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Noguchi T, Hirao M, Okamura G, Tsuiji S, Hashimoto J. Midterm Outcomes After Total Knee Arthroplasty With Lateral Approach for Valgus Knee Deformity in Patients With Rheumatoid Arthritis. Cureus 2024; 16:e58197. [PMID: 38741841 PMCID: PMC11090069 DOI: 10.7759/cureus.58197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Background Valgus knee deformity is often seen in rheumatoid arthritis (RA) cases. Usually, the medial approach has been often utilized for total knee arthroplasty (TKA), even in valgus deformity cases; however, the medial approach is feared to induce further instability in the medial side because it could further break the soft tissue structure, including medial collateral ligament (MCL) and medial patellofemoral ligament (MPFL). Consequently, loosening of the implant, recurrence of valgus knee deformity, and pain due to instability might be induced in the early period after surgery. In this study, a lateral approach for TKA against valgus deformity in RA cases was utilized to avoid further damage on the medial side. Methods Eleven valgus knees in 10 patients with RA (mean age, 61.1 years; mean follow-up, 33.1 months) underwent primary TKA with the lateral approach. Iliotibial band (ITB) dissection and/or peroneal nerve release were performed if necessary. Radiological and clinical investigations were evaluated pre- and postoperatively. Results The average operating time was 106 minutes, which was no longer compared with the time after the medial approach described previously. The extension angle was significantly improved from -15.0 ± 10.2 to -5.5 ± 4.2 degrees (P = 0.03), while the flexion angle showed no significant change (from 111.8 ± 15.9 to 115.0 ± 13.2 degrees). The hip-knee-ankle angle (HKA) was also significantly corrected from -9 ± 4.9 to 0.4 ± 1.7 degrees (P < 0.001). The 2011 Knee Score System (KSS) scores were significantly improved from 6.9 ± 3.4 to 21.5 ± 2.9 (P < 0.001) in symptoms, from 15.6 ± 2.7 to 31.1 ± 4.1 (P < 0.001) in satisfaction, and from 31.5 to 59.5 (P < 0.01) in activity. Conclusion Midterm outcomes after lateral approach TKA were good, and knee alignment was significantly improved. The lateral approach TKA for valgus deformity in patients with RA was not complicated and difficult because it required no additional operating time compared with the medial approach. From the perspective of preventing further damage to the soft tissue structure on the medial side, the lateral approach was meaningful for valgus deformity in patients with RA.
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Affiliation(s)
- Takaaki Noguchi
- Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, JPN
| | - Makoto Hirao
- Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, JPN
| | - Gensuke Okamura
- Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, JPN
| | | | - Jun Hashimoto
- Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, JPN
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Xu K, Zhang L, Yu T, Zhao X, Zhang Y. Effect of Knee Valgus Deformity on Symptomatic Venous Thromboembolism and Prosthesis Revision Risk after Total Knee Arthroplasty: A Multicenter Retrospective Study. Orthop Surg 2024; 16:654-661. [PMID: 38342627 PMCID: PMC10925503 DOI: 10.1111/os.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVE Symptomatic venous thromboembolism (VTE) and prosthesis failure are the most serious complications after total knee arthroplasty (TKA). However, whether knee valgus deformity aggravates these complications has not been fully clarified. To study the difference between perioperative symptomatic VTE and prosthesis revision rate in patients with valgus knee osteoarthritis by comparing with patients undergoing TKA for varus deformity and analyze the reasons for revision. At the same time, the distribution and radiographic features of lower extremity deep venous thrombosis were recorded. METHODS The data of patients who underwent TKA in two tertiary hospitals from January 2016 to December 2020 were retrospectively reviewed, and a total of 8917 patients were included. According to preoperative manifestations of knee malformations, all patients were divided into two groups: valgus group (n = 412) and varus group (n = 8505). Main indicators included the incidence of symptomatic VTE and prosthesis revision. Secondary outcomes included general information on operative time, Kellgren and Lawrence score, total hospital stay, and total costs. The patient data of the two groups were analyzed by Pearson chi-square test, Student t test, or Mann-Whitney U test. The revision was evaluated using Kaplan-Meier survival analysis. RESULTS The proportion of valgus knees in TKA patients was 4.62% (412/8917). The incidence of VTE was 6.23‰ (53/8505) and 16.99‰ (7/412) in the varus and valgus groups, and the results were statistically different (p = 0.009). There was no significant difference in echogenicity, number of occluded vessels, and thrombus length between the valgus group (p = 0.102; p = 0.645; p = 0.684). Patients with valgus deformity had 12.14‰ (5/412) prosthesis revision, the incidence of varus deformity was 4.82‰ (41/8505), and the revision risk of valgus group was 2.5 times higher than varus group, and the results were statistically different (p = 0.043). The operation time and hospital stay in the valgus group were longer than those in the varus group, and the results were statistically different (p = 0.018; p < 0.001). CONCLUSIONS Valgus deformity increases risk of symptomatic VTE and prosthesis revision after TKA. These results have guiding significance for the prevention of complications after TKA in patients with valgus deformity.
