Clark Sean C, Simon Karissa N, Saris Daniel B F, Taunton Michael J, Krych Aaron J, Hevesi Mario
Department of Orthopedic Surgery Mayo Clinic Rochester Minnesota USA.
Department of Orthopedic Surgery, University Medical Center Utrecht University Utrecht The Netherlands.
J Exp Orthop. 2025 Jan 8;12(1):e70140. doi: 10.1002/jeo2.70140. eCollection 2025 Jan.
Double-level osteotomies (DLOs) have shown promising results for knee joint preservation, however, most ultimately progress in terms of degenerative disease resulting in conversion to total knee arthroplasty (TKA). Therefore, the purpose of this study was to examine the time to TKA conversion, long-term clinical outcomes and revision rates of patients who have undergone TKA after prior ipsilateral DLO.
Patients who underwent simultaneous or staged DLO and subsequently underwent conversion to TKA at a single academic institution from 1997 to 2022 were evaluated. The type of osteotomy performed (opening- vs. closing-wedge), osteotomy hardware fixation, when and if osteotomy hardware was removed, implanted TKA components and revision rates were recorded. Postoperative outcomes, including Forgotten Joint Score-12 (FJS-12), Tegner Activity Scale score and subjective knee preference were also obtained.
A total of 22 patients (24 knees) underwent TKA following DLO and were followed for an average of 26.1 ± 7.7 years. The average time from DLO to TKA conversion was 14.1 ± 6.5 years, with 70.8% of knees converting to TKA more than 10 years after DLO. The mean follow-up after conversion to TKA was 12.0 ± 7.7 years. Only 12.5% of patients received a varus-valgus or hinged-constrained TKA. At the final follow-up, the mean FJS-12 was 75.8 ± 23.1, while the mean Tegner Activity Scale score was 2.5 ± 1.1. Seventy-seven percent of patients had no subjective knee preference or preferred their DLO-TKA knee. Only two knees (7.4%) underwent subsequent revision after index arthroplasty at a mean of 9.3 years postoperatively.
A majority of DLOs (70.8%) converted to TKA after more than a decade. Subsequent TKA function was favorable as most patients had either no subjective knee preference or preferred their DLO-TKA knee. This study demonstrates both long-term joint preservation and uncompromised TKA function after prior DLO.
Level IV.
双平面截骨术（DLO）在膝关节保留方面已显示出有前景的结果，然而，大多数最终会因退行性疾病进展而导致转换为全膝关节置换术（TKA）。因此，本研究的目的是检查接受同侧DLO后再行TKA患者的TKA转换时间、长期临床结果和翻修率。
对1997年至2022年在单一学术机构接受同期或分期DLO并随后转换为TKA的患者进行评估。记录所进行的截骨术类型（开放楔形与闭合楔形）、截骨术硬件固定情况、截骨术硬件何时以及是否被移除、植入的TKA组件和翻修率。还获得了术后结果，包括遗忘关节评分-12（FJS-12）、泰格纳活动量表评分和主观膝关节偏好。
共有22例患者（24个膝关节）在DLO后接受了TKA，并平均随访了26.1±7.7年。从DLO到TKA转换的平均时间为14.1±6.5年，70.8%的膝关节在DLO后10年以上转换为TKA。转换为TKA后的平均随访时间为12.0±7.7年。只有12.5%的患者接受了内翻-外翻或铰链约束型TKA。在最后一次随访时，平均FJS-12为75.8±23.1，而平均泰格纳活动量表评分为2.5±1.1。77%的患者没有主观膝关节偏好或更喜欢他们的DLO-TKA膝关节。只有两个膝关节（7.4%）在初次关节置换术后平均9.3年进行了后续翻修。
大多数DLO（70.8%）在十多年后转换为TKA。随后的TKA功能良好，因为大多数患者要么没有主观膝关节偏好，要么更喜欢他们的DLO-TKA膝关节。本研究证明了先前DLO后长期的关节保留和不影响TKA功能。
IV级。
