ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Mid-term survival and physiological joint angles after double level osteotomy of severe varus osteoarthritis.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Sagittal alignment and patellofemoral consequences of open wedge high tibial osteotomy: a comparative radiological and gait analysis of supratubercle and distal tibial tuberosity techniques.Journal of orthopaedic surgery and research · 2026Article
- Reliable pain and function outcomes but limited sport performance after high tibial osteotomy for medial knee osteoarthritis in the grey zone between osteotomy and unicompartmental replacement.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Mid-term survival and physiological joint angles after double level osteotomy of severe varus osteoarthritis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Normative values of the sagittal lumbopelvic alignment in children during the first decade of life : A retrospective observational study from a German paediatric orthopaedic hospital.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Observational
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Abstract
purposeDouble-level osteotomy (DLO) is a joint-preserving technique for the treatment of symptomatic varus knee osteoarthritis (OA) in cases of femoral and tibial combined deformity. The study aimed to investigate the mid-term survival rate (>5 years) and restoration of postoperative joint angles.
methodsSixty-five knees underwent DLO (medial open wedge high tibial osteotomy (MOWHT) and lateral closing wedge distal femoral osteotomy (LCWDFO) between 2011 and 2015. Minimum follow-up was 5 years. The survival rate was recorded and, in case of conversion to knee arthroplasty, the time of conversion. Radiographs were obtained preoperatively, 6 weeks postoperatively and at the last follow-up. On radiographs mechanical tibiofemoral angle (mTFA), mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal femur angle (mLDFA), joint line convergence angle (JLCA) and joint line obliquity (JLO) were measured. The clinical outcome was measured using International Knee Documentation Committee (IKDC), Oxford and Lysholm score.
resultsForty-nine knees (75% follow-up) were included after 8.0 ± 1.4 years. At the last follow-up, six knees underwent arthroplasty (7-year survival rate: 91.8%; 5-year survival rate: 93.9%) in average after 5.1 ± 2.3 years. Preoperatively, there was a varus deformity of -10.0 ± 2.5° (mTFA). In addition, pathologic knee joint angles with an mMPTA of 84.7 ± 2.2°, an mLDFA of 91.4 ± 2.1°, an JLCA of 3.4 ± 1.8 and a JLO of 3.0 ± 1.9°. Six weeks postoperatively mTFA was 0.7 ± 2.2° with values of mMPTA 91.0 ± 2.3°, mLDFA 86.8 ± 2.0° and JLO of 2.8 ± 2.1°. In the mid-term, a preserved leg axis (mTFA: -0.9 ± 2.7°) and preserved joint angles (mMPTA: 90.3 ± 2.7°, mLDFA: 87.1 ± 2.3°, JLCA: 4.3 ± 1.9 JLO: 3.2 ± 2.1°) were observed. At the last follow-up, the IKDC, Oxford Knee Score (OKS) and Lysholm score were: 61.2%, 36.1 points and 78.3 points, respectively.
conclusionThe study demonstrates that DLO is an effective surgical technique to restore physiological joint angles in patients with severe preoperative deformity and symptomatic varus OA. Mid-term results indicate good clinical outcomes and a low conversion rate to TKA. LEVEL OF EVIDENCE: Level IV.
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