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Knee Surg Relat Res. 2018 Mar;30(1):3-16. English. Review.
Kim YC , Yang JH , Kim HJ , Tawonsawatruk T , Chang YS , Lee JS , Bhandare NN , Kim KS , Delgado GD , Nha KW .
Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea.
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.
Department of Orthopaedic Surgery, Mahidol University, Ramathibodi Hospital, Bangkok, Thailand.
Department of Orthopaedic Surgery, KS Hospital, Ansan, Korea.
Department of Orthopaedic Surgery, Bhandare Hospital, Goa, India.
Department of Orthopaedic Surgery, Cheongju St. Mary’s Hosptial, Cheongju, Korea.
Department of Orthopaedic Surgery, University of the Philippines, Philippine General Hospital, Manila, Philippines.


The purpose of this review is to compare the clinical and radiological outcomes between open and closed wedge distal femoral varus osteotomy (DFO).


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.


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.


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.

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