Distal Femoral Osteotomy (DFO) is a specialized surgical procedure designed to correct misalignments in the knee joint by reshaping the thigh bone (femur). This surgery is typically recommended for patients with knee arthritis or deformities causing uneven weight distribution, leading to pain and mobility issues. By carefully adjusting the bone angle, DFO helps redistribute pressure across the knee, relieving pain and preventing further joint damage. Unlike knee replacement, DFO preserves the natural joint, making it an attractive option for younger, active patients. The procedure has gained popularity as a joint-preserving alternative, offering long-term relief while maintaining mobility.
DFO is primarily recommended for patients with valgus (knock-knee) or varus (bow-legged) deformities causing knee pain and early arthritis. Ideal candidates are typically younger (under 60), physically active, and experiencing pain localized to one side of the knee. Common indications include osteoarthritis from malalignment, post-traumatic deformities, or congenital conditions affecting knee alignment. Patients must have sufficient healthy cartilage remaining in the knee joint and be committed to the extensive rehabilitation process. Your orthopedic surgeon will evaluate your condition through physical exams, X-rays, and possibly MRI scans to determine if DFO is the right solution for your knee problems.
During a DFO procedure, your surgeon makes a precise cut (osteotomy) in the distal femur (thigh bone near the knee) and reshapes it to correct the alignment. The surgery typically takes 1-2 hours under general anesthesia. Surgeons may use either an opening wedge (adding bone graft to create correction) or closing wedge (removing a bone section) technique, depending on your specific condition. Advanced imaging and surgical navigation systems ensure millimeter-perfect precision. The bone is then stabilized with plates and screws until healing occurs. Unlike knee replacement, DFO preserves all your natural knee structures - cartilage, ligaments, and meniscus - while addressing the root cause of your pain: mechanical misalignment.
Preparation for DFO begins weeks before surgery. Your medical team will conduct pre-operative tests, review medications, and possibly recommend prehabilitation exercises to strengthen surrounding muscles. You'll need to arrange for help at home during recovery and prepare your living space (consider a ground-floor bedroom if possible). Stop smoking and avoid certain medications (like blood thinners) as advised. The night before surgery, you'll fast after midnight. On surgery day, arrive at the hospital 2-3 hours early for pre-op preparations. Bring loose-fitting clothing, crutches (if prescribed), and any necessary medical documents. Mental preparation is equally important - understanding the recovery timeline helps set realistic expectations for your healing journey.
DFO recovery is a gradual process requiring patience and dedication. First 2 weeks focus on pain management and wound healing, with weight-bearing restricted (using crutches). Weeks 3-6 introduce gentle range-of-motion exercises and partial weight-bearing as bone begins healing. Months 2-3 mark the transition to full weight-bearing and more intensive physical therapy to rebuild strength and flexibility. Most patients return to desk work within 4-6 weeks, but full recovery takes 6-12 months depending on individual factors. Your physical therapist will design a customized rehabilitation program including aquatic therapy, stationary cycling, and progressive strength training. Consistent follow-up with your surgeon ensures proper bone healing and timely adjustments to your recovery plan.
While DFO is generally safe, like all surgeries, it carries potential risks. These may include infection, blood clots, nerve or blood vessel damage, and complications from anesthesia. Specific to DFO are risks of non-union (bone not healing properly), hardware irritation, or over/under-correction of the deformity. Smokers and patients with diabetes face higher complication rates. Choosing an experienced orthopedic surgeon significantly reduces these risks. Modern techniques like locked plating systems have improved stability and reduced non-union rates to less than 5%. Your surgical team will take comprehensive precautions including antibiotics, blood thinners, and careful monitoring to minimize risks and ensure the best possible outcome from your procedure.
Studies show DFO has 80-90% success rates in properly selected patients, with benefits lasting 10-15 years or more. Success is typically measured by pain reduction, improved function, and delay of knee replacement. Younger patients with good cartilage quality tend to have the best outcomes. About 75% of patients return to recreational sports within a year. Long-term studies indicate DFO can delay knee replacement by 8-10 years in many cases. Factors affecting longevity include maintaining healthy weight, following rehabilitation protocols, and avoiding high-impact activities during healing. Regular follow-ups allow early intervention if any issues arise, helping preserve your results for years to come.
DFO isn't right for everyone. Alternative treatments include knee replacement (partial or total) for advanced arthritis, braces for mild cases, or physical therapy to strengthen supporting muscles. For older patients or those with widespread cartilage damage, replacement may be preferable. Non-surgical options like injections (cortisone, PRP) or visco-supplementation can provide temporary relief. Proximal tibial osteotomy (correcting alignment from the shin bone) may be better for certain deformities. Your surgeon will consider your age, activity level, arthritis severity, and personal goals when recommending alternatives. The decision between DFO and other options depends on balancing immediate relief with long-term joint preservation.
How painful is DFO recovery?
Pain is most significant in the first 3-5 days, managed effectively with medications. Most patients report decreasing discomfort after the first week, transitioning to soreness during rehabilitation.
Will I need hardware removal after DFO?
Most plates and screws remain permanently unless they cause discomfort (about 15-20% of cases). Removal, if needed, is a minor outpatient procedure once the bone is fully healed.
Can DFO be combined with other procedures?
Yes, DFO is often performed with cartilage restoration procedures, meniscus repairs, or ligament reconstructions to address multiple issues simultaneously.
How soon can I drive after DFO?
Most patients resume driving at 4-6 weeks for an automatic car (right leg DFO may take longer). Always check with your surgeon first.