Distal femoral osteotomy (DFO) is successful in treating painful valgus arthritis of the knee. We present a case where painless recurrent knee effusion was attributed to constitutional valgus. The absence of pain made the indication for surgery atypical so DFO was carefully considered and planned. A small correction was performed, bringing alignment closer to neutral with complete resolution of the recurrent effusion. We suggest that the indications for knee osteotomy can be expanded to include recurrent joint effusion in carefully selected patients.
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