Skip to main content
SpringerLink
Log in

Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy

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

Abstract

Purpose

To compare the radiographic, clinical, and arthroscopic outcomes of varus osteoarthritic knees treated with an open-wedge high tibial osteotomy (OWHTO) alone or with a double-level osteotomy (DLO). It was hypothesized that treatment with DLO would maintain the joint line obliquity (JLO) and acquire better arthroscopic and clinical outcomes after surgery than OWHTO alone.

Methods

Knees with predicted medial proximal tibial angle (MPTA) > 95° were treated with OWHTO alone or with DLO. Preoperatively, age, body mass index, and hip-knee-ankle angle (HKA) differed between the two groups. Therefore, after adjustment for those factors, 34 knees with OWHTO alone and 34 knees with DLO were compared. On whole-leg radiographs for a single leg, HKA, weightbearing line (WBL) ratio, lateral distal femoral angle (LDFA), MPTA, and JLO were measured before and 2 years after surgery. Clinical outcomes were evaluated by the Knee Society Score (KSS) knee, KSS function, Lysholm, and Knee injury and Osteoarthritis Outcome Score (KOOS) scores before and 2 years after surgery. Arthroscopic findings were obtained before and 1 year after surgery. Various factors were compared between the two groups.

Results

JLO increased significantly from 1.4° to 6.3° in the OWHTO group (p < 0.001) and changed from 1.0° to 1.3° in the DLO group (n.s.). Postoperative MPTA and JLO in the OWHTO group were significantly higher than those in the DLO group (both p < 0.001). There were no significant differences in the KSS knee, KSS function, and KOOS scores between the two groups. Postoperative Lysholm score in the DLO group was higher than that in the OWHTO group (p < 0.025). Femoral and tibial cartilage regeneration in the medial condyles and deterioration in the lateral condyles did not differ between the two groups on second-look arthroscopy.

Conclusions

JLO was not significantly changed after surgery in the DLO group. DLO enabled the acquisition of physiological JLO compared with OWHTO alone.

Level of evidence

Retrospective comparative study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Akamatsu Y, Mitsugi N, Mochida Y, Taki N, Kobayashi H, Takeuchi R, Saito T (2012) Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method. Knee Surg Sports Traumatol Arthrosc 20:586–593

    Article  CAS  Google Scholar 

  2. Akamatsu Y, Kumagai K, Kobayashi H, Tsuji M, Saito T (2018) Effect of increased coronal inclination of the tibial plateau after opening wedge high tibial osteotomy. Arthroscopy 34:2158–2169

    Article  Google Scholar 

  3. Babis GC, An KN, Chao EY, Rand JA, Sim FH (2002) Double level osteotomy of the knee: a method to retain joint-line obliquity. Clinical results. J Bone Jt Surg Am 84:1380–1388

    Article  Google Scholar 

  4. Benjamin A (1969) Double osteotomy for the painful knee in rheumatoid arthritis and osteoarthritis. J Bone Jt Surg Br 51:694–699

    Article  CAS  Google Scholar 

  5. Brinkman JM, Hurschler C, Agneskirchner JD, Freiling D, van Heerwaarden RJ (2011) Axial and torsional stability of supracondylar femur osteotomies: biomechanical comparison of the stability of five different plate and osteotomy configurations. Knee Surg Sports Traumatol Arthrosc 19:579–587

    Article  Google Scholar 

  6. Brittberg M, Peterson L, Sjögren-Jansson E, Tallheden T, Lindahl A (2003) Articular cartilage engineering with autologous chondrocyte transplantation. A review of recent developments. J Bone Jt Surg Am 85(suppl 3):109–115

    Article  Google Scholar 

  7. Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160

    Article  Google Scholar 

  8. Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608

    Article  CAS  Google Scholar 

  9. Goshima K, Sawaguchi T, Shigemoto K, Iwai S, Nakanishi A, Inoue D, Shima Y (2019) Large opening gaps, unstable hinge fractures, and osteotomy line below the safe zone cause delayed bone healing after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 27:1291–1298

    Article  Google Scholar 

  10. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14

    Article  Google Scholar 

  11. Jung WH, Takeuchi R, Chun CW, Lee JS, Ha JH, Kim JH et al (2014) Second-look arthroscopic assessment of cartilage regeneration after medial opening-wedge high tibial osteotomy. Arthroscopy 30:72–79