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Affiliation(s)
- Kuishuai Xu
- Department of Sports MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Liang Zhang
- Department of Abdominal ultrasoundAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Tengbo Yu
- Institute of Sports Medicine and Health, Qingdao UniversityQingdaoChina
- Department of Orthopedic SurgeryQingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital)QingdaoChina
| | - Xia Zhao
- Department of Sports MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yingze Zhang
- Department of Sports MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoChina
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Alesi D, Meena A, Fratini S, Rinaldi VG, Cammisa E, Lullini G, Vaccari V, Zaffagnini S, Marcheggiani Muccioli GM. Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021? Musculoskelet Surg 2021; 106:1-8. [PMID: 33587251 PMCID: PMC8881420 DOI: 10.1007/s12306-021-00695-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/02/2021] [Indexed: 10/31/2022]
Abstract
Total knee arthroplasty in valgus knee deformities continues to be a challenge for a surgeon. Approximately 10% of patients who undergo total knee arthroplasty have a valgus deformity. While performing total knee arthroplasty in a severe valgus knee, one should aware with the technical aspects of surgical exposure, bone cuts of the distal femur and proximal tibia, medial and lateral ligament balancing, flexion and extension gap balancing, creating an appropriate tibiofemoral joint line, balancing the patellofemoral joint, preserving peroneal nerve function, and selection of the implant regarding constraint. Restoration of neutral mechanical axis and correct ligament balance are important factors for stability and longevity of the prosthesis and for good functional outcome. Thus, our review aims to provide step by step comprehensive knowledge about different surgical techniques for the correction of severe valgus deformity in total knee arthroplasty.
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Affiliation(s)
- D Alesi
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - A Meena
- VMMC and Safdarjung Hospital, Central Institute of Orthopedics, New Delhi, 110029, India
| | - S Fratini
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - V G Rinaldi
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - E Cammisa
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - G Lullini
- UO Medicina Riabilitativa e Neuroriabilitazione, IRCCS Istituto delle Scienze Neurologiche, Via Altura 3, 40139, Bologna, Italy
| | - V Vaccari
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - S Zaffagnini
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - G M Marcheggiani Muccioli
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
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Shibano K, Kunugiza Y, Kawashima K, Tomita T. Total Knee Arthroplasty with Concomitant Corrective Tibial Osteotomy Using Patient-Specific Instrumentation and Computed Tomography-Based Navigation in Severe Post-High Tibial Osteotomy Valgus Collapse. Arthroplast Today 2020; 6:742-746. [PMID: 32923561 PMCID: PMC7476213 DOI: 10.1016/j.artd.2020.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 78-year-old woman with lateral knee osteoarthritis and severe valgus knee deformity after high tibial osteotomy. The patient's severe valgus tibial deformity with a valgus angle of 45° was evaluated using a 3-dimensional bone model, and a closing-wedge osteotomy was planned. Combined total knee arthroplasty and closing-wedge tibial osteotomy were performed using patient-specific instrumentation and a computed tomography–based navigation system. A semiconstrained total knee system with a long stem was implanted for fixation of the osteotomy site in the tibia. The patient was able to walk without pain 2 years postoperatively. The Knee Society Score improved from 13 to 73 points, and the functional score improved from 30 to 65 points. This preoperative planning method and the treatment procedure would be beneficial for clinical decision-making and treatment of severe valgus knee deformities.
