Knee Realignment, Life Realigned: A Systematic Review on KOOS-QOL Improvement after Osteotomy

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Rehabilitative Medicine

Background:

• Knee osteoarthritis (OA) significantly impacts joint function and patient quality of life.
• Osteotomy procedures, including distal femoral osteotomy (DFO), double level osteotomy (DLO), and medial open wedge high tibial osteotomy (MOWHTO), are utilized to correct alignment and restore function in degenerative knee conditions.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness of different osteotomy techniques in improving quality of life for patients with knee osteoarthritis and varus deformity.
• To compare the outcomes of DFO, DLO, and MOWHTO based on Knee injury and Osteoarthritis Outcome score (KOOS) quality of life (QOL) scores.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Literature search conducted across PubMed, Scopus, ScienceDirect, and China National Knowledge Infrastructure for studies published between 2019 and 2024.
• Analysis of eight studies involving 501 patients, focusing on pre- and post-operative KOOS QOL scores.

Main Results:

• All evaluated osteotomy techniques demonstrated significant improvements in KOOS QOL scores.
• Distal femoral osteotomy (DFO) yielded the greatest improvement (SMD = -3.13), followed by double level osteotomy (DLO) (SMD = -2.44) and medial open wedge high tibial osteotomy (MOWHTO) (SMD = -2.38).
• DFO exhibited the highest efficacy with a lower reported risk of complications, and low heterogeneity was observed across studies (0%-24%).

Conclusions:

• Distal femoral osteotomy (DFO) provides superior quality of life improvements for knee osteoarthritis patients.
• Double level osteotomy (DLO) is effective for complex deformities, while medial open wedge high tibial osteotomy (MOWHTO) is suitable for active individuals.
• Standardization of surgical techniques and integration of advanced technologies are recommended for optimizing patient outcomes in knee osteotomy.