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.

[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.

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Patient Specific Instrument-Guided Distal Femur Biplanar Osteotomy of Valgus Knees ePoster Presentation Jui Cheng Lin, MD, TAIWAN Jia-Lin Wu, MD, MS, TAIWAN
Correlation Between Histological Assessment of Regenerated Articular Cartilage and Mid- to Long-Term Clinical Outcomes After Open-Wedge High Tibial Osteotomy ePoster Presentation Yasutoshi Ikeda, MD,PhD, JAPAN Kazushi Horita, MD, JAPAN Kodai Hamaoka, MD, JAPAN Kousuke Shiwaku, MD, JAPAN Shinichiro Okimura, MD, PhD, JAPAN Yohei Okada, MD,PhD, JAPAN Tomoaki Kamiya, MD, JAPAN Atsushi Teramoto, MD, PhD, JAPAN
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Neutral to Slightly Undercorrected Mechanical Leg Alignment Provides Superior Long-Term Results in Patients Undergoing Matrix-Associated Autologous Chondrocyte Implantation ePoster Presentation Johannes Weishorn, MD, GERMANY Johanna Wiegand, MD, GERMANY Severin Zietzschmann, MD, GERMANY Raphael Trefzer, MD, GERMANY Kevin-Arno Koch, MD, GERMANY Tilman Walker, GERMANY
Three-Dimensional Change in Tibiofemoral Relationship After High Tibial Osteotomy: Medial Open Wedge Versus Lateral Closed Wedge ePoster Presentation Yuta Tachibana, M.D., Ph.D., JAPAN Kazutaka Kinugasa, MD, PhD, JAPAN Kunihiko Hiramatsu, MD, PhD, JAPAN Yuzo Yamada, MD, PhD, JAPAN Ayaka Tanaka, MD, JAPAN Yoshinari Tanaka, MD, PhD, JAPAN
Support Instruments Provide Remarkable Stability in Medial Closed Wedge Distal Femoral Osteotomy -A Finite Element Analysis- ePoster Presentation Umito Kuwashima, MD, PhD, JAPAN Masafumi Itoh, MD, PhD, JAPAN Junya Itou, MD, PhD, JAPAN Ken Okazaki, MD, PhD, JAPAN
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Normative Values Of Radiographic Parameters In Coronal Plane Lower Limb Alignment In Japanese General Population; Cross-Sectional Study In Iwaki Cohort ePoster Presentation Ryoto Kura, MD, JAPAN Eiji Sasaki, MD, PhD, JAPAN Takahiro Tsushima, MD, PhD, JAPAN Yukiko Sakamoto, MD, PhD, JAPAN Kyota Ishibashi, MD, JAPAN Yuka Kimura, MD, PhD, JAPAN Eiichi Tsuda, Prof., JAPAN Yasuyuki Ishibashi, MD, JAPAN
The distribution of femoral and tibial coronal alignment in Japan: a multicentric retrospective study of patients with knee osteoarthritis ePoster Presentation Takashi Tsuda, JAPAN Kazunori Hino, MD, PhD, JAPAN Tatsuhiko Kutsuna, MD, PhD, JAPAN Kunihiko Watamori, MD, JAPAN Tomofumi Kinoshita, MD, PhD, JAPAN Takafumi Hiranaka, MD, PhD, JAPAN Eiichi Shiigi, MD、PhD, JAPAN Hiroshi Inui, MD, PhD, JAPAN Kohei Kawaguchi, MD, PhD, JAPAN Masaki Takao, Prof., JAPAN
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Comparison Of Clinical Outcomes Between High Tibial Osteotomy And Total Knee Arthroplasty In Older Patients With Severe Osteoarthritis ePoster Presentation Kodai Hamaoka, MD, JAPAN Shinichiro Okimura, MD, PhD, JAPAN Kazushi Horita, MD, JAPAN Yasutoshi Ikeda, MD,PhD, JAPAN Yohei Okada, MD,PhD, JAPAN Tomoaki Kamiya, MD, JAPAN Atsushi Teramoto, MD, PhD, JAPAN
