Purpose
To evaluate return to sport (RTS) and work (RTW), as well as clinical outcomes following
double level osteotomy (DLO) via combined medial open wedge high tibial osteotomy
and lateral closing wedge distal femoral osteotomy for bifocal symptomatic varus malalignment,
and to compare these outcome parameters between patients undergoing a single surgery
and those undergoing a two-stage procedure.
Methods
Consecutive patients who underwent DLO for symptomatic varus malalignment between
12/2007 and 03/2018 were enrolled. Patients converted to arthroplasty (n = 3) during follow-up were excluded. Outcome measures included the International
Knee Documentation Committee (IKDC) Score, Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC), Lysholm score, Tegner Activity Scale, and visual analog
scale (VAS) for pain, which were collected preoperatively and at a minimum of 24 months
postoperatively. RTS and RTW were evaluated by questionnaire. Outcome measures were
compared between DLO performed in a single- versus a two-stage surgery.
Results
Thirty-two patients (mean age: 44.2 ± 12.6 years), who underwent DLO for varus malalignment
(10.1° ± 2.9°) were included at a mean follow-up of 56.9 ± 35.3 months (range: 24-148).
Compared to preoperatively, these patients significantly improved in IKDC (50.4 ±
13.9 to 66.1 ± 15.4; P < .001), WOMAC (29.7 ± 19.2 to 11.8 ± 13.5; P < .001) and Lysholm (53.6 ± 23.6 to 73.1 ± 23.6; P = .002) scores at final follow-up. For the WOMAC score, 78% of the patients included
reached the minimally important clinical difference, along with a significant reduction
of the VAS for pain (5.0 ± 3.0 to 2.5 ± 2.4; P < .001). Postoperatively, 96% of patients returned to sport after 7.7 ± 4.8 months,
but at a lower frequency (P = .010) and to fewer disciplines (P = .005) with a shift to low-impact sports. 90% of the patients returned to work at
a mean 5.9 ± 9.4 months, with 79% reporting a similar or superior working ability.
Patients undergoing a two-stage procedure recovered to full physical working ability
at a significantly longer duration, as compared to a single-stage procedure (9.8 ±
3.8 vs 9.0 ± 13.1 months; P = .047).
Conclusion
The majority of patients undergoing DLO for symptomatic varus malalignment, who were
not converted to arthroplasty, experienced clinically significant functional improvement
at mid-term follow-up. Return to sport and work rates in these patients were high;
however, a shift to lower-impact sports disciplines was observed. Similar clinical
outcomes can be expected when performing DLO in a single surgery or a two-stage procedure.
Level of Evidence
Retrospective case series; Level IV
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Article Info
Publication History
Published online: December 15, 2021
Accepted:
December 1,
2021
Received:
June 23,
2021
See commentary on page 1954Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.B.I. reports being a consultant for Arthrosurface and Medi Bayreuth and receives royalties from Arthrex Inc., and Arthrosurface, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
