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Micicoi G, Grasso F, Hanak L, Kley K, Khakha R, Ayata M, Fayard JM, Ollivier M. Double-level osteotomy for varus knees using patient-specific cutting guides allow more accurate correction but similar clinical outcomes as compared to conventional techniques. Orthop Traumatol Surg Res 2024:103949. [PMID: 39029793 DOI: 10.1016/j.otsr.2024.103949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/12/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE Patient-specific cutting guides are increasingly used in the field of osteotomies around the knee and can improve the accuracy of planned correction and more specifically in the case of double-level osteotomy (DLO). The purpose of this study was to analyse the accuracy of postoperative coronal alignment after DLO using patient-specific cutting guides techniques (PSI) compared to conventional techniques. The secondary objective was to compare the functional results between the two groups at short-term follow-up. HYPOTHESIS The accuracy of global correction (HKA angle) is better with patient-specific cutting guides compared to conventional techniques for double-level osteotomy METHODS: This multicentric comparative retrospective study included 53 patients (mean age: 53.8 ± 5.2 years, male/female: 44/9) who underwent a DLO for knee varus malalignment. The coronal correction accuracy (as expressed by the difference between postoperative angular values and preoperative targeted correction) was compared between techniques using patient-specific cutting guides (PSI group, n = 27) or conventional techniques (n = 26) for the medial proximal tibial angle (MPTA) and the lateral distal femoral angle (LDFA). Postoperatively, the global alignment expressed by the hip-knee-ankle angle and the joint line obliquity were compared between groups. The postoperative functional results for KOOS and UCLA activity scale score were also compared at a mean follow-up of 1.7 years (1.0-3.1 years). RESULTS No difference was observed for the postoperative global alignment between the PSI and the conventional groups (Δ = 0.6 °, p = 0.11) neither for the postoperative posterior proximal tibial angle (Δ = 1.6°, p = 0,99) or the joint line obliquity (Δ = 0.3°, p = 0,17). In the coronal plane, the postoperative MPTA was lower in the PSI group (Δ = 2.3°, p < 0.001) as well as the postoperative LDFA (Δ = 0.9°, p = 0.01). Concerning correction accuracy in the coronal plane, the results showed a significant higher accuracy of the planned correction in the PSI group compared to the conventional group for MPTA (2.2 ± 0.2 versus 0.8 ± 0.7, Δ = 1.5 °, p < 0.001) and LDFA (1.3 ± 1.0 versus 0.6 ± 0.9, Δ = 0.7°, p < 0.001). No improvement difference was observed between the conventional group and the PSI group respectively for the KOOS symptoms (p = 0.12), the KOOS Pain (p = 0,57), the KOOS activities of daily living (p = 0.61), the KOOS sport/rec (p = 0.65), or for the KOOS Quality of Life (p = 0.99) neither for the UCLA (p = 0.97). CONCLUSIONS This study suggests that the use of custom-made cutting guides improves the accuracy of planned correction in double-level osteotomy compared with conventional techniques, which may have implications particularly in centers not performing a large volume of osteotomies. This improved accuracy is not associated with any difference in joint line obliquity or functional results but these results need to be confirmed by a randomized prospective study. LEVEL OF EVIDENCE III; Retrospective comparative study.
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Affiliation(s)
- Grégoire Micicoi
- IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, Hôpital Pasteur II, 30, voie Romaine, 06000 Nice, France
| | - Francesco Grasso
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France
| | | | - Kristian Kley
- Orthoprofis Hannover Luisenstraße 10/11, 30159 Hannover, Germany
| | - Raghbir Khakha
- Guys and St Thomas' Hospitals, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Merwane Ayata
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Matthieu Ollivier
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France.
