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Clinical Results After Double Level Osteotomy For Knee Osteoarthritis With Joint-Line Obliquity

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Clinical Results After Double Level Osteotomy For Knee Osteoarthritis With Joint-Line Obliquity

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

Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, JAPAN

2025 Congress ePoster Presentation 2025 Congress Not yet rated

Anatomic Location

Knee

Anatomic Structure

Bones

Diagnosis / Condition

Osteoarthritis

Treatment / Technique

Osteotomy

Diagnosis Method

Physical Examination X-ray MRI

Sports Medicine

Outcome Studies Research

Summary: Double Level Osteotomy could be a good solution for knees with joint surface inclinations which characterized by low mLDFA and mMPTA.

Purpose

Our department has performed more than 150 double level osteotomies (DLO). The indication for DLO is a severely varus-deformed knee, where the deformity is due to both the femur and tibia (mechanical lateral distal femoral angle (mLDFA) > 87° and mechanical medial proximal tibial angle (mMPTA) < 87°). However, there are rare cases of osteoarthritis (OA) knees that exhibit a phenotype with joint surface inclinations characterized by an mLDFA < 85° and an mMPTA < 85°. Such knees experience shear forces on the joint surface, leading to cartilage wear in the intercondylar area. The purpose of this study is to evaluate the postoperativkkuu e outcomes of DLO in OA knees with joint surface inclinations.

Methods

The study included 9 knees in 8 patients with OA knees and joint surface inclinations who underwent DLO at our department and were followed up for more than 2 years postoperatively. The average age was 50.4 years, with 4 males and 4 females. The mean follow-up period was 46.1 months. Radiographic evaluations included measurements of mLDFA, mMPTA, and the Hip-knee-ankle (HKA) angle. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS).

Results

The preoperative average mLDFA was 83.9°, and mMPTA was 82.6°, indicating joint surface inclinations. The HKA angle was 1.3° in varus alignment. Medial closing wedge osteotomy was performed on the femur, and medial opening wedge high tibial osteotomy was performed on the tibia. Two years postoperatively, the average mLDFA improved to 87.7°, mMPTA to 87.4°, and the HKA angle to 0.5° in valgus alignment, resulting in a level joint surface. The mean preoperative IKDC and KOOS scores were 44 points and 244 points, respectively, which significantly improved to 85 points and 439 points two years postoperatively.

Discussion

Although rare, knees with joint surface inclinations characterized by low mLDFA and mMPTA values induce shear forces on the joint surface, leading to OA knees. DLO, which levels the joint surface without significantly altering the overall alignment, was found to be an effective surgical procedure for such knees.

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Clinical Results After Double Level Osteotomy For Knee Osteoarthritis With Joint-Line Obliquity

Clinical Results After Double Level Osteotomy For Knee Osteoarthritis With Joint-Line Obliquity

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Clinical Results After Double Level Osteotomy For Knee Osteoarthritis With Joint-Line Obliquity

Clinical Results After Double Level Osteotomy For Knee Osteoarthritis With Joint-Line Obliquity

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Methods

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