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Affiliation(s)
- Koji Shibano
- Department of Orthopedics, Minoh City Hospital, Osaka, Japan
| | - Yasuo Kunugiza
- Department of Orthopedics, JCHO Hoshigaoka Medical Center, Osaka, Japan
| | - Kunihiko Kawashima
- Department of Orthopedics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Tetsuya Tomita
- Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
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Cheng W, Li Z, Zhang J, Cao Q, Yu H, Qi L, Yao F, Jing J. A lateral parapatellar approach with iliotibial band dissection from the Gerdy tubercle for total knee arthroplasty of the valgus knee. Exp Ther Med 2020; 21:38. [PMID: 33273968 DOI: 10.3892/etm.2020.9470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 09/11/2020] [Indexed: 01/14/2023] Open
Abstract
Valgus knee, which causes severe dysfunction and seriously affects the quality of life of patients, is a condition affecting 10% of patients who undergo total knee arthroplasty (TKA). The best choice of surgical approach and the method of release of soft tissue, however, is still unclear. Therefore, the aim of the present study was to investigate the clinical efficacy of a lateral parapatellar approach with iliotibial band (ITB) dissection from the Gerdy tubercle for TKA in valgus knees. In total, 56 patients (25 males and 31 females) who underwent surgery via a lateral parapatellar approach with ITB dissection from the Gerdy tubercle for TKA due to valgus knee, with at least one-year follow-up, were retrospectively analyzed. Operation duration, length of time leg was raised post-surgery, prosthetic position, lower limb force line, visual analogue score for pain (VAS), range of movement (ROM), and Knee Society Scores (KSS; including knee score and functional score) were reviewed and analyzed. The data indicated that VAS, ROM and KSS were significantly improved after surgery compared with those before surgery. Additionally, no patient had a deviation in prosthetic position or limb alignment greater than 5˚. These results suggest that a lateral parapatellar approach with ITB dissection from the Gerdy tubercle for TKA is an effective technique to treat valgus knee, which can significantly improve pain and function without deviation of the lower limb mechanical axis or prosthesis position.
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Affiliation(s)
- Wendan Cheng
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, P.R. China
| | - Ziyu Li
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, P.R. China
| | - Jisen Zhang
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, P.R. China
| | - Qiliang Cao
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, P.R. China
| | - Haoran Yu
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, P.R. China
| | - Lei Qi
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Fei Yao
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, P.R. China
| | - Juehua Jing
- Department of Orthopedic Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230000, P.R. China
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Raut V, Matar HE, Singh A. Satisfactory medium-term outcomes with lateral condylar sliver osteotomy to correct valgus deformity in total knee replacements. Knee Surg Sports Traumatol Arthrosc 2020; 28:1394-1399. [PMID: 30887065 DOI: 10.1007/s00167-019-05488-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/13/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe a surgical technique in correcting valgus deformity during total knee replacement and evaluate medium-term clinical outcomes. METHODS This was a retrospective consecutive series of total knee replacement for severe valgus deformity of patients who underwent a lateral ligament complex release with a sliver osteotomy of the lateral femoral condyle with a minimum 1-year follow-up and recording objective and patient-reported outcome measures. RESULTS Twenty-three patients (25 knees) were included with median follow-up of 5 years (range 1-15 years) and average age 67.7 years (range 43-87). The primary diagnosis was osteoarthritis in 14 patients (61%) and inflammatory arthritis in 9 patients (39%). At final follow-up, the median mechanical tibiofemoral angle was restored to 4° (range 2-7) compared with a median valgus of 20° (range 13-30) preoperatively. This was statistically significant (P < 0.00001). Median Oxford Knee Score at final follow-up was 43 (range 36-48) indicating satisfactory outcomes. There were no revisions for any cause with a mean arc range of movement 110° (range 85-120). CONCLUSION This study shows that a technique utilising the familiar medial parapatellar approach, staged soft tissue releases, and a novel sliver lateral femoral condylar osteotomy with intact periosteum to release the lateral ligament complex leads to satisfactory medium-term outcomes, improved range of movement and patients' reported outcome measures. Sliver osteotomy is a useful technique in correcting valgus deformity in total knee replacements at medium-term follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Videshnandan Raut
- Wrightington and Lancashire Teaching Hospitals, Edge Hill University, Wigan, WN6 9EP, UK
| | - Hosam E Matar
- Centre for Hip Surgery, Wrightington Hospital, Wigan, WN6 9EP, UK.
