Poor results of double osteotomy for the rheumatoid knee

Schüller, Hans; Dijk, C. Niek van; Fidler, Malcolm W.

doi:10.3109/17453678709146478

Cited by 12 publications

(9 citation statements)

References 8 publications

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“…The concept of double‐level osteotomy has been introduced to restore physiologic alignment and knee base angles [5, 36, 41, 45]. Whereas older studies have observed poor results and unacceptable high complication rates [46], more recent studies have shown that double‐level osteotomy is a safe procedure which enables accurate and consistent deformity correction with good clinical results and low failure rates [5, 36, 41, 45]. Nevertheless, double‐level osteotomies are technically demanding and more invasive compared to isolated HTO.…”

Section: Discussionmentioning

confidence: 99%

Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided

Feucht

Winkler

Mehl

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To perform a detailed deformity analysis of patients with varus alignment and to define the ideal osteotomy level (tibial vs. femoral vs. double level) to avoid an oblique joint line. Methods A total of 303 digital full-leg standing radiographs of patients aged 18-60 years and varus alignment [mechanical tibiofemoral varus angle (mFTA) ≥ 3°] were included. All legs were analyzed regarding mFTA, mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal femur angle (mLDFA), and joint line convergence angle. Based on mFTA, varus alignment was categorized as "mild" (3°-5°), "moderate" (6°-8°), or "severe" (≥ 9°). Deformity location was determined according to the malalignment test described by Paley. Two osteotomy simulations were performed with different upper limits for mMPTA: anatomic correction (mMPTA ≤ 90°, mLDFA ≥ 85°) and overcorrection (mMPTA ≤ 95°, mLDFA ≥ 85°). If a single osteotomy exceeded these limits at the intended mFTA of 2° valgus, a double-level osteotomy was simulated. If even a double-level osteotomy resulted in deviations from the defined limits, the leg was categorized as "uncorrectable". Results Mean mFTA was 6° ± 11° of varus (range 3°-15°). A tibial deformity was observed in 28%, a femoral deformity in 23%, a combined tibial and femoral deformity in 4%, and no bony deformity in 45%. The prevalence of a tibial deformity did not differ between varus severity groups, whereas a femoral and bifocal deformity was significantly more prevalent in knees with more distinct varus (p < 0.001). Osteotomy simulation revealed that isolated high tibial osteotomy (HTO) was appropriate in only 12% for anatomic correction, whereas a double-level osteotomy was necessary in 63%. If overcorrection of mMPTA was tolerated, the number of HTOs significantly increased to 57% (p < 0.001), whereas the number of doublelevel osteotomies significantly decreased to 33% (p < 0.001). Isolated DFO was considered ideal in 8% for both simulations. Significantly more knees were considered "uncorrectable" by simulating anatomic correction (18 vs. 2%; p < 0.001). A double-level osteotomy was significantly more often necessary in knees with "severe" varus (p < 0.001). Conclusion Less than one-third of patients (28%) with mechanical varus ≥ 3° have a tibial deformity. If anatomic correction (mMPTA ≤ 90°) is intended, only 12% of patients can be corrected via isolated HTO, whereas 63% of patients require a double-level osteotomy. If slight overcorrection is accepted (mMPTA ≤ 95°), 57% of patients can be corrected via isolated HTO, whereas 33% of patients would still require a double-level osteotomy. Level of evidence III, cross-sectional study.

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Section: Discussionmentioning

confidence: 99%

Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided

Feucht

Winkler

Mehl

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…Our results suggest that poor selection of patients is likely the predominant reason for a poor result after HTO. Schuller et al 30 found that 27 out of 30 patients suffering from a rheumatoid arthritis exhibited a poor result after HTO. HTO for rheumatoid arthritis patients is no longer performed.…”

Section: Discussionmentioning

confidence: 99%

Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results

Spahn¹,

Kirschbaum²,

Kahl³

2006

Osteoarthritis and Cartilage

137

131

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“…Most of these procedures have been retired, eg, primary arthrodesis due to poor acceptance of an immobile knee and double osteotomy (above and below the knee) due to poor results [53].…”

Section: Indications and Surgical Methodsmentioning

confidence: 99%

The knee

2000

Acta Orthopaedica Scandinavica

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Poor results of double osteotomy for the rheumatoid knee

Cited by 12 publications

References 8 publications

Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided

Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided

Factors that influence high tibial osteotomy results in patients with medial gonarthritis: a score to predict the results

The knee

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