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Minimally Invasive Double Level Osteotomy in Severe Knee Varus: Pearls and Pitfalls.

ABSTRACT: Minimally invasive double-level osteotomy (DLP) surgery is performed in severe knee varus, when extra-articular deformity is identified in both the distal femur and proximal tibia. The main advantage is to maintain a horizontal joint line and avoid creating secondary anatomic deformities. This article considers the pearls and pitfalls in performing minimally invasive DLO surgery.

SUBMITTER: Sautet P

PROVIDER: S-EPMC9244850 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Minimally Invasive Double Level Osteotomy in Severe Knee Varus: Pearls and Pitfalls.

Sautet Pierre P Kley Kristian K Khakha Raghbir R Ollivier Matthieu M

Arthroscopy techniques 20220621 6

Minimally invasive double-level osteotomy (DLP) surgery is performed in severe knee varus, when extra-articular deformity is identified in both the distal femur and proximal tibia. The main advantage is to maintain a horizontal joint line and avoid creating secondary anatomic deformities. This article considers the pearls and pitfalls in performing minimally invasive DLO surgery. ...[more]

PMID: 35782831

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Project description:PurposeTo analyze the change in rotational alignment caused by double level osteotomy (DLO) based on comparative three-dimensional image analysis of pre- and postoperative CT images.MethodsPre- and postoperative CT examination of the lower extremities were performed with informed consent for 39 consecutive knees undergoing DLO for varus knee deformity. The DLO procedure consisted of closed wedge distal femoral osteotomy (CWDFO) and open wedge high tibial osteotomy (OWHTO). Among those cases, 20 knees complicated with hinge fracture at the osteotomy site were excluded from the analysis to eliminate a confounding factor affecting the results. Consequently, data obtained from 19 knees were subjected to the study analysis while osteotomies with hinge fractures complications were excluded from the study. In the three-dimensional CT image analysis of axial plane images, femoral torsion (the angle between midline along the femoral neck axis and the tangent of the posterior edges of the medial/lateral femoral condyles) and tibial torsion (the angle between the tangent of the posterior edges of the medial/lateral tibial condyles and the transmalleolar axis) were measured. The torsion angle was measured in each of the femurs and the tibias on both pre- and postoperative CT axial images, and the change induced by the osteotomy was calculated and statistically(using Wilcoxon signed-rank test) compared.ResultsThe mean pre- and postoperative femoral torsion (anteversion) angles were 29.3° and 31.4° with a significant postoperative increase in internal rotation of the bony segment distal to the osteotomy(P = 0.002). On the tibial side, the mean pre- and postoperative torsion angles were 26.5° and 25.7°, indicating no significant postoperative change(P = 0.199)（NS）.ConclusionsThis study showed that the DLO procedure (combining CWDFO and OWHTO) increased torsion (anteversion) of the femur by 2.1° on average while inducing no significant rotational change on the tibial side.

Project description:PurposeTo 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.MethodsTwenty-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.ResultsIn 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.ConclusionDLO 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.

Dataset Information

Minimally Invasive Double Level Osteotomy in Severe Knee Varus: Pearls and Pitfalls.

Publications

Minimally Invasive Double Level Osteotomy in Severe Knee Varus: Pearls and Pitfalls.

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