Clinical and Radiological Outcomes of Double-Level Osteotomy Versus Open-Wedge High Tibial Osteotomy for Bifocal Varus Deformity

Abstract

Background: In bifocal varus deformity, double-level osteotomy (DLO) is advocated to treat lower limb alignment to prevent an adverse increase in joint line obliquity. Purpose/Hypothesis: The purpose of this study was to compare the clinical and radiological results after DLO and open-wedge high tibial osteotomy (OWHTO) in patients with combined varus deformity. It was hypothesized that DLO would improve clinical results without increasing the complication rate compared with OWHTO. Study Design: Cohort study; Level of evidence, 3. Methods: Inclusion criteria were medial tibiofemoral compartment pain, varus knee deformity with an abnormal medial proximal tibial angle <84° and a lateral distal femoral angle >90°, a functional anterior cruciate ligament, failure of nonoperative treatment, and a minimum 2-year follow-up with all clinical and radiological data. The rate of return to work or sports; the Knee injury and Osteoarthritis Outcome Score (KOOS); the University of California, Los Angeles (UCLA) activity score; and patient satisfaction were assessed at a minimum of 2 years of follow-up. Statistical comparison of the 2 groups was made using the chi-square or Student t test. Results: A total of 69 consecutive patients were analyzed, of whom 38 underwent OWHTO and 31 underwent DLO surgery. A significant between-group difference was found for all radiological parameters; in particular, there was less joint line obliquity after DLO compared with OWHTO (1.7° vs 5.6°; P < .001). DLO provided better outcomes compared with OWHTO regarding the UCLA score (4.3 vs 6.7; P < .001) and patient satisfaction (2.6 vs 3.9; P < .001), but no significant difference in KOOS or return to work or sports was observed. The OWHTO group had more hinge fractures than the DLO group (34.2% vs 12.9%; P < .001). Conclusion: For combined tibial and femoral varus deformity, DLO produced more physiologic joint line obliquity with slightly improved UCLA and patient satisfaction scores. A greater incidence of hinge fracture was observed after isolated OWHTO compared with DLO due to a larger tibial correction; however, this had little effect on clinical results at the 2-year follow-up.

Assessment of return to sport and functional outcomes following distal femoral, double level and high tibial osteotomies for active patients with symptomatic varus malalignment

“…Despite that DLO is a more complex procedure and potentially carries higher risks, a quick return to sports rate was demonstrated in this group. In a recent study, Abs et al reported that DLO yields better activity and patient satisfaction levels with a more physiologic joint line obliquity [2]. A similarly high satisfaction level following DLO was reported by Schroter et al [35].…”

Neutral to slightly undercorrected mechanical leg alignment provides superior long‐term results in patients undergoing matrix‐associated autologous chondrocyte implantation

“…Additional correction of the mLDFA may be required if further correction is needed [23]. Double‐level osteotomies provide reliable and equivalent clinical results in these patients [1].…”

Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional double plating

“…However, in cases of substantial or bifocal deformities, a single‐level osteotomy may significantly increase the joint line obliquity (JLO) with resultant tibiofemoral subluxation, pressure distribution changes and excessive shear stresses on the articular cartilage [ 2 , 34 , 37 , 54 ]. In such cases, DLO is gaining popularity over single‐level knee osteotomy due to its merits in maintaining a more physiologic joint alignment and orientation with better clinical results [ 1 , 7 , 47 ] and comparable return to sports [ 6 , 12 ]. Nevertheless, DLO is a complex procedure, and accuracy is of the essence.…”