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KMID : 1144520230350010024
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Knee Surgery & Related Research
2023 Volume.35 No. 1 p.24 ~ p.24
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Radiologic simulation of leg length change after double level osteotomy in preoperative surgical planning
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Shuntaro Nejima
Ken Kumagai
Shunsuke Yamada
Masaichi Sotozawa
Yutaka Inaba
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Abstract
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Background : To evaluate the expected postoperative total leg length change using preoperative radiographs during surgical planning of four different methods of double level osteotomy (DLO).
Methods : This study included 34 patients (44 knees) who underwent DLO for varus knee osteoarthritis. Surgical planning was performed so that the postoperative weight bearing line ratio was 62.5%. In DLO, lateral closed or medial open wedge distal femoral osteotomy (LCWDFO, MOWDFO) was performed so that the postoperative mechanical lateral distal femoral angle was 85°, and residual deformity was corrected with medial open or lateral closed wedge high tibial osteotomy (MOWHTO, LCWHTO). Pre- and surgical planning X-rays in the one-leg standing position were compared to assess the change in leg length, and the factors affecting it, in the various surgical groups. The proportion of cases in which Δ total leg length was greater than 6 mm (symptomatic change) was investigated.
Results : The mean postoperative total leg length increased significantly with LCWDFO?+?MOWHTO, MOWDFO?+?MOWHTO, and MOWDFO?+?LCWHTO, while it decreased with LCWDFO?+?LCWHTO. The proportion of cases with a postoperative total leg length change?>?6 mm was 72.7%, 2.3%, 100%, and 6.8% in LCWDFO?+?MOWHTO, LCWDFO?+?LCWHTO, MOWDFO?+?MOWHTO, and MOWDFO?+?LCWHTO, respectively. In addition, the preoperative hip-knee-ankle angle correlated negatively with the postoperative total leg length change in LCWDFO?+?MOWHTO, MOWDFO?+?MOWHTO, and MOWDFO?+?LCWHTO, but not in LCWDFO?+?LCWHTO.
Conclusions : MOWDFO?+?MOWHTO had the largest postoperative leg length change and MOWDFO?+?LCWHTO had the smallest. Symptomatic leg length change (>?6 mm) should be considered in MOWDFO?+?MOWHTO and LCWDFO?+?MOWHTO.
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KEYWORD
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High tibial osteotomy, Double level osteotomy, Distal femoral osteotomy, Leg length change
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