Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line

Schröter, Steffen; Nakayama, Hiroshi; Yoshiya, Shinichi; Stöckle, Ulrich; Ateschrang, Atesch; Gruhn, J

doi:10.1007/s00402-018-3068-9

Cited by 93 publications

(109 citation statements)

References 35 publications

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“…DLO has been reported to produce satisfactory outcomes 12 , 13 , 14 indicating that this procedure is an effective surgical option for varus knees with deformities on both the femoral and tibial sides. Combined correction on both sides of the knee in DLO can effectively prevent the problem of non-physiologic joint line inclination as encountered in correction of severe varus deformity by isolated MOWHTO.…”

Section: Discussionmentioning

confidence: 97%

“…DLO was subsequently performed if the mLDFA was greater than 90°. Based on the normal mechanical alignment described by Paly et al., 16 the lower limit of normal for the mechanical lateral distal femoral angle (mLDFA) was set to 85° in the same manner as previous studies 13 , 14 for the surgical planning of DLO, and the mMPTA was adjusted so as for the HKA angle to achieve a mild valgus alignment (0–2°).…”

Section: Methodsmentioning

confidence: 99%

“…There have been several studies reporting favorable surgical outcomes of DLO. 12 , 13 , 14 Those reports have shown that DLO enables restoration of normal limb alignment without causing non-physiologic joint line inclination as observed in isolated MOWHTO knees; however, most of the previous relevant studies dealt with correction of the femoro-tibial alignment, and associated changes in the patellofemoral joint have not been addressed. Although there have been studies investigating the changes in the patellar position and orientation following MOWHTO, there is lack of information regarding the effects of DLO on patellar height or patellofemoral alignment.…”

Section: Introductionmentioning

confidence: 99%

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Changes in patellar height and patellofemoral alignment following double level osteotomy performed for osteoarthritic knees with severe varus deformity

Akaoka

Iseki

Kanto

et al. 2020

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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Purpose To evaluate the effect of double level osteotomy (DLO), a combination of a lateral closed distal femoral osteotomy (LCWDFO) and medial opening wedge high tibial osteotomy (MOWHTO), on patellar height and patellofemoral alignment as compared to those of isolated MOWHTO. Methods Twenty-six consecutive knees in 26 patients who underwent DLO (DLO group) constituted the study population. For comparative purpose, a control cohort (N: 26) matched for age, sex, and body mass index with the study group were selected from the patients who underwent isolated MOWHTO with an opening gap of more than 10 mm during the same period (MOWHTO group). Patellar height and patellofemoral alignment were assessed on radiographs preoperatively and at 2 years after surgery. For the patellar height, following parameters were measured on a lateral radiograph: Modified Insall-Salvati Index (mISI), modified Caton–Deschamps Index (mCDI), and modified Blackburne-Peel Index (mBPI). In the assessment of patellofemoral alignment, lateral patellar tilt (LPT) and lateral patellar shift (LPS) were measured on a skyline view. The measured values were statistically compared using the Student’s t-test. Results In the DLO group, the patellar height measured by mCDI and mPBPI significantly decreased after surgery. As regards the patellofemoral alignment, LPT significantly decreased with no significant postoperative change detected for LPS. When the amounts of postoperative changes in radiological indices were compared between the DLO and isolated MOWHTO groups, no significant differences were detected for all parameters. Conclusion DLO induced reduction in patellar height and decreased lateral patellar tilt. Those changes in patellar position and orientation were similarly observed in isolated MOWHTO knees. Although DLO is specifically indicated for knees with severe varus deformity, the two surgical options for correction of varus knee deformity exerted similar influences on patellofemoral biomechanics.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in patellar height and patellofemoral alignment following double level osteotomy performed for osteoarthritic knees with severe varus deformity

Akaoka

Iseki

Kanto

et al. 2020

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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“… 18 ) To our knowledge, no report has yet described weight-bearing gait training that commenced 3 days after DFO and DLO. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 10 , 11 , 12 , 13 )…”

Section: Discussionmentioning

confidence: 99%

Preliminary Evaluation of the Efficacy of Postoperative Early Weight-bearing Rehabilitation Protocol for Patients after Double-level Osteotomy

