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

Elbardesy, Hany; McLeod, André; Ghaith, Hazem S.; Hakeem, Samir; Housden, Philip

doi:10.1051/sicotj/2022009

Cited by 12 publications

(6 citation statements)

References 49 publications

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“…Double‐level knee osteotomy is another attractive option that can be employed to address unicompartmental varus knee OA to achieve physiological alignment parameters in cases with severe deformities [9, 28]. Nevertheless, Nejima et al [29] reported an increased preoperative JLCA to be a risk factor for increased postoperative medial proximal tibial angle (MPTA > 95°) in 41% of the cases undergoing planning for double‐level knee osteotomy.…”

Section: Discussionmentioning

confidence: 99%

The joint line convergence angle (JLCA) correlates with intra‐articular arthritis

Mabrouk,

An,

Glauco

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Knees with unicompartmental varus osteoarthritis (OA) usually display a combination of tibiofemoral bony deformity and increased joint line convergence angle (JLCA). The JLCA is a product of intra-articular deformity and lateral soft tissue laxity. This study aims to define the correlation between the JLCA and progression of OA. Methods A retrospective radiological analysis of 501 patients, who underwent either high tibial osteotomy (HTO) or unicompartmental knee arthroplasty (UKA), was performed. The preoperative OA grade was reported based on the Ahlbäck and the Kellgren-Lawrence (KL). The hip-knee-ankle angle (HKA), the medial proximal tibial angle (MPTA), the mechanical lateral distal femoral angle (mLDFA) and the joint line convergence angle (JLCA) were recorded. The primary outcome was the relationship between the JLCA values and the OA grade. The secondary outcomes were comparing the JLCA and other alignment parameter values between HTO and UKA groups. Results A total of 501 (59.3% females n = 297) cases were included, comprising 293 cases of HTO and 208 cases of UKA. Patients had a mean age of 57.63 ± 8.97 years, a mean BMI of 28.37 ± 7.39 kg/m 2 . Patients with Ahlbäck grade 2 represented 49.3% of all patients (n = 247) and patients with KL grade 3 represented 54.7% of all patients (n = 274). A high JLCA was observed in both groups. The reported mean JLCA in the UKA group was 3.69 ± 2.1°, and in the HTO group was 2.93 ± 1.82. There was a significant association between the increase in the JLCA and the progression of OA based on both the Ahlbäck and KL grades (both p values < 0.001). The mean JLCA in patients with Ahlbäck grades 1 and 4 was 1.48 ± 1.32°, and 7 ± 0.93°, respectively. The mean JLCA in patients with KL grades 1 and 4 was 1.77 ± 1.42°, and 4.89 ± 1.73°, respectively. The mean recorded preoperative HKA angle in the UKA group was 175.06 ± 3.08°, and in the HTO group was 173.26 ± 3.02°, whereas the mean MPTA was 88.63 ± 1.72° for the UKA group and 89.31 ± 2.29° for the HTO group. ConclusionThe JLCA progressively increases with osteoarthritis progression in patients with unicompartmental varus knee osteoarthritis. The JLCA can potentially be used as a grading parameter for osteoarthritis progression akin to Ahlbäck and Kellgren-Lawrence grading systems.

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Section: Discussionmentioning

confidence: 99%

The joint line convergence angle (JLCA) correlates with intra‐articular arthritis

Mabrouk,

An,

Glauco

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…Currently, medial closed wedge distal femoral osteotomy (DFO) 8 , 9 for valgus knees and lateral closed wedge DFO combined with medial OWHTO or lateral CWHTO; i.e. , double-level osteotomy 10 , 11 , 12 for severe varus knees are also becoming more common since the launch of various around-knee osteotomy (AKO)-specific locking plates. As a result, coronal alignment correction for uni-compartmental knee osteoarthritis with a varus/valgus deformity is a well-established option.…”

Section: Introductionmentioning

confidence: 99%

Femoral-varus tibial-valgus osteotomy (FVTVO) for neutrally-aligned knee osteoarthritis with severe joint line obliquity enables return to sports activities: A case series study

Nakamura¹,

Amemiya

Shimakawa³

et al. 2023

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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“…There are concerns, however, that DLO remains a challenging procedure with no additional clinical benefit and an increased rate of complications. 6 …”

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confidence: 99%

“…There are concerns, however, that DLO remains a challenging procedure with no additional clinical benefit and an increased rate of complications. 6 The purpose of this study was to compare the clinical and radiological results between isolated OWHTO and DLO in patients with combined varus deformity and to analyze the rate of hinge fractures between these 2 groups. We hypothesized that DLO would improve clinical results without increasing the complication rate compared with OWHTO.…”

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confidence: 99%

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

Abs

Micicoi

Khakha

et al. 2023

Orthopaedic Journal of Sports Medicine

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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.

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

Cited by 12 publications

References 49 publications

The joint line convergence angle (JLCA) correlates with intra‐articular arthritis

The joint line convergence angle (JLCA) correlates with intra‐articular arthritis

Femoral-varus tibial-valgus osteotomy (FVTVO) for neutrally-aligned knee osteoarthritis with severe joint line obliquity enables return to sports activities: A case series study

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

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