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Sano S, Matsushita T, Nagata N, Tokura T, Nukuto K, Nakanishi Y, Nishida K, Nagai K, Kanzaki N, Hoshino Y, Matsumoto T, Kuroda R. Morphological analysis of the distal femur as a surgical reference in biplane distal femoral osteotomy. Sci Rep 2024; 14:12130. [PMID: 38802483 PMCID: PMC11130220 DOI: 10.1038/s41598-024-62988-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
Distal femoral osteotomy (DFO) is performed alone or with high tibial osteotomy (HTO) for patients with osteoarthritis and distal femur deformities. DFO is technically demanding, particularly when creating an anterior flange. Herein, we examined the morphological characteristics of the distal femur based on the cortical shape as a surgical reference for biplanar DFO. Computed tomography images of 50 valgus and 50 varus knees of patients who underwent biplanar DFO or total knee arthroplasty were analyzed. Axial slices at the initial level of the transverse osteotomy in the DFO and slices 10 mm proximal and 10 mm distal to that level were selected. The medial and lateral cortical angles and heights (MCLA, LCLA, MCH, and LCH) were measured on axial slices. Statistical comparisons were performed between the medial and lateral cortices and valgus and varus knees. MCLA and MCH were significantly smaller and lower, respectively, than LCLA and LCH (P < 0.01). The MCLA and MCH of varus knees were significantly smaller and lower, respectively, than those of valgus knees (P < 0.01). Surgeons should carefully observe morphological differences in the distal femur cortex, distinguishing between medial and lateral knees and varus and valgus knees during the creation of the anterior flange in the DFO.
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Affiliation(s)
- Shohei Sano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Naosuke Nagata
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takeo Tokura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Koji Nukuto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuta Nakanishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Avellan S, Mabrouk A, Taillebot V, Pithioux M, Ollivier M. Using a patient-specific cutting guide enables identical knee osteotomies: An evaluation of accuracy on sawbones. Orthop Traumatol Surg Res 2024:103813. [PMID: 38218221 DOI: 10.1016/j.otsr.2024.103813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
PURPOSE It was hypothesized that using a Patient-Specific Cutting Guide (PSCG) would allow the creation of sawbones model osteotomies, identical in the 3 planes and the hinge parameters, that can be used for biomechanical studies. The aim of the study was to evaluate the accuracy of the PSCG system and to introduce and assess the new hinge parameter; the hinge area. METHODS Six identical sawbones tibia models were identically set up for identical osteotomy cuts by the same surgeon in the same session and with identical instruments. A medical scanner was used to evaluate the 3D configuration of all the specimens. The analyzed parameters included the cutting angles in both the coronal and sagittal planes (degrees) and the hinge and the slicing areas (cm2), and the hinge thickness (mm). The values were statistically evaluated for average, standard deviation, 95% confidence index, and delta to the expected values were calculated. RESULTS The mean values for the coronal and sagittal angles were 110.5̊±1̊ and 89.8̊±0.8̊, respectively. The 95% confidence index level ranged between 0.1̊, and 0.8̊ in both the coronal & the sagittal planes. The mean values for the hinge thickness, the hinge area, and the slicing area were 12.7±1.5mm, 4.2±0.9 cm2, and 18.3±1.2 cm2, respectively. CONCLUSION In the presented study, it can be demonstrated that mechanically identical osteotomy specimens, with regard to the cutting planes and hinge parameters, can be reliably created using the PSCG. The identical specimens can be used for biomechanical research purposes to further expand our knowledge of the factors affecting osteotomy outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sébastien Avellan
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France; BIOBank®, Tissue Bank, Lieusaint, France
| | - Ahmed Mabrouk
- Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France; Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Virginie Taillebot
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France.