| | - Amit Singh
- Trauma and Orthopaedics, Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP, UK
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Wang B, Xing D, Li JJ, Zhu Y, Dong S, Zhao B. Lateral or medial approach for valgus knee in total knee arthroplasty - which one is better? A systematic review. J Int Med Res 2019; 47:5400-5413. [PMID: 31642382 PMCID: PMC6862885 DOI: 10.1177/0300060519882208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To identify whether the medial or lateral approach is superior for patients with valgus knees undergoing primary total knee arthroplasty (TKA). Methods Studies evaluating the 2 approaches were sourced from the PUBMED, EMBASE, Web of Science, and OVID databases. The quality of included studies was assessed using a modified quality evaluation method, and differences between approaches were systematically reviewed. Results Seventeen observational studies were included. The studies were published between 1991 and 2016, and included 5 retrospective studies and 12 prospective studies. Sixteen evaluation methods for the study outcomes were identified. Twelve and eight complication types were identified by studies reporting the lateral and medial approaches for valgus knee, respectively. Several studies showed that pain scores and knee function were superior using a lateral approach. Conclusion The lateral approach (combined with a tibial tubercle osteotomy or proximal quadriceps snip) was more useful and safer than the medial approach in the treatment of severe uncorrectable valgus knee deformity in patients undergoing TKA. Most of the available evidence supports the use of a lateral approach provided that the surgeon is familiar with the pathological anatomy of the valgus knee.
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Affiliation(s)
- Bin Wang
- Orthopedic Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Jiao Jiao Li
- Kolling Institute, University of Sydney, Sydney, Australia
| | - Yuanyuan Zhu
- Pharmaceutical Department, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Shengjie Dong
- Orthopedic Department, Yantaishan Hospital, Yantai, Shandong, China
| | - Bin Zhao
- Orthopedic Department, Second Hospital of Shanxi Medical University, Taiyuan, China
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Mou P, Zeng Y, Pei F, Zhou Z, Shen B, Kang P, Yang J. Medial femoral epicondyle upsliding osteotomy with posterior stabilized arthroplasty provided good clinical outcomes such as constrained arthroplasty in primary total knee arthroplasty with severe valgus deformity. Knee Surg Sports Traumatol Arthrosc 2019; 27:2266-2275. [PMID: 30430221 DOI: 10.1007/s00167-018-5292-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/09/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE A modified technique referred to as a medial femoral epicondyle upsliding osteotomy was proposed to address severe valgus deformity with unconstrained posterior stabilized (PS) arthroplasty. The study compared the effectiveness of the technique and PS arthroplasty with constrained arthroplasty during primary total knee arthroplasty (TKA). METHODS Fifty-three patients presenting with valgus knees with a mean valgus angle (VA) greater than 30° were prospectively randomized and divided into two groups, and both groups received primary TKA. Upsliding osteotomy with PS arthroplasty was performed on the knees of 27 patients (group A), while the remaining 26 patients (group B) received a constrained arthroplasty. The Knee Society function score (KSF), Hospital for Special Surgery knee score (HSS), range of motion (ROM), mediolateral stability and hospitalization expenses were recorded. The hip-knee-ankle angle (HKA), femorotibial angle (FTA) and VA were analysed. Complications were also recorded. RESULTS The patients received follow-up care