A Lateral Hinge Screw Significantly Resists Varus Stress In Biplanar Medial Closing Wedge Distal Femoral Osteotomy ePoster Presentation Benjamin Main, DO, UNITED STATES Matthieu Ollivier, Prof, MD, PhD , FRANCE Pooyan Abbasi, MSc, UNITED STATES Wiemi A Douoguih, MD, UNITED STATES
Effect Of Meniscal Tear Patterns And Preoperative Cartilage Status On Joint Space Width After Medial Opening-Wedge High Tibial Osteotomy ePoster Presentation Sang-Min Lee, Prof., KOREA, REPUBLIC OF Lih Wang, MD, PhD, KOREA, REPUBLIC OF Jung Shin Kim, Prof., KOREA, REPUBLIC OF Won Chul Shin, Prof., KOREA, REPUBLIC OF
Same Day Discharge Knee Osteotomy: The Results of a High-Volume Canadian Centre ePoster Presentation Nicola Denese Mackay, BMSc (Hons), MB ChB (Hons), FRCS (Tr&Orth), UNITED KINGDOM Hana Marmura, MPT, PhD, UNITED STATES Vincent Roy, MD, MSc, CANADA Ryan M. Degen, MD, FRCSC, CANADA Robert Litchfield, MD, FRCSC, CANADA J. Robert Giffin, MD, FRCSC, MBA, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Clinical Results After Double Level Osteotomy For Knee Osteoarthritis With Joint-Line Obliquity ePoster Presentation Mitsuki Shimizu, MD, JAPAN Hiroshi Nakayama, MD., PhD., JAPAN Akira Kawai, MD, JAPAN Yoshitaka Nakao, MD, JAPAN Ryo Kanto, MD, PhD., JAPAN Shintaro Onishi, MD, PhD, JAPAN Tomoya Iseki, MD, PhD, JAPAN Shinichi Yoshiya, MD, JAPAN Toshiya Tachibana, MD, PhD, JAPAN
Smoking Is Associated With Poor Outcomes And Return To Work Following Opening Wedge High Tibial And Distal Femoral Osteotomy ePoster Presentation Griffith G. Gosnell, MS, UNITED STATES Katherine L. Esser, BS, UNITED STATES Peter Commisso, BS, UNITED STATES Michael Moore, BA, UNITED STATES Nathaniel P. Mercer, MD, UNITED STATES Heath Patrick Gould, MD, UNITED STATES Anil S. Ranawat, MD, UNITED STATES Seth L. Sherman, MD, UNITED STATES Michael J Alaia, MD, UNITED STATES
Mid-Term Outcome Analysis Between Isolated Hto V/S Hto Combined With Arthroscopy In Medial Compartment Oa Knee - A Comparative Study ePoster Presentation Arun Gr, MBBS,MS,FASM, INDIA
Short-Term Clinical Outcomes Of Medial Open-Wedge Distal Tuberosity Tibial Osteotomy For Early Osteoarthritis Of The Knee ePoster Presentation Yoshitaka Nakao, MD, JAPAN Hiroshi Nakayama, MD., PhD., JAPAN Tomoya Iseki, MD, PhD, JAPAN Ryo Kanto, MD, PhD., JAPAN Shintaro Onishi, MD, PhD, JAPAN Takuya Iseki, MD, PhD, JAPAN Toshiya Tachibana, MD, PhD, JAPAN
Preoperative Mechanical Proximal Tibial Angle is Perfectly Correlated to Correction Angle in Medial Open Wedge High Tibial Osteotomy with MPTA-based Surgical Planning ePoster Presentation Thanh Sang Nguyen, MD, MS, TAIWAN Jia-Lin Wu, MD, MS, TAIWAN

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Double Level Osteotomy Provides Fairly Satisfactory Mid-term Outcomes in Patients with Symptomatic Severe Varus Osteoarthritic Knee.

Double Level Osteotomy Provides Fairly Satisfactory Mid-term Outcomes in Patients with Symptomatic Severe Varus Osteoarthritic Knee.

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Double Level Osteotomy Provides Fairly Satisfactory Mid-term Outcomes in Patients with Symptomatic Severe Varus Osteoarthritic Knee.

Double Level Osteotomy Provides Fairly Satisfactory Mid-term Outcomes in Patients with Symptomatic Severe Varus Osteoarthritic Knee.

Method

Results

Conclusions