Persistent pain
– the most important determinant of sustained pain relief is accuracy of correction
– patients with > 15 of varus will likely do poorly, because you will not get them over farenough.
– also, patients with a high adductor moment may not do as well

Patient Selection
– what side is the angular deformity on.
– varus closing wedge osteotomies do poorly for valgus knees – the joint line is made oblique, the nerve is stretched, and if the MCL is stretched out, the closing of the medial side will simply make this more loose – DO THE VALGUS KNEE FROM THE FEMORAL SIDE.
– if there is significant MCL laxity in the varus knee, consider medial OPENING wedge osteotomy
– avoid inflammatory arthritides

Preoperative planning

– beware the calculation of correction based on angles alone. In a short person, a 15o wedge will not create a greater change than in a tall person!
– Try to consider where the osteotomy will put the mechanical axis – it should be shifted into the medial one third of the lateral compartment, approximating a 183 to 185 degree valgus weightbearing axis.

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