for more than 50 months. The postoperative KSF, HSS and ROM showed marked improvement in both groups (p < 0.05). Radiological assessments showed that HKA, FTA and VA for group A were restored to (179.9 ± 3.0)°, (173.0 ± 2.4)° and (7.0 ± 2.4)°, respectively. For group B, the HKA, FTA and VA were restored to (181.5 ± 2.3)°, (172.5 ± 2.3)° and (7.5 ± 2.3)°, respectively. Only two patients from group A demonstrated mild medial laxity in their knees, and the remaining patients from both groups were stable medially and laterally. However, the total hospitalization expenses and material expenses of group A were less than those of group B because of the more expensive constrained prosthesis and stems. No late-onset loosening or recurrent valgus deformity was displayed. CONCLUSIONS Both medial femoral epicondyle upsliding osteotomy with PS arthroplasty and constrained arthroplasty showed good outcomes for the restoration of neutral limb alignment and soft tissue balance, which are demonstrated to be safe and effective techniques for correcting severely valgus knees. Therefore, the clinically important finding of this study is that medial femoral epicondyle upsliding osteotomy with PS arthroplasty can be an alternative method for correcting severe valgus knees. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ping Mou
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Zeng
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bin Shen
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Pengde Kang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jing Yang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Scior W, Hilber F, Hofstetter M, Graichen H. Short-term and mid-term results of lateral condyle sliding osteotomy in the treatment of valgus total knee arthroplasty: A successful therapy option in Grade 2 valgus total knee arthroplasty. Knee 2018; 25:466-472. [PMID: 29631793 DOI: 10.1016/j.knee.2018.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/01/2018] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Different methods exist for deformity correction and ligament balancing in total knee arthroplasty (TKA) of valgus knees, the sliding osteotomy being one of them. The objective of the current study was to analyze the clinical and radiological short-term and mid-term results of this technique in a larger series. METHODS Between June 2007 and May 2014, 98 patients were treated with 98 TKAs and a simultaneous sliding osteotomy. All of them had a Grade 2 fixed valgus deformity (between 10° and 20°). All patients received a mobile-bearing, non-constrained (CR) implant. After prospective inclusion (T1), patients were clinically assessed after one (T2) and 4.5years (±2.1years) (T3), and radiological and Oxford Knee Score (OKS), Knee Society Knee Score (KSS) and the Knee Society Function Score (KSF) were obtained. RESULTS All knees were corrected to a mechanical leg alignment within three degrees. Significant improvement of all scores could be measured at T2 and T3. Seven revisions needed to be performed; three of them were procedure-related. In two of them, a problem of capsular closure occurred, while in one the slided epicondyle dislocated after three months. All other revisions were performed because of non-procedure-related problems (e.g. infection). CONCLUSIONS Sliding osteotomy of the lateral condyle is a successful option for the treatment of Grade 2 fixed valgus deformity. Due to this technique, higher constraint could be avoided. The results stayed constant over time. The procedure-related complications need to be kept in mind. Long-term results still need to be awaited.
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Affiliation(s)
- Wolfgang Scior
- Department for Arthroplasty and General Orthopaedic Surgery, Orthopaedic Hospital Lindenlohe, Schwandorf, Germany.
