Distal Femoral Varus Osteotomy in Valgus Knee With Lateral Compartment Osteoarthritis: A Systematic Review.

INTRODUCTION: The precise role of distal femoral varus osteotomy (DFVO) in managing lateral compartment gonarthrosis remains incompletely defined, particularly concerning the extent of joint degeneration that supports or contraindicates the procedure at different stages of arthritis. This systematic review synthesizes recent comparative studies to evaluate the indications, functional outcomes, survivorship rates, and complication profiles associated with both closing wedge and opening wedge techniques. Given the scarcity of controlled trials and direct comparative analyses, this review aims to provide evidence-based insights into the clinical efficacy of DFVO. METHODS: This systematic review evaluated studies primarily focused on DFVO for valgus knees with lateral compartment osteoarthritis, published in PubMed, Medline, Embase, or Cochrane databases since 2000. Only English-language studies reporting clinical outcomes with a minimum follow-up of 2 years in human patients were included. After duplicate removal and screening-based on title, abstract, and full-text review, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses methodology-the methodologic quality of the included studies was assessed using the Newcastle-Ottawa Scale. RESULTS: A total of 18 studies met the inclusion criteria, with six evaluating closing wedge DFVO and 12 focusing on opening wedge DFVO. Among these studies, the highest reported conversion rate to total knee arthroplasty was 48.4%, with lateral cortex injury identified as the most common complication. Two studies reported no minor or major complications. Long-term clinical and radiologic follow-up, along with functional assessments, demonstrated substantial efficacy and acceptable safety for DFVO. The reported survival rates at 5, 10, and 15 years ranged from 74% to 88%, 74% to 90%, and 45% to 79%, respectively. DISCUSSION: This systematic review indicates that DFVO provides acceptable long-term survival, favorable functional outcomes, and a manageable complication profile, supporting its role as a viable treatment option for valgus knees with lateral compartment osteoarthritis. Recent studies suggest that when osteotomy is done at the precise site of the deformity, both closing wedge and opening wedge techniques achieve comparable survivorship rates. CONCLUSION: Current evidence supports that DFVO yields favorable functional outcomes and acceptable survival rates in the management of valgus knee osteoarthritis affecting the lateral compartment. When performed at the precise site of deformity, both closing wedge and opening wedge techniques exhibit comparable survivorship and functional results. Additional randomized studies are necessary to refine surgical techniques and optimize patient selection criteria.