Patients’ expectations of osteotomies around the knee are high regarding activities of daily living

  • Leonard Grünwald
  • Peter Angele
  • Steffen Schröter
  • Jörg Dickschas
  • Jörg Harrer
  • Stefan Hinterwimmer
  • Matthias J. Feucht
  • Achim Preiss
  • Philipp Minzlaff
  • Tim SaierEmail author



This study was conducted to investigate patients’ expectations on high tibial osteotomies, distal femur osteotomies, and double-level osteotomies in different health-related domains. It was hypothesized that expectations are high in terms of capacity to work, pain relief, and restoring knee function.


A total of 264 patients (age 47 years ± 11 years) were enrolled in this study from March 2015 until May 2016 in seven specialized orthopaedic surgery departments. Data were collected via the Knee injury and Osteoarthritis Outcome Score, the Hospital for Special Surgery-Knee Surgery Expectations Survey, and a ten-item (non-validated) questionnaire to specifically ask about expectations of osteotomies around the knee 24–48 h prior to surgery. In addition, self-efficacy was assessed. Parametric tests were used to test the hypothesis.


Knee injury and Osteoarthritis Outcome Score test results showed that all patients suffered because of their knee impairments prior to surgery. All participants had high expectations in all aspects regarding the surgical outcome: on a four-point Likert scale ranging from 1 (very important) to 4 (not important), all mean values were between 1.2 and 1.7. For patients who had a demanding physical work, the ability to keep a stressful working posture was more important than for other patients (i.e. to kneel, to squat). Furthermore, preoperative lower quality of life was associated with higher expectations concerning improving the ability to walk, to achieve improvements in activities of daily living and social well-being.


Patients’ expectations of osteotomies around the knee are high in terms of capacity to work, pain relief, and restoring functions. The natural course of osteoarthritis and the potential need for conversion to TKA were underestimated by a substantial proportion of the study population. However, the expectation regarding survival rate is in line with the reported literature. The results of this study should assist surgeons in discussing realistic expectations when considering and counselling patients regarding osteotomies around the knee. This may help to clarify realistic expectations preoperatively and ultimately improve patients’ satisfaction.

Level of evidence

Therapeutic study, Level II.


Osteotomy Knee Expectation Osteoarthritis HTO DFO Malalignment 


Author contributions

LG: creation of the database, data acquisition, statistics, and drafting the manuscript. PA: involved in study design, data acquisition, literature research, and final editing. SS: involved in study design, data acquisition, literature research, and final editing, JH: involved in study design, data acquisition, literature research, and final editing. JD: involved in study design, data acquisition, literature research, and final editing. SH: involved in study design, data acquisition, literature research, and final editing. AP: involved in study design, data acquisition, literature research, and final editing. PM: created the study design, data acquisition, literature research, and final editing. TS: created the study design, data acquisition, and final editing.


No funding.

Compliance with ethical standards

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Leonard Grünwald
    • 1
  • Peter Angele
    • 2
  • Steffen Schröter
    • 1
  • Jörg Dickschas
    • 3
  • Jörg Harrer
    • 4
  • Stefan Hinterwimmer
    • 5
  • Matthias J. Feucht
    • 6
  • Achim Preiss
    • 7
  • Philipp Minzlaff
    • 8
    • 9
  • Tim Saier
    • 10
    Email author
  1. 1.BG Traumahospital Tübingen, Trauma- and Reconstructive SurgeryUniversity of TübingenTübingenGermany
  2. 2.Department of Trauma SurgeryUniversity Medical Center Regensburg and Sporthopaedicum RegensburgRegensburgGermany
  3. 3.SozialStiftung Bamberg, Klinikum BambergBambergGermany
  4. 4.Regiomed Kliniken, Klinikum LichtenfelsLichtenfelsGermany
  5. 5.OrthoPlus MunichMunichGermany
  6. 6.Department of Orthopedics and Trauma Surgery, Medical CenterAlbert-Ludwigs-University of FreiburgFreiburgGermany
  7. 7.Department of Trauma and Reconstructive SurgeryASKLEPIOS Clinic St. GeorgHamburgGermany
  8. 8.Berufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurtGermany
  9. 9.Abteilung für Sportorthopädie, Chirurgisches Klinikum München SüdMuchenGermany
  10. 10.Berufsgenossenschaftliche Unfallklinik MurnauMurnauGermany

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