| | - Franz Hilber
- Department for Arthroplasty and General Orthopaedic Surgery, Orthopaedic Hospital Lindenlohe, Schwandorf, Germany
| | - Martin Hofstetter
- Department for Arthroplasty and General Orthopaedic Surgery, Orthopaedic Hospital Lindenlohe, Schwandorf, Germany
| | - Heiko Graichen
- Department for Arthroplasty and General Orthopaedic Surgery, Orthopaedic Hospital Lindenlohe, Schwandorf, Germany
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Kahlenberg CA, Trivellas M, Lee YY, Padgett DE. Preoperative Valgus Alignment Does Not Predict Inferior Outcome of Total Knee Arthroplasty. HSS J 2018; 14:50-54. [PMID: 29398995 PMCID: PMC5786588 DOI: 10.1007/s11420-017-9576-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative valgus deformity is present in an estimated 10-20% of patients undergoing total knee replacement (TKR). QUESTIONS/PURPOSES The objective of this study was to compare the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores after TKR in a matched cohort of patients with preoperative valgus and varus deformities. METHODS This is a matched cohort study of 162 patients with varus native knees and 162 patients with valgus native knees who underwent TKR and were prospectively followed in our institutional registry. Patients matched were based on age, BMI, sex, and severity of preoperative knee deformity, which was classified as mild, moderate, severe varus or valgus, or no deformity. Outcomes were evaluated using the WOMAC preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. RESULTS No significant difference was found between the matched varus and valgus cohorts in all WOMAC subdomain scores except for a marginally worse stiffness at 1 year in patients with valgus deformity (WOMAC stiffness, 75.1 varus vs. 70.1 valgus; P = 0.049). This is below the minimal clinically important difference for WOMAC scores. There was no significant difference in postoperative varus/valgus alignment between the two groups (P = 0.092). CONCLUSION We found no clinically significant difference in any of the WOMAC domains in patients with preoperative varus deformity versus valgus deformity within the first year after TKR. These findings may allow surgeons to more appropriately counsel patients with osteoarthritis with valgus deformity that they can expect similar outcomes compared to patients with varus deformity.
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Affiliation(s)
- Cynthia A. Kahlenberg
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Myra Trivellas
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Yuo-yu Lee
- Healthcare Research Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Douglas E. Padgett
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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11
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Aurich M, Lenz M, Best N. A Modified Lateral Approach for Total Knee Replacement in Type 2 Valgus Deformity. Orthopedics 2017; 40:313-316. [PMID: 28585993 DOI: 10.3928/01477447-20170602-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
Total knee replacement for patients with osteoarthritis and valgus deformity remains challenging, with soft tissue balance often difficult to achieve. Most orthopedic surgeons use the medial parapatellar approach for total knee replacement. However, the lateral approach described in this case allows direct access to the pathology. The valgus deformity is corrected by using a modified lateral parapatellar arthrotomy with a staged and gradual release of the contracted lateral capsuloligamentous structures and the iliotibial tract. A Z-shaped dissection of the lateral retinaculum and careful dissection and preservation of the infrapatellar fat pad is performed. The creation of this laterally based vascularized flap provides the necessary tissue to cover the soft tissue gap resulting on the lateral aspect of the knee after valgus correction. The lateral approach has advantages, including ligament balancing and preservation of the medial retinaculum and the medial neurovascular structures for the supply of the patella. However, this approach should be used with caution by experienced surgeons. [Orthopedics. 2017; 40(5):313-316.].
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Unconstrained total knee arthroplasty in significant valgus deformity: a modified surgical technique to balance the knee and avoid instability. Knee Surg Sports Traumatol Arthrosc 2017; 25:2825-2834. [PMID: 26615591 DOI: 10.1007/s00167-015-3881-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 11/12/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE Correction of valgus deformity in total knee arthroplasty (TKA) is technically challenging and has produced variable results. A modified surgical technique involving adapting the distal femoral cut with minimal soft tissue release is proposed. The authors hypothesise that using this technique would result in satisfactory radiological and functional outcome. METHODS The technique involves balancing the knee in extension by changing the distal femoral resection angle and confining soft tissue release to only the posterolateral capsule if required. Retrospective analysis of 276 consecutive TKAs performed using this technique under the care of a single surgeon in patients with valgus knee deformity ≥10° was undertaken. An unconstrained mobile bearing implant was used in all knees with a medial para-patellar approach, and outcome scores were collected prospectively. Seventy-five percent of the knees were cementless. [corrected] RESULTS Mean coronal alignment of the lower limb was corrected from 15.6° (±5.7°) to 3.8° (±2.5°). 97.8 % knees had their coronal alignment restored to ≤7°. Seventy-eight knees (28 %) were balanced by only changing the distal femoral resection angle. One hundred and ninety-eight knees (72 %) had release of the posterolateral capsule. Sixteen knees (5.8 %) also had release of iliotibial band. Lateral patellar release was performed in 39 knees (14 %). 93.1 % had central patello-femoral alignment. At between 5.8 and 10.5 year follow-up, there has been one spinout, managed by closed reduction, and one revision of tibial tray for subsidence. The mean American Knee Society clinical score improved from 19.1 to 86.5 (±12.2). CONCLUSION Adequate correction of valgus knee deformity was successfully achieved using this modified technique with satisfactory medium-term outcome and avoidance of instability.
