origin-specific osteotomy for the correction of genu valgum deformity of the knee: a retrospective study

Background: valgus deformity in adults may originate from the distal femur, proximal tibia, or a combined pattern. correcting a deformity at the wrong anatomical level may improve the mechanical axis but leave the joint line oblique, potentially affecting load distribution and symptoms. objectives: this study evaluated an origin-directed osteotomy strategy using long-leg radiographic measurements. methods: thirty-one patients (34 knees) with symptomatic genu valgum underwent deformity analysis based on the lateral distal femoral angle (ldfa), medial proximal tibial angle (mpta), and joint-line convergence angle (jlca). according to the dominant radiographic deviation, patients were treated with distal femoral osteotomy (dfo), proximal tibial osteotomy (pto), or double-level correction. radiographic outcomes, knee range of motion (rom), koos, womac, and complications were assessed at a mean follow-up of 4.2 years. results: most deformities were femoral-based (76.5%), followed by combined (17.6%) and tibial-based (5.9%) patterns. ldfa improved from 80.5° to 86.8° (p<0.001), jlca from −3.44° to 3.2° (p<0.001), and the valgus angle from 14° to 6.5° (p<0.001). mpta did not change significantly (90.4° to 89.8°, p=0.10). at final follow-up, mean koos was 79.6 and mean womac was 23.5. seven knees (20.6%) underwent elective plate removal, and one nonunion (2.9%) occurred. no postoperative joint-line obliquity or recurrent valgus was observed. conclusion: assigning correction to the anatomical origin of valgus deformity resulted in accurate coronal realignment, preservation of joint-line orientation, and satisfactory mid-term outcomes. origin-specific planning based on long-leg radiographs is a practical and reproducible strategy for adult valgus correction.