A new double level osteotomy procedure to restore a joint line and joint angles in severe varus osteoarthritis. - Double level osteotomy associated with tibial condylar valgus osteotomy (DLOTO)

Saito, Hidetomo; Yonekura, Akihiko; Saito, Kimio; Shimada, Yasuhiro; Yamamura, Toshiaki; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroshi; Fujii, Mamoru; Kawano, Tetsuya; Murata, Shohei; Miyakoshi, Naohisa

doi:10.1016/j.asmart.2020.11.001

Cited by 8 publications

(12 citation statements)

References 18 publications

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“…In this situation, concomitant TCVO may be able to reduce the JLCA [ 9 , 21 ]. Considering this issue, our surgical strategy for varus knees with a large JLCA angle was changed to concomitant TCVO with DLO from 2017 [ 9 , 21 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…In August 2018, open wedge distal tuberosity tibial osteotomy (OWDTO) was introduced to our practice to avoid postoperative patella infra, which was considered an inherent complication following OWHTO. Since then, OWDTO has replaced OWHTO and OWDTO using TriS plate (Olympus, Tokyo, Japan) has been the procedure of our primary option for proximal tibial osteotomy [ 4 , 26 , 35 ] (Fig. 2 ).…”

Section: Methodsmentioning

confidence: 99%

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Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity

et al. 2023

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Purpose The purpose of this study was to examine the relationship between preoperative Ahlbäck radiographic classification grade and the clinical outcomes of double level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity. Methods The study population comprised a consecutive series of 99 knees (68 patients) for which DLO was performed and follow-up results for a minimum of two years were available. The Ahlbäck radiographic classification system was used to determine the osteoarthritic grade. The following radiological parameters for alignment and bone geometry were measured: mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint-line convergence angle (JLCA), and mechanical tibiofemoral angle (mTFA). Clinical results were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) subjective score preoperatively and at 2 years after surgery. Difference between preoperative and postoperative measurements as well as relationship between Ahlbäck grade and radiological/clinical results were statistically assessed. Results The average age of the study participants was 60.9 ± 6.2 years and the mean follow-up period was 45.4 ± 15.2 months. Each of the radiological parameters exhibited preoperative abnormal values. Knees with Ahlbäck grade 3 and 4 osteoarthritis exhibited significantly greater JLCA and mTFA than grade 1 knees. Two years post-surgery, all radiological parameter values measured within a normal range. Clinical evaluation showed significant improvement in KOOS after surgery. Analysis of the relationship between Ahlbäck grade and clinical score showed that the 2-year postoperative KOOS scores in grade 3 and 4 osteoarthritic knees were significantly lower than grade 1 knees (with the mean 2-year KOOS scores of 350.0 ± 79.9, 317.9 ± 78.3, and 420.2 ± 42.9, respectively). Conclusions While DLO may produce significant radiological and clinical improvement in knees with joint space obliteration, Ahlbäck grade 3 and 4 osteoarthritic knees associated with larger JLCA and mTFA showed less satisfactory clinical results compared to grade 1 knees. Level of Evidence: IV case series.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity

et al. 2023

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“…No significant difference was reported between the two cohorts [ 33 , 35 , 36 ]. Other non-comparative studies reported satisfactory postoperative mLPTA alignment after DLO [ 25 , 37 – 39 ].…”

Section: Systematic Reviewmentioning

confidence: 98%

“…Four studies reported on the JLCA. All four found that DLO corrected JLCA more successfully than HTO in severe varus deformity ( P < 0.05) [ 16 , 33 , 37 , 39 ].…”

