Double level osteotomy (DLO) (femoral and tibial) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO), and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of two years.
A single-centre, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), lateral distal femoral angle (ΔLDFA), and posterior proximal tibial angle (ΔPPTA). Pre- and post-operative JLO was also evaluated. At two year follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann–Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables; the paired Student’s t test was used to estimate evolution of functional outcomes.
The mean ΔHKA was 1.3 ± 0.5°; the mean ΔMPTA was 0.98 ± 0.3°; the mean ΔLDFA was 0.94 ± 0.2°; ΔPPTA was 0.45 ± 0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4 ± 0.2. At last follow-up, it was recorded a significant improvement in all KOOS scores, and 19 patients were enthusiastic, two satisfied, and one moderately satisfied.
Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at two year follow-up
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Ethics approval and consent to participate and to publish
Patient consent was collected pre-operatively after they were informed of the procedure in accordance with the principles of the Declaration of Helsinki. Local Ethical Committee approval was obtained prior to study’s initiation (Comité Informatique et Liberté (CIL)/Assistance Publique des Hopitaux de Marseille (AP-HM)/Registration Number 2019–127)).
Conflict of interest
MO is educational consultant for New-Clip, Stryker, and Arthrex. KK is educational consultant for New-Clip. CJ, RK, FG, PM, GM, and LH have no relevant financial or non-financial interests to disclose.
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Grasso, F., Martz, P., Micicoi, G. et al. Double level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patients. International Orthopaedics (SICOT) (2021). https://doi.org/10.1007/s00264-021-05194-z
- Double level osteotomy
- Patient-specific cutting guide
- Joint line obliquity
- Clinical outcomes