| | - Martine Pithioux
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
| | - Matthieu Ollivier
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
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Capella M, Sabatini L, Bosco F, Barberis L, Giustra F, Risitano S, Camazzola D, Massè A. A novel geometrical planning method to restore knee joint obliquity in double-level osteotomies. Arch Orthop Trauma Surg 2023; 143:6685-6693. [PMID: 37505270 PMCID: PMC10541832 DOI: 10.1007/s00402-023-04997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Precise preoperative planning is mandatory when a double-level osteotomy (DLO) is required to correct a severe knee deformity. Literature does not report a validated planning method regarding DLO that could be performed directly on digital radiographs using simple measurement tools. This study aims to validate a novel DLO planning method called New Mikulicz-Joint Line (NM-JL) based on essential measurement tools, in which the correction angles are induced by the predicted post-operative joint line obliquity (JLO). METHODS Twenty-three patients who satisfied the inclusion criteria were enrolled. NM-JL planning method was performed using basic measurement tools to detect corrective angles and gaps. The correction was then simulated using a Virtual Segmentation Software method to obtain the osteotomy fragments. Both planning procedures were performed independently and later repeated by two orthopaedic surgeons to assess the inter and intra-observer reliability. RESULTS The intraclass correlation coefficient (ICC) regarding corrective angles and gaps showed a significant positive correlation between the values determined using the two procedures by both raters (p < 0.05). Pearson's correlation analysis revealed a significant correlation between the measured results of the two planning methods. (p < 0.05). Finally, the Bland-Altman analysis showed an excellent agreement (p < 0.05) for all measurements performed. CONCLUSIONS The NM-JL method showed high values of intra and inter-rater reliability. The procedure is built up starting from the predicted value of post-operative joint line obliquity, allowing to maintain this parameter fixed. Other advantages include the quickness, adaptability, and possibility to be performed on any Digital Imaging and Communication in Medicine (DICOM) viewer. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Marcello Capella
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
| | - Luca Barberis
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Daniele Camazzola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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An JS, Mabrouk A, Khakha R, Kley K, Koga H, Jacquet C, Ollivier M. Assessment of return to sport and functional outcomes following distal femoral, double level and high tibial osteotomies for active patients with symptomatic varus malalignment. Knee Surg Sports Traumatol Arthrosc 2023; 31:4285-4291. [PMID: 37329369 DOI: 10.1007/s00167-023-07457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/13/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE This study indicated the outcomes of three surgical techniques for the treatment of symptomatic unicompartmental knee osteoarthritis (UKOA) with varus malalignment in younger, active patients: distal femoral osteotomy (DFO), double-level osteotomy (DLO) and high tibial osteotomy (HTO). The outcomes measured included the return to sport, sport activity and functional scores. METHODS A total of 103 patients (19 DFO, 43 DLO, 41 HTO) were enrolled in the study and were divided into three groups based on their oriented deformity, each undergoing one of the three surgical techniques. All patients underwent pre- and post-operative evaluations including X-rays, physical exams and functional assessments. RESULTS All three surgical techniques were effective in treating UKOA with constitutional malalignment. The average time to return to sport was similar among the three groups (DFO: 6.4 ± 0.3 [5.8-7] months, DLO: 4.9 ± 0.2 [4.5-5.3] months, HTO: 5.6 ± 0.2 [5.2-6] months). The sport activity and functional scores improved significantly for all three groups, with no significant differences observed among the groups. CONCLUSION Various knee osteotomy procedures, DFO, DLO, and HTO, result in high RTS rates and quick RTS times with satisfactory functional scores. Despite pre- to post-operative improvements in sport activities following DFO and DLO, pre-symptom levels were not reached following all evaluated procedures. LEVEL OF EVIDENCE Retrospective case-control study, Level III.
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Affiliation(s)
- Jae-Sung An
- Tokyo Medical and Dental University, Tokyo, Japan
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Ahmed Mabrouk
- Leeds Teaching Hospitals, Leeds, UK
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Raghbir Khakha
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
- Guys and St. Thomas' Hospitals, Great Maze Pond, London, UK
| | - Kristian Kley
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
- Harley Street Specialist Hospital, 18-22, Queen Anne Street, London, W1G8HU, UK
- Orthopädie Maximilium, Donauwörth, Germany
| | | | - Christophe Jacquet
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France.
