Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome

Fürmetz, Julian; Patzler, Sven; Wolf, Florian; Degen, Nikolaus; Prall, Wolf Christian; Soo, Chris; Böcker, Wolfgang; Thaller, Peter Helmut

doi:10.1186/s12891-020-03232-2

Cited by 19 publications

(22 citation statements)

References 37 publications

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“…Four of these patients shifted to moderate and 1 to very heavy work intensity. The general duration of the inability to work was 12.2 ± 4.4 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) weeks.…”

Section: Resultsmentioning

confidence: 99%

“…All patients who were unable to work before surgery due to symptomatic varus knee osteoarthritis were able to return to work with moderate or even very heavy workloads. The duration of the inability to work was 12.2 ± 4.4 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) weeks with an improved pain situation. Based on these results, surgeons can preoperatively assume that patients will return to work following DLO in the short term regardless of the work intensity.…”

Section: Discussionmentioning

confidence: 99%

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Work intensity and quality of life can be restored following double-level osteotomy in varus knee osteoarthritis

Ihle

Dorn

Ateschrang

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to assess changes in health-related quality of life (HRQL) and work intensity following double-level knee osteotomy (DLO). It was hypothesized that postoperative HRQL would be comparable to that of the general population and that work intensity can be restored in the short term. Methods Twenty-four patients (28 varus knees; mechanical tibiofemoral angle: −11.0 ± 3.0° (−6.0 to −17.0), age: 49.1 ± 9.5 (31–65) years) who underwent DLO were included. The duration the patients were unable to work was evaluated. HRQL was measured with the SF-36 questionnaire, which consists of a physical (PCS) and mental component summary score (MCS). The pre- to postoperative changes in the PCS and MCS were analysed. The PCS and MCS were also compared to those of the general population, who has a reference score value of 50 points. The work intensity measured with the REFA classification and the Tegner activity scale were assessed preoperatively and at the final postoperative follow-up examination (18.0 ± 10.0 (5–43) months). Results The duration that the patients were unable to work was 12.2 ± 4.4 (6–20) weeks. The PCS improved from 32.1 ± 11.3 (14.5–53.3) preoperatively to 54.6 ± 8.5 (25.2–63.7) (p < 0.001) at the final follow-up, and the MCS improved from 53.9 ± 11.1 (17.1–67.7) to 57.2 ± 3.1 (47.3–61.7) (n.s). The preoperative PCS was significantly lower than the reference score of the general population (p < 0.001), whereas the preoperative MCS was similar between the two groups (n.s.). At follow-up, no significant differences were observed between the PCS and the MCS of the patient group and those of the general population. Five patients who were unable to work prior to surgery due to knee symptoms returned to work with moderate (four patients) or even very heavy (one patient) workloads. The Tegner activity scale increased significantly from a median of 2.0 (0.0–5.0) to 4.0 (2.0–7.0) (p < 0.001). Conclusion Our results demonstrate an improvement in quality of life and return to working activity following DLO in the short term. The HRQL can be improved by DLO in patients with varus knee osteoarthritis to the level of the general population. These results can assist surgeons in discussing realistic expectations when considering patients for DLO. Level of evidence Study type: therapeutic, IV.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Work intensity and quality of life can be restored following double-level osteotomy in varus knee osteoarthritis

Ihle

Dorn

Ateschrang

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…To date, only one study has reported results after both, DFO and HTO to correct varus malalignment. Fürmetz et al [ 16 ] prospectively evaluated 25 consecutive patients undergoing realignment osteotomy of a varus deformity. HTO was performed in 17 patients and DFO in 11 patients.…”

Section: Discussionmentioning

confidence: 99%

“…HTO was performed in 17 patients and DFO in 11 patients. After a mean follow-up of 47 months, improvement in all clinical scores was observed, without differences between the two techniques [ 16 ]. However, the small patient cohort and relatively short follow-up period limit the conclusion of this study.…”

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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“…Akaoka et al [ 35 ] did not report any significant difference between the two cohorts with regard to patellofemoral biomechanics. However, Fürmetz et al [ 36 ] reported a significant reduction in the patellar height for the HTO group compared with the DLO cohort.…”

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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Tibial and femoral osteotomies in varus deformities - radiological and clinical outcome

Cited by 19 publications

References 37 publications

Work intensity and quality of life can be restored following double-level osteotomy in varus knee osteoarthritis

Work intensity and quality of life can be restored following double-level osteotomy in varus knee osteoarthritis

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

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

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