Double Osteotomy of the Knee

Abstract

In 1967, eighty double osteotomies of the knee and thirty double osteotomies of the metacarpophalangeal joints had been carried out. The results had been dramatic in two respects: ( a ) relief of pain, and (b) disappearance of exuberant rheumatoid synovium.Only a week after double osteotomy of the metacarpophalangeal joints, some patients remarked that wrinkles on the back of the hand were visible for the first time for years. The possibility of the shoulder joint responding to this procedure was considered, as arthrodesis of the shoulder is difficult and tedious, both for patient and surgeon. In 1967, a painful, rheumatoid arthritic shoulder was referred to me for arthrodesis. Instead, I did a double osteotomy through an anterior approach. The humerus was osteotomised through the surgical neck and the scapula through the neck of the glenoid. The postoperative treatment was 10 days in a sling only. The pain relief was so dramatic that the patient wanted to remove the sling earlier. I have operated on two such shoulders and George Arden from Windsor has operated on three recently. This is a preliminary report of this procedure. All 5 patients have relief of pain, including the first after 5 years. In each case there is an apparent increase in movement, though this may be due to pain relief only. X-ray improvement appears to occur. Although this may be significant, it could however signify mere reversal of disuse atrophy. The aavantages of this procedure are that it is simple, it is quick, there are few complications, it is financially attractive as no prosthesis is required, there is no plaster of Paris, and the patient need stay in hospital only 2 to 3 days. It seems worthwhile undertaking a series, which George Arden and I now intend to start. It is ofinterest to note that double osteotomy appears to be successful in the metacarpophalangeal joints and in the shoulder joint in rheumatoid arthritis. These are non-weight-bearing joints and thus the effect of this procedure is unlikely to be due purely to a mechanical effect of the operation. From 1960 to the present I have performed this operation on 300 knees, approximately equally divided between rheumatoid arthritis and osteoarthritis. A detailed analysis of the results in the first 57 was given in November 1969 in The Jour-I nal of Bone and Joint Surgery. The percentage of good and poor results has remained the same in the subsequent series. A further 60 cases at Windsor and a similar number at The London Hospital have been reported to me, showing similar results.A 6-year follow-up revealed some recurrence but still 60% were satisfactory and those who suffered a recurrence felt that the 6 years' pain relief made the operation justifiable. I still perform this operation because more recent and sophisticated methods can end in catastrophe. -741865There are few serious complications and nothing but time is lost by the operation. If it should prove unsuccessful, prosthetic replacement can still be undertaken.[A film was shown of the technique of the operation and o...

Double-level osteotomy for severe varus osteoarthritic knees can prevent change in leg length and restore physiological joint geometry

“…Osteotomy around the knee has been a commonly performed and well-established surgical procedure for knees with unicompartmental osteoarthritis (OA) [1][2][3][4]. It is an optimal surgical treatment, especially for patients who have higher physical demands such as participation in sports and work [5][6][7]. Until recently, deformity correction by the osteotomy had conventionally been conducted only in the proximal tibia [1,3,8].…”

“…Until recently, deformity correction by the osteotomy had conventionally been conducted only in the proximal tibia [1,3,8]. However, correction of severe varus deformity by isolated high tibial osteotomy (HTO) requires a large opening wedge which may result in non-physiologic joint line obliquity leading to several potential problems [6,7,9]. In this situation, double-level osteotomy (DLO) combining HTO and distal femoral osteotomy (DFO) can cope with deformities in both the femur and the tibia, and thus restore normal bone and joint geometries while correcting limb alignment [5,6,9].…”

Hinge fracture in lateral closed-wedge distal femoral osteotomy in knees undergoing double-level osteotomy: assessment of postoperative change in rotational alignment using CT evaluation

“…There are several surgical options for the mode and the level of osteotomies. Among those, correction by a single‐level isolated high tibial osteotomy (HTO) in knees with severe varus deformity has been shown to result in non‐anatomical joint line obliquity which induces subsequent problems such as increased shear force at the cartilage [1, 3, 13, 31, 34, 35, 38, 42, 46, 48]. Double‐level osteotomy (DLO) combining a lateral closed‐wedge distal femoral osteotomy (LCW‐DFO) [5, 9] and a medial open‐wedge high tibial osteotomy (MOW‐HTO) [15, 26, 45] was introduced with the intent to anatomically reconstruct the bony geometry and limb alignment [1–3, 31, 38].…”

Lower Limb Deformity Analysis and the Planning of an Osteotomy

“…In the 1970s and 1980s, osteotomies around the knee were regularly performed. [1][2][3][4][5][6][7][8] The advent of knee arthroplasty in the 1980s was associated with reduced interest in osteotomies around the knee. Total knee replacement became a widespread procedure for the purpose of knee reconstruction.…”