Distal Femoral Osteotomy

Occasionally, arthritis affects the knee only in the lateral (outside) compartment.  A Distal Femoral Osteotomy (DFO) is a procedure that is designed to “unload” the outside part of the knee and take some more load through the medial (inside) compartment.

A DFO is performed in patients who are younger, are active, and have good cartilage preservation in the medial compartment. It delays further surgeries like partial or total knee replacement. It usually allows patients to perform the more demanding manual type work duties such as squatting, kneeling and carrying heavy loads and also allows some patients to return to high impact type of activities like running, jumping and contact sports (in moderation).

Dr Gallagher prefers to perform a Distal Femoral Osteotomy (DFO) using an opening wedge technique which involves putting a metallic plate with a wedge and some bone graft and screws on the lateral side of the femur.

Patients have a graduated range of motion (ROM) and weight bearing (WB) protocol to follow post operatively. This allows the bone graft to strengthen and mature. Patients who are too vigorous with WB or ROM may have post operative complications such as fixation failure or subsidence of the grafted bone.

The ROM / WB protocol is as follows:

 WEEKROMWB
 1 – 20 – 30°Nil
3 – 40 – 45°< 25%
5 – 60 – 60°25%
7 – 80 – 90°50%
9 – 100 – 105°75%
11 – 120 – 120°90%
13 – 14Full ROM90 – 100%

X-rays are performed at 6 and 12 weeks post operatively. Patients may progress to full weight bearing after the 12 week x-ray if the bone graft has consolidated.

Post op exercises (0 – 2 weeks)

  • Following a DFO, you will generally stay 2 – 3 nights in hospital and then sent home on crutches with a post op ROM brace.
  • Swelling control and gentle terminal extension drills are the priorities in the early stage. You MUST “take it easy”, elevate the leg and ice regularly.
  • Circulation drills- foot pumping, static quads and glutes
  • Hamstring stretch and calf stretch with towel
  • Static quad (thigh setting) with small rolled towel behind knee- encourages extension and gets VMO to fire.
  • Straight leg raise.
  • Mobilising safely NWB on crutches

Review by Dr Gallagher and Robert Godbolt at 2 weeks

  • Dressing changed or removed
  • Circulation drills- foot pumping, static quads and glutes
  • Hamstring stretch and calf stretch with towel
  • Static quad (thigh setting) with small rolled towel behind knee- encourages extension and gets VMO to fire.
  • Straight leg raise / Inner range quads
  • Side leg raise
  • Reverse leg raise
  • Commence <25% Partial WB- use bathroom scales to gauge. Progress to 25% PWB at 4 weeks
  • Reinforce good gait pattern
  • Use EMS if VMO a bit sluggish

Review with Dr Gallagher with x-rays and Robert Godbolt at 6 weeks

  • Patient should be 25% weight bearing and 0-60 degrees.
  • Progress to 50% (even weight) and 0-90 degrees as allowed.
  • Calf raises
  • Clams
  • Pool program – 50 % weight bearing (belly button level water) gait re-education, squats, 3 way leg swings – pain as guide

Review with Dr Gallagher with x-rays and Robert Godbolt at 12 weeks

  • If the osteotomy is well united, patient will progress to full weight bearing at 12 weeks. If not quite there then progress to full weight bearing over the subsequent fortnight. Dr Gallagher will advise you.
  • Progress to closed chain body weight exercises – bridging, squat, step up, hamstring bridge
  • Gait re-education
  • Bike (stationary)
  • Commence gym program from 16 weeks
  • Commence graduated impact work and begin return to running program from 6 months

Manual Therapy

The following Physiotherapy interventions may be useful in restoring the joint:

  • Patellofemoral mobilisation
  • Release / soft tissue massage lateral thigh and ITB
  • The use of NMS (neuromuscular stimulators) for VMO activation
  • Patellofemoral taping