Single Center Experience Performing Simultaneous Double Level Osteotomies for Sever Deformities Around the Knee

Osteotomies around the knee, including high tibial osteotomies and distal femoral osteotomies, are commonly used to surgically correct lower limb malalignment. While they are well indicated for some patients, providing pain relief and functionality, these demanding surgeries carry the risk of over or undercorrection and joint line obliquity. The latter could be potentially avoided by performing a simultaneous double level osteotomy (DLO). Our experience is based on 7 DLOs performed over the last two years in the Hadassah Medical Center in Jerusalem. Four females and 3 males ages between 16-49 underwent DLO indicated for significant deformities resulting from either developmental, postsurgical or degenerative etiologies. A standing AP long-leg X-ray was routinely performed preoperatively to measure the mechanical axis deviation (62+-6mm), lateral distal femoral angle (92+-4°), medial proximal tibial angle (78+-6°), joint line convergence angle (3.7+-1.4°) and leg length discrepancy (16.8+-6mm). All 7 patients underwent DLO based on preoperative computer aided planning. Surgical technique included the use of either a medial or a lateral approach to the distal femur utilizing open or closing wedge osteotomy. All tibial osteotomies were performed at the medial side using open or closing wedge technique. Patients have been followed up clinically and radigraphically. Complications included one case of tibial delayed union requiring bone grafting and one instance supeficial surgical site infection.