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Tonelli Filho JR, Passarelli MC, Brito JAS, Campos GC, Zorzi AR, Miranda JBD. Keblish's lateral surgical approach enhances patellar tilt in valgus knee arthroplasty. Rev Bras Ortop 2017; 51:680-686. [PMID: 28050540 PMCID: PMC5198141 DOI: 10.1016/j.rboe.2016.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/15/2016] [Indexed: 11/24/2022] Open
Abstract
Objective To compare the clinical and radiological outcomes of conventional medial and lateral approaches for total knee replacement in the valgus osteoarthritic knee. Methods In this randomized controlled trial, 21 patients with valgus knee osteoarthritis were randomized to total knee replacement through medial or lateral approach. The primary outcome was radiographic patellar tilt. Secondary outcomes were visual analog scale of pain, postoperative levels of hemoglobin, and clinical aspect of the operative wound. Results There were no differences between the groups regarding other clinical variables. Mean lateral tilt of the patella was 3.1 degrees (SD ± 5.3) in the lateral approach group and 18 degrees (SD ± 10.2) in the medial approach group (p = 0.02). There were no differences regarding the secondary outcomes. Conclusion Lateral approach provided better patellar tilt following total knee replacement in valgus osteoarthritic knee.
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Affiliation(s)
- José Roberto Tonelli Filho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Marcus Ceregatti Passarelli
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - João Alberto Salles Brito
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Gustavo Constantino Campos
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Alessandro Rozim Zorzi
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - João Batista de Miranda
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
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Tonelli Filho JR, Passarelli MC, Brito JAS, Campos GC, Zorzi AR, Miranda JBD. Acesso lateral de Keblish melhora a inclinação da patela na artroplastia do joelho valgo. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2016.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Abstract
BACKGROUND An ideal approach for valgus knees must provide adequate exposure with minimal complications due to approach per se. Median parapatellar approach is most commonly used approach in TKA including valgus knees. A medial subvastus approach is seldom used for valgus knees and has definite advantages of maintaining extensor mechanism integrity and minimal effect on patellar tracking. The present study was conducted to evaluate outcomes of total knee arthroplasty (TKA) and efficacy of subvastus approach in valgus knees in terms of early functional recovery, limb alignment and complications. MATERIALS AND METHODS We retrospectively reviewed 112 knees with valgus deformity between January 2006 and December 2011. All patients were assessed postoperatively for pain using Visual Analog Scale (VAS) and quadriceps recovery in form of time to active straight leg raising (SLR) and staircase competency and clinical outcomes using American Knee Society (AKS) score and radiographic evaluation with average followup of 40 months (range 24-84 months). RESULTS The mean VAS on postoperative day (POD) 1 and POD2 at rest was 2.73 and 2.39, respectively and after mobilization was 3.28 and 3.08, respectively (P < 0.001). The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h. The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001). The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°-35°) to 5° (range 3°-9°) valgus (P < 0.001). CONCLUSIONS Mini-subvastus quadriceps approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications.
