Femoral osteotomies for the valgus knee

Coronal limb malalignment is an important contributing factor to articular cartilage damage and to the development of knee osteoarthritis. Osteotomies around the knee are effective and well-recognized treatments for unloading the affected compartment. Valgus malalignment is less common than varus malalignment. Consequently, distal Femoral Osteotomies to correct the valgus knee are less commonly performed compared to high tibial osteotomy (HTO) for the varus knee. There are few papers describing the outcomes of distal femoral osteotomy (DFO) to treat valgus knee alignment and knee arthritis. In literature, there is still an open debate about the correct indication and contraindication, the best surgical technique (opening versus closing wedge), the amount of correction to achieve and the use of bone grafts to enhance osteotomies healing. However, with the correct indications, Distal Femoral Osteotomies showed good outcomes in the treatment of valgus knee. The aim of this manuscript is to review the literature about DFO in the valgus knee, summarizing the indications and contraindications, the available surgical techniques, outcomes, complications and failure rates.