Osteotomy — Distal Femoral Osteotomy (DFO)

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Toe-touch WB in locked brace at 0 deg x6 wks Phase I (brace worn 2 wks locked in extension while ambulating/sleeping, then daytime only); TWB to 25% WB with crutches Phase II advancing weekly; brace discontinued Phase II

Key Restrictions

ROM 0-90 deg while supine Phase I (progress past 90 after 2 wks); avoid open chain exercises Phase II; patellar mobilization 5-10 min/day for 6 months

Timeline & Phases

Phase I (0-6 wks): TTWB in locked brace at 0 deg (worn 2 wks locked in extension for ambulation/sleeping, then daytime only after wk 2), maintain full extension progressing to flexion, reduce swelling with cryocuff, ROM 0-90 deg while supine (progress past 90 after 2 wks), calf pumps, patellar mobilization 5-10 min/day x6 months, isometric quad sets at 0 deg flexion (3x10, 10 sec hold), SLR in locked post-op brace (3x10, 3x/day), UE ergometer, floor-based core/glute exercises, progress to Phase II if pain well-controlled; Phase II (6-8 wks): TWB to 25% WB with crutches advancing weekly, discontinue brace, full ROM, avoid open chain exercises, closed chain quadriceps exercises, progressive balance and core/pelvis stability, advance SLRs and floor-based exercises, stationary bike, core strengthening, progress to Phase III with pain well-controlled and progressive quad control; Phase III (8-16 wks): dual-to-single limb control, progression of functional balance, core/glute strengthening, flexibility, stationary bike/elliptical/swimming, progress with pain-free minimal swelling and independent non-antalgic gait; Phase IV (16+ wks): progress to functional training, continue LE strengthening/flexibility/proprioceptive/agility programs, floor beam if applicable, agility drills and cutting activities (plyometric program allowed) after 20 wks, advance agility/sport-specific programming, maintenance exercise program

Notes

OSMS Rehabilitation Guidelines; used for limb re-alignment involving bone cuts repaired with pins/plates/rods; patellar mobilization continued for 6 months to prevent stiffness during bone healing