Femoral shaft osteotomy for malunited femoral fractures presenting with varus OA of the knee.

Seven patients presenting between 1992 and 1999 with osteoarthritic knee symptoms in consequence of old malunited femoral shaft fractures, were treated by open femoral shaft osteotomy. The osteotomies were sited at the apex of the deformity and were fixed by locked intramedullary nailing. The patients were followed up until osteotomy union and reviewed clinically and radiologically with particular emphasis on symptoms and function. The mean age at presentation was 48 years and the mean time from fracture was 28 years. The mean time to osteotomy union was 28 months. Five of the seven patients reported excellent pain relief and functional improvement. These patients presented a difficult management problem at an age that would be worryingly young for total knee replacement. Arthroplasty has been avoided in all but one of this cohort, and is still far from imminent in the remainder, after a mean follow-up period of 5 years.