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Batailler C, Naaim A, Daxhelet J, Lustig S, Ollivier M, Parratte S. Impact of the diaphyseal femoral deformity on the lower limb alignment in osteoarthritic varus knees. Bone Jt Open 2023; 4:262-272. [PMID: 37051842 PMCID: PMC10085644 DOI: 10.1302/2633-1462.44.bjo-2023-0024.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
The impact of a diaphyseal femoral deformity on knee alignment varies according to its severity and localization. The aims of this study were to determine a method of assessing the impact of diaphyseal femoral deformities on knee alignment for the varus knee, and to evaluate the reliability and the reproducibility of this method in a large cohort of osteoarthritic patients. All patients who underwent a knee arthroplasty from 2019 to 2021 were included. Exclusion criteria were genu valgus, flexion contracture (> 5°), previous femoral osteotomy or fracture, total hip arthroplasty, and femoral rotational disorder. A total of 205 patients met the inclusion criteria. The mean age was 62.2 years (SD 8.4). The mean BMI was 33.1 kg/m2 (SD 5.5). The radiological measurements were performed twice by two independent reviewers, and included hip knee ankle (HKA) angle, mechanical medial distal femoral angle (mMDFA), anatomical medial distal femoral angle (aMDFA), femoral neck shaft angle (NSA), femoral bowing angle (FBow), the distance between the knee centre and the top of the FBow (DK), and the angle representing the FBow impact on the knee (C'KS angle). The FBow impact on the mMDFA can be measured by the C'KS angle. The C'KS angle took the localization (length DK) and the importance (FBow angle) of the FBow into consideration. The mean FBow angle was 4.4° (SD 2.4; 0 to 12.5). The mean C'KS angle was 1.8° (SD 1.1; 0 to 5.8). Overall, 84 knees (41%) had a severe FBow (> 5°). The radiological measurements showed very good to excellent intraobserver and interobserver agreements. The C'KS increased significantly when the length DK decreased and the FBow angle increased (p < 0.001). The impact of the diaphyseal femoral deformity on the mechanical femoral axis is measured by the C'KS angle, a reliable and reproducible measurement.
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Affiliation(s)
- Cécile Batailler
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Claude Bernard Lyon 1 University, Villeurbanne, France
| | | | - Jeremy Daxhelet
- Department of Orthopaedic Surgery, Clinique Saint-Luc Bouge, Namur, Belgium
| | - Sébastien Lustig
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Claude Bernard Lyon 1 University, Villeurbanne, France
| | - Matthieu Ollivier
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
| | - Sebastien Parratte
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France
- Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
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Kuiper RJA, Seevinck PR, Viergever MA, Weinans H, Sakkers RJB. Automatic Assessment of Lower-Limb Alignment from Computed Tomography. J Bone Joint Surg Am 2023; 105:700-712. [PMID: 36947661 DOI: 10.2106/jbjs.22.00890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Preoperative planning of lower-limb realignment surgical procedures necessitates the quantification of alignment parameters by using landmarks placed on medical scans. Conventionally, alignment measurements are performed on 2-dimensional (2D) standing radiographs. To enable fast and accurate 3-dimensional (3D) planning of orthopaedic surgery, automatic calculation of the lower-limb alignment from 3D bone models is required. The goal of this study was to develop, validate, and apply a method that automatically quantifies the parameters defining lower-limb alignment from computed tomographic (CT) scans. METHODS CT scans of the lower extremities of 50 subjects were both manually and automatically segmented. Thirty-two manual landmarks were positioned twice on the bone segmentations to assess intraobserver reliability in a subset of 20 subjects. The landmarks were also positioned automatically using a shape-fitting algorithm. The landmarks were then used to calculate 25 angles describing the lower-limb alignment for all 50 subjects. RESULTS The mean absolute difference (and standard deviation) between repeat measurements using the manual method was 2.01 ± 1.64 mm for the landmark positions and 1.05° ± 1.48° for the landmark angles, whereas the mean absolute difference between the manual and fully automatic methods was 2.17 ± 1.37 mm for the landmark positions and 1.10° ± 1.16° for the landmark angles. The manual method required approximately 60 minutes of manual interaction, compared with 12 minutes of computation time for the fully automatic method. The intraclass correlation coefficient showed good to excellent reliability between the manual and automatic assessments for 23 of 25 angles, and the same was true for the intraobserver reliability in the manual method. The mean for the 50 subjects was within the expected range for 18 of the 25 automatically calculated angles. CONCLUSIONS We developed a method that automatically calculated a comprehensive range of 25 measurements that defined lower-limb alignment in considerably less time, and with differences relative to the manual method that were comparable to the differences between repeated manual assessments. This method could thus be used as an efficient alternative to manual assessment of alignment. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ruurd J A Kuiper
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter R Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- MRIguidance B.V., Utrecht, the Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ralph J B Sakkers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
