Valgus Osteotomy

What is Valgus Osteotomy?

Valgus osteotomy is a surgical procedure employed to correct deformities of the proximal femur or thigh bone in children. The term valgus or varus refers to bowing or angulation at a joint or within the shaft of a bone. Proximal femoral deformities usually include a valgus or varus neck-shaft angulation, rotational malalignments, and leg-length difference in any combination. Children with proximal femoral deformity eventually develop severe pain and arthritis in the affected hip as a result of abnormal joint wear due to malalignment. Valgus osteotomy surgery aims at restoring normal joint anatomy and optimal congruency of the joint to prevent degenerative deterioration of the hip. In general, a valgus osteotomy surgery of the femur can help to:

• Effectively increase hip abduction by the degree of correction and similarly decrease adduction by an equivalent degree
• Increase limb length in cases of mild limb-length discrepancy
• Increase mechanical loading at the fracture area and assist in fracture healing
• Rotate better sections of the femoral ball into the weight-bearing area
• Move greater trochanter distally to enhance abductor mechanics

Anatomy of the Hip

The hip joint is a ball-and-socket joint. A part of the pelvis bone known as the acetabulum forms the cup-shaped socket and the upper end of the femur, known as the femoral head, forms the ball. It is surrounded by strong muscles and tough ligaments that prevent the dislocation of the hip. The joint surface is covered by a smooth articular cartilage that cushions and enables smooth movement of the joint.

Indications for Valgus Osteotomy Surgery

Valgus osteotomy surgery is mainly indicated to treat femoral deformities in children due to acquired or developmental conditions. These conditions may include:

• Coxa vara, a deformity of the proximal femur
• Developmental hip dysplasia
• Fibrous dysplasia
• Femoral  neck fracture nonunions and malunions
• Avascular necrosis of the femoral head
• Legg-Calve-Perthes disease (LCPD)
• Leg-length discrepancy

Preparation for Valgus Osteotomy Surgery

Preoperative preparation for valgus osteotomy will involve the following steps:

• A thorough examination of the patient’s limb is performed by the physician that involves measurement of the clinical malformations (angular, rotational, or translational) and limb lengths.
• Physical exam also involves assessment of gait pattern, long bone torsion, ligamentous laxity, and patellar tracking.
• Depending on the patient’s medical history, social history, and age, the patient may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if the patient has allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that the patient is taking.
• The patient should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
• The patient should not consume any solids or liquids at least 8 hours prior to surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Valgus Osteotomy Surgery

Valgus osteotomy is usually performed under general anesthesia and involves the following steps:

• Your child’s surgeon makes an incision of several inches along the outside of your child’s hip.
• The underlying subcutaneous fat and muscles are retracted to expose the upper end of the femur.
• Your surgeon performs an osteotomy of the femur in which the bone is surgically cut to change its length, shape, or alignment as required by the child’s prevailing condition.
• In some cases, the socket is also suitably trimmed to facilitate a better fit for the femoral head inside the socket.
• After confirming the desired length and position of the femur, metal plates and screws are placed to hold the bone in this new position, until it is completely healed.
• These plates and screws may need to be taken out once complete healing is accomplished in a year or two.
• All surrounding tissues and structures are restored to their normal anatomic position.
• Finally, the incision is closed with sutures and sterile dressings are applied.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery will involve the following steps:

• The patient will be transferred to the recovery area to be monitored until the patient is awake from the anesthesia.
• The patient’s nurse will monitor the blood oxygen level and other vital signs as the patient recovers.
• The patient may notice some pain, swelling, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
• Medications may also be prescribed as needed for symptoms associated with anesthesia, such as vomiting and nausea.
• Antibiotics are prescribed to address the risk of surgery-related infection.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• The patient is encouraged to walk with assistance as frequently as possible to prevent the risk of blood clots.
• Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
• The patient should refrain from strenuous activities and lifting heavy weights for the first couple of months. Gradual increase in activities over a period of time is recommended.
• A physical therapy protocol is usually recommended to help strengthen muscles and optimize joint function.
• Most children typically stay in the hospital for 5 to 7 days depending upon the procedures performed.
• Most patients will be able to resume normal activities within 2 to 3 weeks with certain activity restrictions.
• A periodic follow-up appointment will be scheduled to monitor the progress.

Risks and Complications

Valgus osteotomy surgery is a relatively safe procedure; however, as with any surgical procedure, it does carry some risks and complications, including:

• Blood clots
• Infection 
• Bleeding
• Joint stiffness
• Loss of function
• Injury to nerves and blood vessels
• Anesthetic-related complications
• Implant failure
• Revision surgery