2025 ISAKOS Biennial Congress ePoster
Double Level Osteotomy Provides Fairly Satisfactory Mid-term Outcomes in Patients with Symptomatic Severe Varus Osteoarthritic Knee.
Ryo Ueshima, MD, Nishinomiya-Shi, hyogo JAPAN
Shintaro Onishi, MD, PhD, Nishinomiya, Hyogo JAPAN
Tomoya Iseki, MD, PhD, Nishinomiya, Hyogo JAPAN
Ryo Kanto, MD, Nishinomiya, Hyogo JAPAN
Ryuichi Gejo, MD, PhD, Toyama City, Toyama JAPAN
Shinichi Yoshiya, MD, Nishinomiya, Hyogo JAPAN
Toshiya Tachibana, MD, PhD, Nishinomiya, Hyogo JAPAN
Hiroshi Nakayama, MD., Ph.D., Nishinomiya, Hyogo JAPAN
Hyogo Medical University, Nishinomiya, Hyogo, JAPAN
FDA Status Cleared
Summary
Mid-term outcomes after double level osteotomy showed slight under-correction compared to the preoperative planning and small amount of recurrence of bone/joint deformity over time; however, postoperative clinical improvement was maintained until 5 years. Clinical outcomes were significantly inferior in the under-corrected group with residual varus of less than 2° of HKA.
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Abstract
[Objectives] Double level osteotomy (DLO) is indicated for symptomatic severe varus osteoarthritic (OA) knees with the intent of restoring physiologic joint alignment and bony geometry. Although satisfactory short-term outcomes of this procedure have been reported, there is a paucity of information regarding its mid-term clinical outcomes. Therefore, the purpose of this study was to examine the mid-term outcomes following DLO and analyze the relationship between the radiological and clinical outcomes.
Method
This retrospective study was composed of a consecutive series of 26 patients (36 knees) with a mean age of 62.4 years (range, 52-75) who underwent DLO for severe varus OA knees. All patients could be followed up for a minimum of 5 years. DLO was adopted when there were combined varus deformities both in the distal femur and proximal tibia, and the postoperative hip-knee-ankle angle (HKAA) was aimed at +1° valgus. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), while radiological parameters including lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle (JLCA) and HKAA were measured in the radiological evaluation. In the data analysis, the influences of pre- and postoperative geometric parameter values on the radiological and clinical outcomes as well as the relationship between the radiological and clinical outcomes at the follow-up were statistically assessed.
Results
Clinical score using the KOOS was significantly improved from 190 ± 76 before surgery to 393 ± 78 at 2 years and the clinical improvement had been maintained at 5 years (384 ± 78). Radiological evaluation showed that the HKAA was corrected from -13.2° ± 3.0° varus to -0.4° ± 3.1° varus at 2 years, which indicated under-correction as compared to the intended value. Thereafter, a small amount of varus recurrence was observed at 5 years with the mean HKAA decreased by 1.2° ± 3.6°. While JLCA was decreased from 6.2° ± 2.4° preoperatively to 3.7° ± 1.9° at 2 years, the value measured at 5 years increased again to 4.8° ± 2.1°. When the study subjects were divided into the under-corrected group with the HKAA of less than -2° (n=15, 41.7 %) and the other group of the remaining knees (n=21), the mean KOOS score in the former group was significantly lower than that in the latter group (342 ± 91 vs 413 ± 51, p<0.01).
Conclusions
The present study results with mid-term follow-up evaluation showed slight under-correction and small amount of recurrence of bone/joint deformity over time; however, postoperative clinical improvement was maintained until 5 years. Analysis of the relationship between the radiological and clinical outcomes showed that the clinical outcomes were significant inferior in the under-corrected group exhibiting residual varus.