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Pioger C, Mabrouk A, Siboni R, Jacquet C, Seil R, Ollivier M. Double-level knee osteotomy accurately corrects lower limb deformity and provides satisfactory functional outcomes in bifocal (femur and tibia) valgus malaligned knees. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07325-y. [PMID: 36705689 DOI: 10.1007/s00167-023-07325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Double-level knee osteotomy (DLO) is a challenging procedure that requires precision in preoperative planning and intraoperative execution to achieve the desired correction. It is indicated in cases of severe varus or valgus deformities where a single-level osteotomy would yield significantly tilted joint line obliquity (JLO). This study aimed to evaluate the effectiveness of DLO in achieving accurate correction without compromising JLO, using patient-specific cutting guides (PSCGs), in cases of bifocal valgus maligned knees. METHODS A single-centre, retrospective analysis of prospectively collected data for a total of 26 patients, who underwent DLO by PSCGs for valgus malaligned knees, between 2015 and 2020. Post-operative alignment was evaluated and the delta for different lower limb0.05, not statistically significant (ns)). All KOOS subs alignment parameters was calculated; the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), and lateral distal femoral angle (ΔLDFA). At the two-year follow-up, changes in the KOOS sub-scores, UCLA scores, lower limb discrepancy (LLD), and mean time to return to work and sport were recorded. All intraoperative and postoperative complications were recorded. The Mann-Whitney U test with a 95% confidence interval (95% CI) was used to evaluate the differences between two variables; one-way ANOVA between more than two variables and the paired Student's t-test was used to estimate the evolution of functional outcomes. RESULTS The postoperative mean ΔHKA was 0.9 ± 0.9°, the mean ΔMPTA was 0.7 ± 0.7°, and the mean ΔLDFA was 0.7 ± 0.8° (all values with p > 0.05, not statistically significant (ns)). All KOOS subscore's mean values were improved to an extent two-fold superior to the reported minimal clinically important difference (MCID) (all with p < 0.0001). There was a significant increase in the UCLA score at the final follow-up (5.4 ± 1.5 preoperatively versus 7.7 ± 1.4, p < 0.01). The mean time to return to sport and work was 4.7 ± 1.1 and 4.3 ± 2.1 months, respectively. There was an improvement in Lower-limb discrepancy preoperative (LLD = 1.3 ± 2 cm) to postoperative measures (LLD = 0.3 ± 0.4 cm), ns. Complications were 2 femoral hinge fractures, 2 deep vein thromboses, 1 delayed tibial healing, and 1 hardware removal for hamstring irritation syndrome. CONCLUSION DLO is effective and safe in achieving accurate correction in bifocal valgus malaligned knees with maintained lower limb length and low complication rate with no compromise of JLO. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Charles Pioger
- Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, 9, Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
| | - Ahmed Mabrouk
- Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, France
| | - Renaud Siboni
- Department of Orthopaedic Surgery, Reims Teaching Hospital, Hôpital Maison Blanche, 45 Rue Cognacq-Jay, 51092, Reims, France
| | - Christophe Jacquet
- Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, France
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
| | - Matthieu Ollivier
- Department of Orthopaedic Surgery, Sainte-Marguerite Hospital, Institut du Mouvement de L'Appareil Locomoteur (IML), 19, Avenue Viton, 13009, Marseille, France
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9
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Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H, Inaba Y. Potential anatomic risk factors resulting oversized postoperative medial proximal tibial angle after double level osteotomy. BMC Musculoskelet Disord 2022; 23:1121. [PMID: 36550449 PMCID: PMC9784003 DOI: 10.1186/s12891-022-06101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Double level osteotomy (DLO) has been introduced to prevent increased postoperative joint line obliquity. However, although DLO is planned, knees with postoperative medial proximal tibial angle (MPTA) > 95° in preoperative surgical planning are present. This retrospective study aimed to evaluate risk factors for an MPTA > 95° in preoperative surgical planning for DLO in patients with varus knee osteoarthritis (OA). METHODS A total of 168 knees that underwent osteotomies around the knee for varus knee OA were enrolled. The hip-knee-ankle angle (HKA), weight-bearing line (WBL) ratio, mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA) and mechanical medial proximal tibial angle (mMPTA) were measured on preoperative radiographs. The postoperative WBL ratio was planned to be 62.5%. When the postoperative mMPTA was more than 95° in isolated high tibial osteotomy (HTO), (DLO) was planned so that the postoperative mLDFA was 85°, and residual deformity was corrected by HTO. Knees with postoperative mMPTA ≤ 95° and > 95° were classified into the correctable group and uncorrectable group, respectively. RESULTS DLO was required in 101 knees (60.1%). Among them, 41 knees (40.6%) were classified into the uncorrectable group. Binomial logistic regression analysis showed that preoperative JLCA and mMPTA were independent predictors in the uncorrectable group. CONCLUSIONS Even with DLO, postoperative mMPTA was more than 95° in approximately 40% of cases. Preoperative increased JLCA and decreased mMPTA were risk factors for a postoperative mMPTA of > 95° after DLO.
