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Change of leg length after double level osteotomy for severe varus
ESSKA Academy. MAKOTO K. May 9, 2018; 212526; P11-610
KANTO MAKOTO
KANTO MAKOTO
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Abstract
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Objectives: Around the knee osteotomy is generally indicated for patients with high levels of activity who have uni-compartmental knee osteoarthritis. It has been reported that opening wedge high tibial osteotomy (OWHTO) results in increased whole leg length in proportion to the wedge size. Especially in knees with large amount of correction, the resultant limb lengthening may cause problems such as gait disturbance and discomfort. Combination of OWHTO and closing wedge distal femoral osteotomy in double level osteotomy (DLO) may cope with this complication by reducing the postoperative change in leg length; however, there have been no studies that examined the leg length change after DLO. The purpose of the study was to examine the change in leg length after DLO in our patient population.

Methods: DLO was indicated for medial compartment osteoarthritic knees with severe varus malalignment. Among the patients who underwent DLO, 40 knees in 31 patients with postoperative radiological assessment data available were included in the study. The mean age was 63.5 ± 6.1 years. Radiological measurements of leg length were made on whole leg weight-bearing radiographs both before and after surgery. Analytical parameters were as follows: length of the femur (from the top of the femoral head to the center of the distal femur), length of the tibia (from the center of the tibial plateau to the center of the tibial plafond), and whole leg length (from the top of the femoral head to the center of the tibial plafond). The measurements were performed using the digital planning software (mediCAD®). In addition, wedge size values on the femur and the tibia were obtained from the operative record.

Results: The mean femoral length changed from 415.3 ± 17.4 mm preoperatively to 410.2 ± 18.2 mm postoperatively. The mean tibial length changed from 311.1 ± 17.9 mm preoperatively to 315.1 ± 17.1 mm postoperatively. The mean whole leg length changed from 725.0 ± 33.6 mm preoperatively to 729.2 ± 33.6 mm postoperatively with the postoperative increase of 4.2 ± 14.1 mm. The mean medial opening wedge size on the tibia was 5.4 ± 1.4 mm and the lateral closing wedge size on the femur averaged 8.7 ± 2.1 mm.

Conclusions: There have been no reports examining the change in leg length after DLO. Although leg elongation following OWHTO with large amount of correction can be a problem causing discomfort and disability, the results of this study showed that postoperative change in leg length can be reduced in DLO due to the combined effect of closing and opening wedge osteotomies.

Keywords:
Double level osteotomy, leg length
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