Superior accuracy in knee double level osteotomy using a novel hybrid fixation technique compared to conventional...

Area of Science:

• Orthopedic surgery
• Knee osteotomy
• Biomechanical fixation techniques

Background:

• Double-level knee osteotomy (DLO) is a surgical procedure to correct knee alignment.
• Fixation techniques are crucial for achieving accurate and stable correction.
• Comparing different fixation methods is essential for optimizing surgical outcomes.

Purpose of the Study:

• To compare the radiological coronal plane correction accuracy of two DLO fixation techniques: nail-plate (NP) versus double-plate (DP).
• To evaluate secondary outcomes including correction outliers, clinical results, and 5-year patient satisfaction.

Main Methods:

• Retrospective review of 24 DLO cases (2011-2019) divided into NP (n=12) and DP (n=12) groups.
• Radiographic parameters (mFTA, MPTA, mLDFA, JLCA, Mikulicz %) were measured.
• Correction accuracy was calculated, and outliers defined as >10% deviation from planned correction.

Main Results:

• Both NP and DP groups achieved significant coronal plane corrections (p < 0.05).
• The NP group showed higher correction accuracy (3.4% ± 3.4%) compared to the DP group (7.1% ± 3.9%) (p < 0.05).
• No outliers were observed in the NP group, versus two outliers (16.7%) in the DP group. Both groups reported significant clinical improvement at 2 and 5 years.

Conclusions:

• Hybrid fixation using a nail-plate system achieved superior correction accuracy and fewer outliers in DLO compared to conventional double-plating.
• The magnetic extendable nail's potential for postoperative adjustment is highlighted.
• This technique may serve as a template for future implant designs focused on postoperative correction.