Knee Surgery & Related Research  
Distal Femoral Varus Osteotomy for Valgus Arthritis of the Knees: Systematic Review of Open versus Closed Wedge Osteotomy
Young Chan Kim, MD1,*, Jae-Hyuk Yang, MD2,*, Hyun Jung Kim, MD3, Tulyapruek Tawonsawatruk, MD4, Yong Suk Chang, MD1, Jong Seong Lee, MD5, Nikhil N Bhandare, MD6, Ki Seong Kim, MD7, Giorgio D.G. Delgado, MD8, and Kyung Wook Nha, MD1
1Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang;
2Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri;
3Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea;
4Department of Orthopaedic Surgery, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand;
5Department of Orthopaedic Surgery, KS Hospital, Ansan, Korea;
6Department of Orthopaedic Surgery, Bhandare Hospital, Goa, India;
7Department of Orthopaedic Surgery, Cheongju St. Mary’s Hosptial, Cheongju, Korea;
8Department of Orthopaedic Surgery, University of the Philippines, Philippine General Hospital, Manila, Philippines
Correspondence to: Kyung-Wook Nha, MD
Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea
Tel: +82-31-910-7312, Fax: +82-31-910-7319
*The first two authors contributed equally to this study.
Received: October 25, 2016; Revised: December 31, 2016; Accepted: January 12, 2017; Published online: January 4, 2018.
© Korean Knee Society. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: The purpose of this review is to compare the clinical and radiological outcomes between open and closed wedge distal femoral varus osteotomy (DFO). Methods: A literature search of online databases (MEDLINE, EMBASE, and Cochrane Library database) was made in addition to manual search of major orthopedic journals. Data were searched from the time period of January 1990 to October 2016. A modified Coleman Methodology Score system was used to assess the methodologic quality of the included studies. A total of 20 studies were included in the review. All studies were level IV evidence. Results: Comparative analysis of open and closed wedge DFO did not demonstrate clinical and radiological differences. The survival rates were also similar. Five studies (56%) on open wedge DFO mentioned the need for either bone grafting or substitute for osteotomy gap filling and reported higher incidences of reoperation for plate removal than the closed wedge DFO studies. Conclusions: The present systematic review showed similar performance between open and closed wedge DFO. Outcomes including survival rates were not statistically significantly different. However, additional bone grafting or substitutes were often needed to prevent delayed union or nonunion for open wedge techniques. Additional operations for plate removal were commonly required due to plate irritation in both techniques.
Keywords: Knee, Femur, Valgus, Osteotomy


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