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Affiliation(s)
- Shuntaro Nejima
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Ken Kumagai
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Shunsuke Yamada
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Masaichi Sotozawa
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Dan Kumagai
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Hironori Yamane
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
| | - Yutaka Inaba
- grid.268441.d0000 0001 1033 6139Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004 Japan
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10
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No benefits of knee osteotomy patient's specific instrumentation in experienced surgeon hands. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07288-6. [PMID: 36538058 DOI: 10.1007/s00167-022-07288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare the clinical and radiological outcomes of patient-specific instrumentation (PSI) with the conventional free hand (FH) technique in performing coronal plane corrective knee osteotomies in terms of limb alignment and functional scores. The hypothesis is that conventional FH technique in experienced hands with proper pre-operative planning is as precise as PSI. METHODS Patients who underwent coronal plane corrective knee osteotomies with either PSI or FH technique between 2017 and 2019 by the same senior surgeon and have a minimum of 2 years follow-up period were included in this study. A total of 91 knees (84 patients) with mean age of 42.9 ± 12.5 years who had a pre- and post-operative complete weight-bearing radiographic work-up (50 of them were performed with the FH technique and 41 by means of PSI) were included for comparison. The data were retrospectively reviewed both radiologically and clinically using the Knee Injury and Osteoarthritis Outcome Score (KOOS) sub-scores. All cases in both groups were evaluated for the following measurements: hip-knee-ankle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle (mLDFA), and joint line convergence angle (JLCA) both preoperatively and postoperatively. In addition, FH and PSI osteotomy cases were also compared for their precision in achieving the target correction that was planned preoperatively. All cases were also evaluated clinically preoperatively and at 2-year follow-up using KOOS sub-scores and the two groups were compared. RESULTS The mean HKA precision was 1.5 ± 0.9 in FH group and 1.3 ± 0.7 in PSI (P value = n.s.), the mean MPTA precision was 1.6 ± 1.6 in FH group and 2.1 ± 1.2 in PSI (P value = n.s.), the mean m-LDFA precision was 1.9 ± 1.7 in FH group and 1.4 ± 1.3 in PSI (P value = n.s.), and the mean JLCA precision in the FH group was 1.5 ± 1.2 and 1.7 ± 1.2 in PSI (P value = n.s.). For all the radiographic parameters, there were no statistically significant differences between the target correction and the obtained correction in both groups. Moreover, PSI and FH techniques were comparable in terms of clinical outcomes and no significant difference was found between the two groups in any of the 2-year follow-up KOOS sub-scores. CONCLUSION Conventional FH method in the hands of experienced surgeons is as precise as PSI in reliably achieving the planned correction in different coronal plane knee corrective osteotomies. Moreover, there was also no difference between both methods in the 2-year clinical outcome scores.