Hai

Takahashi

Shima

et al. 2020

PRM

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Objective: There are no reports describing in detail postoperative rehabilitation after double-level osteotomy (DLO). Consequently, the establishment of a safe and effective rehabilitation protocol is required. Methods: This retrospective study included 26 patients with varus knees who underwent DLO. No patient had obvious fracture around the femoral osteotomy sites, as evaluated using computed tomography (CT) 3 weeks postoperatively. From 3 days postoperatively, gait training with early weight bearing was performed using our parallel bar protocol. Range of motion exercises were permitted as tolerated. Radiological evaluation was performed to confirm the presence or absence of fracture around the femoral osteotomy sites using CT at 3 weeks and X-ray at 6 weeks postoperatively. X-ray imaging 6 months postoperatively indicated no femoral correction loss. Additionally, the time from initiation to completion of the protocol and the time from initiation to achievement of independent gait were recorded. Results: No fractures around the femoral osteotomy sites in any patient were found using CT 3 weeks postoperatively and X-rays 6 weeks postoperatively. There was no correction loss at the femoral osteotomy site according to X-ray findings 6 months postoperatively. The mean time until completion of the parallel bar protocol was 19.8 ± 6.2 (7–30) days, and that from the initiation of rehabilitation to the achievement of independent gait was 26.8 ± 7.1 (16–45) days. Conclusion: Patients without fracture around the femoral osteotomy site during the rehabilitation period could achieve independent gait within an average of <1 month using the parallel bar protocol. Early weight-bearing walking and independent walking could be achieved using this protocol.

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“…Long-leg weight-bearing radiographs (LLR) provide a precise view of the whole lower limb including the centre of the femoral head, the knee and the ankle. In clinical practice as well as in clinical studies, LLR are routinely obtained pre-and postoperatively for bone deformity corrections, knee osteotomies, knee replacements, and to control limb lengthening or a segmental bone transport [1][2][3][4][5][6][7]. Using LLR, it is possible to measure mechanical and anatomical limb alignment and determine limb length [8,8].…”

Section: Introductionmentioning

confidence: 99%

Distance from the magnification device contributes to differences in lower leg length measured in patients with TSF correction

Ahrend

Rühle

Springer³

et al. 2021

Arch Orthop Trauma Surg

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Introduction In absence of deformity or injury of the contralateral leg, the contralateral leg length is used to plan limb lengthening. Length variability on long-leg weight-bearing radiographs (LLR) can lead to inaccurate deformity correction. The aim of the study was to (1) examine the variability of the measured limb length on LLR and (2) to examine the influence of the position of the magnification device. Materials and methods The limb lengths of 38 patients during deformity correction with a taylor-spatial-frame were measured retrospectively on 7.3 ± 2.6 (4–13) LLR per patient. The measured length of the untreated limb between LLR were used to determine length variability between LLR in each patient. To answer the secondary aim, we took LLR from a 90 cm validation distance. A magnification device was placed in different positions: at the middle of the 90 cm distance (z-position), 5 cm anterior and 5 cm posterior from the z-position, at the bottom and top of the validation distance as well as 5 cm medial and 15 cm lateral from the z-position. Results The measured length variability ranged within a patient from 10 to 50 mm. 76% of patients had a measured limb length difference of ≥ 2 cm between taken LLR. Compared to length measurement of the 90 cm test object with the magnification device in the z-position (90.1 cm), positioning the device 5 cm anterior led to smaller (88.6 cm) and 5 cm posterior led to larger measurements (91.7 cm). The measured length with the magnification device at the bottom, top, medial or lateral (90.4; 89.9; 90.2; 89.8 cm) to the object differed not relevantly. Conclusions High variability of limb length between different LLR within one patient was observed. This can result from different positions of the magnification device in the sagittal plane. These small changes in positioning the device should be avoided to achieve accurate deformity correction and bone lengthening. This should be considered for all length and size measurements on radiographs.

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Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line

Cited by 93 publications

References 35 publications

Changes in patellar height and patellofemoral alignment following double level osteotomy performed for osteoarthritic knees with severe varus deformity

Changes in patellar height and patellofemoral alignment following double level osteotomy performed for osteoarthritic knees with severe varus deformity

Preliminary Evaluation of the Efficacy of Postoperative Early Weight-bearing Rehabilitation Protocol for Patients after Double-level Osteotomy

Distance from the magnification device contributes to differences in lower leg length measured in patients with TSF correction

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