedge distal femur osteotomy is a patient with isolated lateral compartment osteoarthritis and moderate valgus alignment. Beyond a method to address osteoarthritis, lateral opening wedge distal femur osteotomy can be a concomitant procedure to protect reconstructive surgery, such as with a lateral cartilage restoration procedure or lateral meniscus transplant. Additionally, the procedure can accommodate for pathology, such as medial ligament instability or a deficient lateral meniscus or patellofemoral instability. Clinical studies have reported overall satisfactory results and an acceptable complication rate. Accurate surgical planning and patient selection are essential for good outcomes of this procedure. This chapter provides an overview of the indications, surgical techniques, and complications of lateral opening wedge distal femur osteotomy.