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Alves P, van Rooij F, Kuratle T, Saffarini M, Miozzari H. Consistent indications, targets and techniques for double-level osteotomy of the knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:4078-4087. [PMID: 35290484 DOI: 10.1007/s00167-022-06915-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/05/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE To systematically review and critically appraise the literature on double-level osteotomy (DLO) of the knee, and determine the indications, contraindications, targets and outcomes. MATERIALS AND METHODS A systematic literature search was performed on PubMed, Embase®, and Cochrane for studies that reported on DLO by any technique or approach, including indications, contraindications, and targets for DLO, as well as patient-reported outcome measures (pROMS) and radiographic angles. RESULTS Twelve eligible studies were found: 9 case series and 3 studies that compared DLO to high-tibial osteotomy (HTO). In all studies, DLO was performed by medial opening-wedge tibial osteotomy and lateral closing-wedge femoral osteotomy. Seven specified that DLO was performed if simple HTO would exceed thresholds of postoperative medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), and/or predicted wedge size. The targets were 88°-95° for MPTA, 84°-89° for LDFA, and 0°-4° for hip-knee-ankle (HKA) angle. The 3 comparative studies reported lower MPTA after DLO (89.6°-92.5°) than after HTO (91.5°-98.3°). All 3 reported similar postoperative HKA after DLO (0.2°-4.4°) as HTO (0.4°-4.8°); only 2 compared postoperative LDFA, which was lower after DLO (85.4° and 84.9°) than HTO (88.7° and 88.8°). Two comparative studies reported postoperative overall KOOS which was slightly lower after DLO (351-403) than HTO (368-410); only 1 study reported separate items of the KOOS. CONCLUSION There was relative consistency between studies on the indications, targets and techniques for DLO. Furthermore, while the comparative studies reported similar preoperative MPTA, LDFA and HKA, the postoperative MPTA and LDFA were lower after DLO than after HTO, though both treatments achieved equivalent postoperative HKA. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
- Philippe Alves
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals and University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | | | | | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
| | - Hermes Miozzari
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals and University of Geneva, Faculty of Medicine, Geneva, Switzerland
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12
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Guy S, Khakha R, Ollivier M. Anterior Closing-Wedge High Tibial Osteotomy Using Patient-Specific Cutting Guide in Chronic Anterior Cruciate Ligament-Deficient Knees. Arthrosc Tech 2022; 11:e1605-e1612. [PMID: 36185113 PMCID: PMC9520025 DOI: 10.1016/j.eats.2022.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/18/2022] [Indexed: 02/03/2023] Open
Abstract
An increased posterior tibial slope has been identified as an independent risk factor for anterior cruciate ligament (ACL) graft rupture, with a critical threshold of 12°. Surgical slope correction by anterior closing wedge (ACW)-high tibial osteotomy (HTO) can reduce ACL force and anterior tibial translation with good clinical outcomes when combined with revision ACL reconstruction. Performing ACW-HTO preserving the tibial tubercule can be challenging for inexperienced surgeons. Patient-specific cutting guides have been shown to be effective in facilitating the surgeon's learning curve in medial opening wedge-HTO by reducing operative time and the use of fluoroscopy as well as decreasing anxiety. The present technique describes a retro-tibial tubercule ACW-HTO using a patient-specific cutting guide.
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Affiliation(s)
- Sylvain Guy
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France,Institute for Locomotion, Aix Marseille University, APHM, CNRS, ISM, Marseille, France
| | - Raghbir Khakha
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France,Guy’s and St. Thomas’ Hospitals, London, United Kingdom
| | - Matthieu Ollivier
- Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, Marseille, France,Institute for Locomotion, Aix Marseille University, APHM, CNRS, ISM, Marseille, France,Address correspondence to Matthieu Ollivier, M.D., Ph.D., Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29 13274 Marseille, France.
