Distal Femoral Osteotomy

DFO is often recommended for younger, active individuals who have malalignment and early to mid-stage osteoarthritis predominantly in the outer (lateral) compartment of the knee. These patients typically have intact ligaments and good range of motion in the knee.

Your knee surgeon Dr. Mayo will make an incision on either the inner or outer side of the thigh, just above the knee, to expose the femur bone. Then, the femur is cut to either remove a wedge of bone, or create a wedge-shaped opening. This is done while taking x-rays during surgery to ensure an accurate cut is made. The femur is then realigned to distribute the body’s weight more evenly across the knee joint. Because the cut is essentially a fracture in the bone, it must be fixed in place with a metal plate and screws to hold the femur in its new alignment while the bone heals.

Recovery times vary, but patients can typically expect to start weight-bearing exercises under the supervision of a physical therapist as early as one to two weeks post-surgery. Most patients can expect to return to daily activities and work within three months. Full recovery and return to sports can take six to twelve months.

Immediately following the surgery, you’ll likely be in a recovery room where healthcare professionals monitor you as the anesthesia wears off. Pain medications will be administered to help manage any discomfort. You’ll be provided with a knee brace and crutches to aid mobility. You can expect some degree of swelling, which will gradually improve.

Physical therapy is a crucial part of recovery. Initially, the focus is on pain management, reducing swelling, and regaining knee motion. Once healing progresses, the emphasis shifts to strengthening exercises and gradually returning to weight-bearing activities. You will participate in physical therapy for several months after surgery.

Like all surgeries, DFO comes with potential risks:

• Infection: This is a rare complication and can be minimized with antibiotics which are given to you during surgery.
• Blood clots: Rare but serious, blood clots can be managed with medication if they occur. You will take an aspirin for 30 days after surgery to minimize this risk
• Nerve injury: This is extremely rare but can lead to numbness or weakness in the leg.
• Nonunion or delayed union: This is when the bone takes longer to heal or doesn’t heal, requiring further surgery. If it does not heal, the metal holding the bones in place could break.
• Changes in leg alignment: There can be over-correction or under-correction, affecting the success of the surgery.

Choosing not to have a DFO when recommended can lead to increased pain and loss of function due to the progression of osteoarthritis. This can lead to an increased risk of falls and further joint damage. Over time, you may require more complex procedures such as a total knee replacement.