Tag Archive for: Double Level Osteotomy

Volume 6 | Issue 2 | July-December 2021 | Page 27-33 | Sam Trowbridge, Hamid Razak, Dominic Davenport, Philip Pastides, Kristian Kley, Matthieu Ollivier, Raghbir S Khakha, Adrian J Wilson

DOI:10.13107/aja.2021.v06i02.031


Author: Sam Trowbridge [1], Hamid Razak [2, 3], Dominic Davenport [4], Philip Pastides [1], Kristian Kley [7], Matthieu Ollivier [5, 6], Raghbir S Khakha [1], Adrian J Wilson [7]

[1] Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
[2] Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore 544886.
[3] SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, 20 College Road, Academia Level 4, Singapore 1698.
[4] Consultant Trauma & Orthopaedic Surgeon, Princess Royal University Hospital, Bromley, London.
[5] Institute of movement and locomotion Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France,
[6] Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France.
[7] Harley Street Specialist Hospital, 18-22 Queen Anne Street, London W1G 8HU.

Address of Correspondence:

Dr. Raghbir S Khakha,
Consultant, Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
E-mail: raghbir.khakha@gmail.com


Abstract

High tibial osteotomy (HTO) has been a well accepted surgical procedure for knees with varus knee osteoarthritis. It is an excellent option for patients who are younger and have higher functional demands. However, correction of a severe varus knee by isolated (HTO) would require a significant opening which will invariably lead to joint line obliquity ( JLO) and increase the risk of complications such as hinge fractures. As such, double level osteotomy (DLO) consisting of a HTO and distal femoral osteotomy (DFO) has been purported as the preferred joint preserving procedure in patients with severe varus deformity. DLO is able to restore the mechanical alignment of the limb without causing JLO. In this narrative review, we explore the pathomechanics of varus osteoarthritis, surgical considerations for DLO planning, indications, outcomes and complications of DLO. We have also presented our preferred approach for DLO.


References

1. Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, et al. Hip contact forces and gait patterns from routine activities. J Biomech. 2001;34(7):859-71.
2. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am. 1994;25(3):425-65.
3. Shelburne KB, Torry MR, Pandy MG. Muscle, ligament, and joint-contact forces at the knee during walking. Med Sci Sports Exerc. 2005;37(11):1948-56.
4. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585-608.
5. Marti CB, Gautier E, Wachtl SW, Jakob RP. Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy. Arthroscopy. 2004;20(4):366-72.
6. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332-54.
7. Lee SS, Lee HI, Cho ST, Cho JH. Comparison of the outcomes between two different target points after open wedge high tibial osteotomy: The Fujisawa point versus the lateral tibial spine. Knee. 2020;27(3):915-22.
8. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clin Orthop Relat Res. 1989(246):250-9.
9. Khakha RS, Bin Abd Razak HR, Kley K, van Heerwaarden R, Wilson AJ. Role of high tibial osteotomy in medial compartment osteoarthritis of the knee: Indications, surgical technique and outcomes. Journal of Clinical Orthopaedics and Trauma. 2021;23:101618.
10. Elson DW, Petheram TG, Dawson MJ. High reliability in digital planning of medial opening wedge high tibial osteotomy, using Miniaci’s method. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2041-8.
11. Razak H, Micicoi G, Khakha RS, Ehlinger M, Faizan A, LiArno S, et al. Patients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees. Knee Surg Sports Traumatol Arthrosc. 2021.
12. Kim JS, Lim JK, Choi HG, Jeong HW, Park SB, Shim SJ, et al. Excessively Increased Joint-Line Obliquity After Medial Opening-Wedge High Tibial Osteotomy Is Associated With Inferior Radiologic and Clinical Outcomes: What Is Permissible Joint-Line Obliquity. Arthroscopy. 2021.
13. Nakayama H, Schröter S, Yamamoto C, Iseki T, Kanto R, Kurosaka K, et al. Large correction in opening wedge high tibial osteotomy with resultant joint-line obliquity induces excessive shear stress on the articular cartilage. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1873-8.
14. Benjamin A. Double osteotomy for the painful knee in rheumatoid arthritis and osteoarthritis. J Bone Joint Surg Br. 1969;51(4):694-9.
15. Babis GC, An KN, Chao EY, Rand JA, Sim FH. Double level osteotomy of the knee: a method to retain joint-line obliquity. Clinical results. J Bone Joint Surg Am. 2002;84(8):1380-8.
16. Schröter S, Nakayama H, Yoshiya S, Stöckle U, Ateschrang A, Gruhn J. Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg. 2019;139(4):519-27.
17. Saragaglia D, Mercier N, Colle PE. Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop. 2010;34(2):185-90.
18. Nakayama H, Iseki T, Kanto R, Kambara S, Kanto M, Yoshiya S, et al. Physiologic knee joint alignment and orientation can be restored by the minimally invasive double level osteotomy for osteoarthritic knees with severe varus deformity. Knee Surg Sports Traumatol Arthrosc. 2020;28(3):742-50.
19. Chernchujit B, Tharakulphan S, Prasetia R, Chantarapanich N, Jirawison C, Sitthiseripratip K. Preoperative planning of medial opening wedge high tibial osteotomy using 3D computer-aided design weight-bearing simulated guidance: Technique and preliminary result. J Orthop Surg (Hong Kong). 2019;27(1):2309499019831455.
20. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989(248):13-4.
21. Asif S, Choon DS. Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong). 2005;13(3):280-4.
22. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985(198):43-9.
23. Mitsou A, Vallianatos P, Piskopakis N, Maheras S. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg Br. 1990;72(3):398-404.


How to Cite this article: Trowbridge S, Razak A, Davenport D, Pastides P, Kley K, Ollivier M, Khakha RS, Wilson AJ Double Level Osteotomy of the Knee | for Varus Osteoarthritis | Asian Journal Arthroscopy | July-December 2021; 6(2): 27-33.


(Abstract Text HTML)      (Download PDF)