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

OBJECTIVE

Degenerative knee osteoarthritis (OA) impairs joint function and quality of life. Osteotomies such as distal femoral osteotomy (DFO), double level osteotomy (DLO), and medial open wedge high tibial osteotomy (MOWHTO) aim to restore alignment and function.

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies from 2019-2024 were identified from PubMed, Scopus, ScienceDirect, and China National Knowledge Infrastructure. Included studies reported Knee injury and Osteoarthritis Outcome score (KOOS) quality of life scores (QOL) before and after surgery in patients with varus deformity and compartmental OA. Eight studies with 501 patients were analyzed.

RESULTS

All techniques improved KOOS scores. The greatest improvement was seen in DFO (standardized mean difference=-3.13), followed by DLO (-2.44) and MOWHTO (-2.38). Heterogeneity ranged from 0% to 24%. DFO showed the highest improvement with lower complication risk.

CONCLUSIONS

DFO provides the greatest QOL improvement. DLO is useful for complex deformities, while MOWHTO suits active patients. Standardized techniques and advanced technologies are needed for optimal outcomes.