Double Level Osteotomy of the Knee

Trivedi, Jayesh; Thomson, Jeffrey D.; Slakey, Joseph B.; Banta, John V.; Jones, Peter W.

doi:10.2106/00004623-200208000-00014

Cited by 168 publications

(120 citation statements)

References 7 publications

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“…In our series, mLDFA values were similar and within normal range in both groups. In a recent case with malalignment of the femoral condyle, we added distal femoral osteotomy (double-level osteotomy) [36]. Most patients with medial knee OA show varus deformity at the proximal tibia (decreased MPTA or MTPD) and knee joint (increased JLCA) [37, 38].…”

Section: Discussionmentioning

confidence: 99%

Comparison of radiological features of high tibial osteotomy and tibial condylar valgus osteotomy

Higuchi

Koseki

Yonekura

et al. 2019

BMC Musculoskelet Disord

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Background The purpose of this study was to compare radiological features between high tibial osteotomy (HTO) and tibial condylar valgus osteotomy (TCVO), in order to define the radiological indication criteria for TCVO. Methods Thirty-two cases involving 35 knees that had undergone HTO and the same number that had undergone TCVO for knee osteoarthritis were retrospectively evaluated. Characteristics of both groups did not differ significantly. Lower limb alignment, bone morphology, joint congruity, and joint instability were measured in standing full-length leg and knee radiographs obtained before and after surgery. Results Radiological features in the TCVO group included greater frequencies of advanced knee OA grade, varus lower limb malalignment, depression of the medial tibial plateau, and varus-valgus joint instability compared to the HTO group before surgery. However, tibial morphology, alignment of the lower limb, and joint instability improved to comparable levels after surgery in both groups. Conclusions TCVO appears preferable in cases with advanced knee OA, destroyed or inclined medial tibial plateau, widened and subluxated lateral joint, and high varus-valgus joint instability.

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Section: Discussionmentioning

confidence: 99%

Comparison of radiological features of high tibial osteotomy and tibial condylar valgus osteotomy

Higuchi

Koseki

Yonekura

et al. 2019

BMC Musculoskelet Disord

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“…A previous study have noted that correcting only the proximal tibia with the aim of achieving a normal mechanical axis(MA) with HTO may result in overcorrection of the tibia [5]. An overcorrection in the proximal tibia may induce abnormal knee joint line orientation (KJLO), which has been raised as a concern in previous studies for the negative effect on joint biomechanics [6–9]. KJLO plays a crucial role in analysing the balance of forces across the knee joint.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a prediction model for knee joint line orientation after high tibial osteotomy

Park

Chang

Kang

et al. 2019

BMC Musculoskelet Disord

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Background Maintenance of optimal knee joint line orientation (KJLO) is important after high tibial osteotomy (HTO). No tools, however, are currently available that could predict the value of postoperative KJLO before surgery. First, this study sought to determine the effects of various preoperative anatomical alignment parameters to postoperative KJLO. Based upon these analyses, we aimed to devise an equation that predicts the value of postoperative KJLO. Methods A total of 14 radiographic parameters were measured in preoperative and postoperative full-limb standing anteroposterior radiographs on 50 patients who underwent open-wedge HTO. The parameters were analysed using multivariable linear regression to predict KJLO after HTO. External validation of the equation was done with 20 patients who underwent HTO at another institution. Results After HTO, KJLO increased from − 0.8° to 2.9° (P < 0.001). Based on the multivariable linear regression analysis, an equation was derived that can estimate postoperative KJLO after HTO; postoperative KJLO(°) = 1.029 + 0.560 × preoperative KJLO(°) + 0.310 × preoperative tibia plateau inclination(°) + 0.463 × aimed correction angle(°). The adjusted coefficients of determination value for this equation was 0.721. The equation also showed good calibration and predictability in external validation with predicted squared correlation coefficient of 0.867. Conclusions This study analysed the effects of preoperative anatomical alignment parameters on the postoperative KJLO. An equation which predicts postoperative KJLO with preoperative anatomical alignment factors was devised and validated. This equation would help in selecting optimal patients for HTO and in selecting the optimal target correction angle in HTO.

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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] The benefits of shortening the unloaded period are considered to be significant in several past reports. Early loading can reduce the risk of developing deep vein thrombosis 19,20) and prevent muscle weakness.…”

Section: Discussionmentioning

confidence: 99%

“…1). [3][4][5] Early weight bearing starting several days after medial, open-wedge, high tibial osteotomy (MOWHTO) has become common and has proven to be safe. [6][7][8][9] Additionally, several reports have described the timing for initiating weightbearing gait training in rehabilitation after distal femoral osteotomy (DFO).…”

Section: Introductionmentioning

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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Double Level Osteotomy of the Knee

Cited by 168 publications

References 7 publications

Comparison of radiological features of high tibial osteotomy and tibial condylar valgus osteotomy

Comparison of radiological features of high tibial osteotomy and tibial condylar valgus osteotomy

Development and validation of a prediction model for knee joint line orientation after high tibial osteotomy

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

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