Section: Systematic Reviewmentioning

confidence: 99%

Outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity. A systematic review

Elbardesy

McLeod

Ghaith

et al. 2022

SICOT-J

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Background: When correcting severe genu varus deformity, knee surgeons must choose between performing a single or double-level osteotomy. This systematic review aims to provide this equipoise with some clarity. Patients and methods: We conducted this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies evaluating the effect of the double level osteotomy (DLO) or those comparing it to high tibial osteotomy (HTO) from all regions and written in any language were included. Results: Six studies were included in this systematic review. They were prepared and analysed using Review Manager V5.0 [Computer Program] (RevMan5). Performing DLO resulted in restoring patellar height, joint-line convergence angle (JLCA), and mMPTA to normal values. DLO was also more successful at avoiding joint line obliquity (JLO) in severe varus deformity when compared to HTO (P < 0.001). No significant difference was reported between the two cohorts regarding the mLPTA. DLO resulted in satisfactory short term KOOS and IKDC scores. The complication rate after DLO was 2.28%. Conclusions: DLO showed a low complication rate and satisfactory short term KOOS and IKDAC scores. Randomised control trials with long term follow-up comparing the DLO and HTO are recommended.

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“…Por otra parte, se ha estudiado que la deformidad intraarticular puede corregirse mediante osteotomía convencional a valores aceptables (ACLA ≤ 5°) si el valor del ACLA preoperatorio es ≤ 6°. 15 De no ser posible una corrección extrarticular satisfactoria de una deformidad combinada (intra y extraarticular), sugerimos valorar caso a caso la opción de una osteotomía intraarticular de Chiba 16 17 18 19 en especial en aquellos casos de artrosis en etapa ≤ 3 en la clasificación de Kellgren-Lawrence (KL) que presenten deformidades tibiales en pagoda (en que la inclinación coronal de la superficie articular del platillo tibial se encuentra excesivamente alterada), tales como: enfermedad de Blount, defectos postraumáticos y consolidaciones viciosas. Por otra parte, en casos de artrosis severa monocompartimental (contacto hueso-hueso) recomendamos la cirugía protésica unicompartimental, que puede asociarse a osteotomía correctora de eje en los casos de malalineamiento metafisario residual, 20 ya que éste conducirá a sobrecargas que finalmente alterarán la sobrevida del implante.…”

Section: Principios Biomecánicos En La Planificación De Una Deformida...unclassified

Conceptos actuales en osteotomías en doble nivel alrededor de la rodilla

Díaz-Allende¹,

Partarrieu-Stegmeier²,

Colmenares-Sandoval

et al. 2022

Revista Chilena de Ortopedia y Traumatología

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ResumenCon la osteotomía en un solo nivel, se puede lograr la corrección del eje de la extremidad en pacientes con deformidades combinadas femoral y tibial, pero de forma simultánea generará una alteración patológica de oblicuidad de la interlínea articular, lo que conducirá a elongación ligamentaria, inestabilidad, degeneración condral y, en última instancia, comprometerá su sobrevida y los resultados funcionales. En virtud del análisis de la literatura más reciente, podemos concluir que existe un número significativo de pacientes que requieren de un procedimiento combinado para lograr un objetivo biomecánico óptimo. La finalidad de una osteotomía en doble nivel alrededor de la rodilla consiste en restablecer la anatomía normal, descargar el compartimiento afectado, normalizar los ángulos mecánicos y la orientación de la interlínea articular. Los ejes fisiológicos pueden restablecerse a través de un análisis preoperatorio exhaustivo, respetando principios biomecánicos y fijación estable con placas bloqueadas. Es un procedimiento demandante y con indicaciones en evolución, que progresivamente se ha instaurado como una alternativa de tratamiento justificada en estudios clínicos y biomecánicos para el manejo de deformidades severas alrededor de la rodilla.

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A new double level osteotomy procedure to restore a joint line and joint angles in severe varus osteoarthritis. - Double level osteotomy associated with tibial condylar valgus osteotomy (DLOTO)

Cited by 8 publications

References 18 publications

Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity

Preoperative Ahlbäck radiographic classification grade significantly influences clinical outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity

Outcomes of double level osteotomy for osteoarthritic knees with severe varus deformity. A systematic review

Conceptos actuales en osteotomías en doble nivel alrededor de la rodilla

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