This Article Full Text Full Text (PDF) Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Babis, G. C. Articles by Sim, F. H. Search for Related Content PubMed PubMed Citation Articles by Babis, G. C. Articles by Sim, F. H. Social Bookmarking                   What's this?

Double Level Osteotomy of the Knee: A Method to Retain Joint-Line Obliquity

Clinical Results

Investigation performed at the Mayo Clinic, Rochester, Minnesota

George C. Babis, MD, DSc
Kai-Nan An, PhD
Edmund Y.S. Chao, PhD
Franklin H. Sim, MD
Department of Orthopedic Surgery (E.Y.S.C., emeritus member), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. Please send requests for reprints to F.H. Sim.

James A. Rand, MD
Department of Orthopedics, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Although general guidelines have been proposed for proximal tibial and supracondylar osteotomies, double level osteotomy provides the advantage of maintaining neutral joint-line obliquity in addition to correcting limb malalignment around the knee. The goal of this prospective study was to determine the outcome of double level osteotomy of the knee performed after analysis with computer-aided preoperative planning software in patients with varus malalignment.

Methods: Twenty-nine double level osteotomies of the knee were performed in twenty-four patients. The patients were followed for an average duration of 82.7 months (range, twenty-seven to 137 months). All knees had moderate-to-severe varus deformity and arthritis. The mean preoperative mechanical tibiofemoral angle was 193.9° (that is, 13.9° of varus). Preoperative and postoperative evaluations included clinical (scores according to the Knee Society system), radiographic, and computer-aided analysis of the mechanical status of the knee joint. Failure was defined as conversion of an osteotomy to a total knee arthroplasty or the presence of severe pain in a patient who declined arthroplasty.

Results: The mean clinical and functional scores according to the Knee Society system improved from 34 and 64 points, respectively, before the osteotomy to 90 (p < 0.0001) and 81 points (p = 0.079) at the time of the final follow-up examination. One patient was lost to follow-up. One of the twenty-nine knees was subsequently converted to total knee arthroplasty forty-nine months postoperatively. The cumulative rate of survival at 100 months was 96% (95% confidence interval, +4.5 to -8.7), with eight patients remaining at risk.

Conclusions: Double osteotomy is a valuable procedure for patients with such a large varus deformity that appropriate realignment and load transfer to the unaffected compartment, together with an acceptable joint-line obliquity, cannot be achieved by a single osteotomy.

CiteULike    Connotea    Del.icio.us    Facebook    Technorati    Twitter    What's this?

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2002 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.