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Comparison of the indications for high tibial osteotomy and double-level osteotomy for the correction of diverse lower-leg deformities in an Asian population with medial compartment osteoarthritis: a retrospective observational study

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A Correction to this article was published on 03 June 2024

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Abstract

Purpose

Double-level osteotomy (DLO) for knee osteoarthritis is becoming increasingly popular to achieve superior anatomical correction. This study aimed to compare the indication for open-wedge high tibial osteotomy (OWHTO) and DLO and to investigate preoperative bone morphology.

Methods

Data of 166 knees treated with osteotomy were evaluated. The weight-bearing line ratio, mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured. Bone deformity assessment and osteotomy simulation were conducted. Normal values of mLDFA and mMPTA were defined as 85–90°. Bone deformity was classified into four patterns: femoral, tibial, both, and no deformity. Simulation was performed to achieve a postoperative weight-bearing line ratio of 62%. Distal femoral osteotomy (DFO) or OWHTO was performed to achieve an mLDFA of 85° or mMPTA of up to 95°. If the postoperative parameter remained outside the correctable limit, DLO was performed. Cases were classified according to the corrective surgery performed, and those that could not be corrected after DLO were classified into the uncorrectable group.

Results

Femoral, tibial, both, and no deformities were observed in 14.2%, 37.8%, 10.7%, and 33.9% of cases, respectively. No cases were classified into the DFO group; however, 53.6%, 38.1%, and 8.3% were classified into the OWHTO, DLO, and uncorrectable groups, respectively.

Conclusion

Bone deformity differed among cases, and only one-third had tibial deformity. OWHTO and DLO were indicated in approximately 50% and 40% of cases, respectively. Our study results reinforce the importance of evaluating leg morphology before surgical planning to achieve acceptable alignment.

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Data Availability

Raw data were generated from electronical records of the medical center. Due to confidentiality and concerns, the raw data used in this study is not publicly available. Derived data supporting the findings of this study are available from the corresponding author on request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan

    Shu Takagawa, Yohei Yukizawa, Kunihito Hirotomi, Shota Higashihira & Naomi Kobayashi

  2. Department of Orthopedic Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan

    Yutaka Inaba

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  1. Shu Takagawa
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Shu Takagawa, Kunihito Hirotomi and Shota Higashihira. The first draft of the manuscript was written by Shu takagawa, Yohei Yukizawa, Yutaka Inaba, Naomi Kobayashi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Naomi Kobayashi.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Yokohama city university (1/30/2023/ F221200007).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1 and 3.

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The original version of this article was revised. The correct name should be Shota Higashihira and not Shota Hiagashihra.

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Takagawa, S., Yukizawa, Y., Hirotomi, K. et al. Comparison of the indications for high tibial osteotomy and double-level osteotomy for the correction of diverse lower-leg deformities in an Asian population with medial compartment osteoarthritis: a retrospective observational study. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06218-0

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