    Article  Google Scholar 

  12. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  Google Scholar 

  13. Koshino T, Yoshida T, Ara Y, Saito I, Saito T (2004) Fifteen to 28 years’ follow-up results of high tibial valgus osteotomy for osteoarthritic knee. Knee 11:439–444

    Article  Google Scholar 

  14. Krackow KA (1983) Approaches to planning lower extremity alignment for total knee arthroplasty and osteotomy about the knee. Adv Orthop Surg 7:69–88

    Google Scholar 

  15. Lobenhoffer P, Agneskirchner JD (2003) Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 11:132–138

    Article  Google Scholar 

  16. Nakamura R, Komatsu N, Murao T, Okamoto Y, Nakamura S, Fujita K et al (2015) The validity of the classification for lateral hinge fractures in open wedge high tibial osteotomy. Bone Jt J 97-B:1226–1231

    Article  CAS  Google Scholar 

  17. Nakayama H, Schröter S, Yamamoto C, Iseki T, Kanto R, Kurosaka K, Kambara S, Yoshiya S, Higa M (2018) 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 26:1873–1878

    Article  Google Scholar 

  18. Nakayama H, Iseki T, Kanto R, Kambara S, Kanto M, Yoshiya S, Schröter S (2020) 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 28:742–750

    Article  Google Scholar 

  19. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS): development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96

    Article  CAS  Google Scholar 

  20. Saragaglia D, Mercier N, Colle PE (2010) Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop 34:185–190

    Article  Google Scholar 

  21. Schröter S, Elson DW, Ateschrang A, Ihle C, Stöckle U, Dickschas J, Harrer J (2017) Lower limb deformity analysis and the planning of an osteotomy. J Knee Surg 30:393–408

    Article  Google Scholar 

  22. Schröter S, Nakayama H, Yoshiya S, Stöckle U, Ateschrang A, Gruhn J (2019) Development of the double level osteotomy in severe varus osteoarthritis showed good outcome by preventing oblique joint line. Arch Orthop Trauma Surg 139:519–527

    Article  Google Scholar 

  23. Staubli AE, De Simoni C, Babst R, Lobenhoffer P (2003) TomoFix: a new LCP-concept for open wedge osteotomy of the medial proximal tibia—early results in 92 cases. Injury 34(Suppl 2):B55-62

    Article  Google Scholar 

  24. Takeuchi R, Ishikawa H, Aratake M, Bito H, Saito I, Kumagai K, Akamatsu Y, Saito T (2009) Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 25:46–53

    Article  Google Scholar 

  25. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Alison Sherwin, PhD, from Edanz Group for editing a draft of this manuscript. The authors deeply appreciate the surgical instructions of Prof. Steffen Schröter in the BG Trauma Center Tübingen for 6 months.

Funding

No funding was obtained for this study.

Author information

Authors and Affiliations

  1. Department of Joint Surgery, Fureai Yokohama Hospital, 2-3-3, Bandai-cho, Naka-ku, Yokohama, 231-0031, Japan

    Yasushi Akamatsu, Hideo Kobayashi & Shuntaro Muramatsu

  2. Department of Orthopaedic Surgery, Yokohama City University Hospital, Yokohama, Japan

    Yasushi Akamatsu, Shuntaro Nejima, Masaki Tsuji, Hideo Kobayashi & Shuntaro Muramatsu

Authors
  1. Yasushi Akamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuntaro Nejima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masaki Tsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hideo Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shuntaro Muramatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YA study design, data collection, interpretation of the data, and writing of the paper. SN data collection. MT, HK, and SM interpretation of the data.

Corresponding author

Correspondence to Yasushi Akamatsu.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Ethics approval

Ethical approval for the study was obtained from the Institutional Review Board of Yokohama City University Hospital (B120906024).

Consent to participate

Written informed consent was obtained from all the participants.

Consent for publication

Written informed consent was obtained from all the participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Akamatsu, Y., Nejima, S., Tsuji, M. et al. Joint line obliquity was maintained after double-level osteotomy, but was increased after open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 30, 688–697 (2022). https://doi.org/10.1007/s00167-020-06430-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06430-6

Keywords

Search

Navigation