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Double level osteotomy for medial osteoarthritis and bifocal varus malalignment has excellent short-term results while maintaining physiologic radiographic joint parameters

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to prospectively evaluate the clinical and radiological results of double level osteotomy (distal femoral lateral closed wedge and proximal tibial medial open wedge) in medial osteoarthritis and varus malalignment due to bifocal deformity of femur and tibia.

Methods

From 2017 to 2019 all cases of DLO in osteoarthritic varus malaligned knees with bifocal deformity (femoral and tibial deformity) were prospectively enrolled into this observational therapeutic study. Evaluation was performed preoperatively, at six, twelve, 18 and 24 months with regard to survival (not requiring arthroplasty), functional outcome [subjective International Knee Documentation Committee score (IKDC), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome score (KOOS) and Tegner Activity Scale], pain level (numeric rating scale), subjective satisfaction (rating 1–5), radiographic parameters on a pre-and postoperative full leg x-rays (mechanical axis, mechanical proximal tibial and distal femoral angles) and complications. For statistical evaluation student’s t test, Mann–Whitney U test and Wilcoxon-signed-rank test were used.

Results

Fifty-two consecutive cases in 48 patients were enrolled in the study. Three cases were excluded, resulting in a follow-up rate of 94%. No arthroplasties were performed within follow-up. All functional outcome scores substantially and significantly increased as early as six months after the index procedure and further increased until final follow-up (p < 0.001). Pain level significantly decreased (p < 0.001). At final follow-up all patients stated that they would retrospectively undergo the operation again, and rated the result with 4.5 ± 0.6 out of 5 (3–5). Radiographic parameters were within physiological limits postoperatively. No severe complications occurred.

Conclusions

Double level osteotomy has excellent short-term results while maintaining physiological radiographic parameters. Therefore, it should be an integral part and standard procedure in realignment surgery for monocompartimental osteoarthritis.

Level of evidence

IV (prospective observational therapeutic study).

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Data availability

The authors declare that data supporting the findings of this study are available within the article.

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Author information

Author notes

  1. Philipp Schuster and Frida Rathgeb both contributed equally to the manuscript, therefore this has to be marked as “Shared 1st authorship”.

Authors and Affiliations

  1. Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany

    Philipp Schuster, Frida Rathgeb, Philipp Mayer, Stefan Michalski, Lotta Hielscher, Julia Buchholz & Jörg Richter

  2. Clinic Nuremberg, Department of Orthopedics and Traumatology, Paracelsus Private Medical University, Nuremberg, Germany

    Philipp Schuster, Lotta Hielscher & Julia Buchholz

  3. Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Frida Rathgeb & Lara Krüger

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Correspondence to Philipp Schuster.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the competent ethical committee.

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Schuster, P., Rathgeb, F., Mayer, P. et al. Double level osteotomy for medial osteoarthritis and bifocal varus malalignment has excellent short-term results while maintaining physiologic radiographic joint parameters. Knee Surg Sports Traumatol Arthrosc 31, 3124–3132 (2023). https://doi.org/10.1007/s00167-022-07247-1

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