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13
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Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Analysis of bone union after medial closing wedge distal femoral osteotomy using a new radiographic scoring system. Arch Orthop Trauma Surg 2022; 142:2303-2312. [PMID: 35676376 DOI: 10.1007/s00402-022-04495-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To compare bone union after medial closing wedge distal femoral osteotomy (MCWDFO) with that after lateral closing wedge distal femoral osteotomy (LCWDFO) using a novel scoring system. MATERIALS AND METHODS The data of 30 patients who received biplanar MCWDFO for valgus knees (MCWDFO group) were retrospectively examined and compared to that of 22 patients (25 knees) who underwent biplanar LCWDFO via a double-level osteotomy (DLO) for varus knees (LCWDFO group). The progression of bone union of the transverse osteotomy plane in the femur was assessed using a newly developed scoring system using radiographs taken immediately after surgery and 3 and 6 months postoperatively. The scoring system is based on a scale of zero to six points with higher scores indicating better bone union. The incidence of hinge fractures was assessed using CT images, and the rates of reoperation were evaluated using medical record data. RESULTS The mean bone union score was significantly lower in the MCWDFO group than in the LCWDFO group 3 months (2.1 ± 1.9 vs. 3.7 ± 1.7, P < 0.01) and 6 months (3.8 ± 2.1 vs 4.9 ± 1.5, P < 0.05) postoperatively. The incidence ratio of hinge fractures was significantly higher in the MCWDFO group than in the LCWDFO group (70.0% vs. 32.0%, P < 0.01). Two patients in the MCWDFO group underwent reoperation for delayed bone union or non-union. CONCLUSION Bone union progression was slower and hinge fractures were more frequently observed after MCWDFO than after LCWDFO via DLO. MCWDFO is technically challenging, and patients must be monitored closely during and after surgery.
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Affiliation(s)
- Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Akiyoshi Mori
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shu Watanabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kiminari Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shinya Oka
- Department of Orthopaedic Surgery, Meiwa Hospital, Nishinomiya, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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14
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Bafor A, Iobst CA. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2022; 104:1419-1425. [PMID: 35703147 DOI: 10.2106/jbjs.22.00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Anirejuoritse Bafor
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio
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15
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Sautet P, Kley K, Khakha R, Ollivier M. Minimally Invasive Double Level Osteotomy in Severe Knee Varus: Pearls and Pitfalls. Arthrosc Tech 2022; 11:e1105-e1109. [PMID: 35782831 PMCID: PMC9244850 DOI: 10.1016/j.eats.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 02/03/2023] Open
Abstract
Minimally invasive double-level osteotomy (DLP) surgery is performed in severe knee varus, when extra-articular deformity is identified in both the distal femur and proximal tibia. The main advantage is to maintain a horizontal joint line and avoid creating secondary anatomic deformities. This article considers the pearls and pitfalls in performing minimally invasive DLO surgery.
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Affiliation(s)
- Pierre Sautet
- Institut du Mouvement et de l'Appareil Locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | | | - Raghbir Khakha
- London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, London, United Kingdom
| | - Matthieu Ollivier
- Institut du Mouvement et de l'Appareil Locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
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16
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Nejima S, Kumagai K, Yamada S, Sotozawa M, Kumagai D, Yamane H, Inaba Y. Surgical planning of osteotomies around the knee differs between preoperative standing and supine radiographs in nearly half of cases. BMC Musculoskelet Disord 2022; 23:497. [PMID: 35619060 PMCID: PMC9134639 DOI: 10.1186/s12891-022-05461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the difference in surgical planning of osteotomies around the knee between preoperative standing and supine radiographs and to identify risk factors for discrepancies in surgical planning. Methods This study included 117 knees of 100 patients who underwent osteotomies around the knee for knee osteoarthritis with genu varum. Surgical planning was performed so that the target point of the postoperative weight-bearing line (WBL) ratio was 62.5% in preoperative standing and supine radiographs. If the opening gap would be > 13 mm in open-wedge high tibial osteotomy (OWHTO), closed-wedge HTO (CWHTO) was planned. If the postoperative mMPTA would be > 95° in isolated HTO, double-level osteotomy (DLO) was planned. In DLO, lateral closed-wedge distal femoral osteotomy was performed so that the postoperative mechanical lateral distal femoral angle (mLDFA) was 85°, and any residual varus deformity was corrected with HTO. Results Surgical planning differed between standing and supine radiographs in 43.6% of cases. In all knees for which surgical planning differed between standing and supine radiographs, a more invasive type of osteotomy was suggested by standing radiographs than by supine radiographs. The risk factors for discrepancies in surgical planning were a lower WBL ratio in standing radiographs and a lower joint line convergence angle in supine radiographs. Conclusions Surgical planning of DLO, CWHTO and OWHTO, in standing radiographs differed from that in supine radiographs in nearly half of the cases. Surgical planning based on standing radiographs leads to more invasive surgical procedures compared to supine radiographs.
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Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan.
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Dan Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Hironori Yamane
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan
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