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Affiliation(s)
- Nilen Amulak Shah
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India,Address for correspondence: Dr. Nilen Amulak Shah, Flat No. 2, Building No. 2, India House, Kemps Corner, Mumbai - 400 026, Maharashtra, India. E-mail:
| | - Nimesh Prakash Jain
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India,Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang-Gu, Seongnam-Si, Korea
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Jiang J, Fernandes JC. A lateral approach defect closure technique with deep fascia flap for valgus knee TKA. J Orthop Surg Res 2015; 10:173. [PMID: 26555547 PMCID: PMC4641429 DOI: 10.1186/s13018-015-0316-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/02/2015] [Indexed: 11/12/2022] Open
Abstract
Background Routinely, we use a midline skin incision and lateral parapatellar approach of the knee to perform valgus knee TKA (total knee arthroplasty). It is generally very difficult to close the lateral capsular defect after valgus knee TKA, especially for severe valgus and flexion knee deformity. Methods We describe a new surgical technique to close the lateral capsular defect with a deep fascia flap. From 2009 to 2012, we used the new technique to close lateral capsular defects for nine valgus TKA in eight patients. The wound healing, infection, range of motion, and postoperative X-ray Laurien view were evaluated. Results According to follow-up, we found that this technique can reduce the risk of intra- and postoperative complications (exposure of knee prosthesis, larger subcutaneous hematoma, poor wound healing, and higher risk of infection) and improve clinical outcome of total knee replacement (good range of motion and patellar tracking). There is no need for lateral parapatellar capsule Z-plasty during incision or filling the distal capsular defect with fat pad or composite meniscal-capsular-fat pad. Conclusion Closing lateral capsular defect with a deep fascia flap for valgus knee TKA through a lateral parapatellar approach is a new and effective surgical technique.
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Affiliation(s)
- Jun Jiang
- Arthritis Clinical & Research Center, Peking University People Hospital, #11 Xizhimen South Avenue, Xicheng District, Beijing, 100044, China.
| | - Julio C Fernandes
- Orthopaedic department, Hopital Du Sacre-Coeur De Montreal, 5400, Boul. Gouin Ouest, Montreal, Quebec, H4JIC5, Canada.
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Nikolopoulos D, Michos I, Safos G, Safos P. Current surgical strategies for total arthroplasty in valgus knee. World J Orthop 2015; 6:469-482. [PMID: 26191494 PMCID: PMC4501933 DOI: 10.5312/wjo.v6.i6.469] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 04/23/2015] [Accepted: 05/18/2015] [Indexed: 02/06/2023] Open
Abstract
The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees.
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Gunst S, Villa V, Magnussen R, Servien E, Lustig S, Neyret P. Equivalent results of medial and lateral parapatellar approach for total knee arthroplasty in mild valgus deformities. INTERNATIONAL ORTHOPAEDICS 2015; 40:945-51. [PMID: 26156728 DOI: 10.1007/s00264-015-2893-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/14/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE When performing total knee arthroplasty (TKA) in valgus knee deformities, a medial or lateral parapatellar approach can be performed, but the lateral approach is often considered technically more difficult. The purpose of this study was to compare intra-operative, early clinical and radiological outcomes of medial and lateral parapatellar approaches for TKA in the setting of moderate knee valgus (<10°). METHODS We prospectively analysed 424 knees with pre-operative valgus deformity between 3° and 10° that underwent TKA over an 18-year period; 109 were treated with a medial approach and 315 with a lateral approach. Intra- and post-operative outcomes and complication rates after a minimum follow-up of one year were compared. RESULTS Tourniquet (p = 0.25) and surgical (p = 0.62) time were similar between groups. The popliteus tendon was released more frequently in the medial-approach group (p = 0.04), while the iliotibial band was released more frequently in the lateral-approach group (p < 0.001). A tibial tuberosity osteotomy was performed more frequently in the lateral- than medial-approach group (p = 0.003). No significant differences in limb alignment (p = 0.78), or Knee Society Score (KSS) knee (p = 0.32) and function (p = 0.47) results were noted based on surgical approach, and complication rates were similar between groups (p = 0.53). CONCLUSIONS Lateral parapatellar approach is a safe and effective surgical technique for performing TKA in moderately valgus knees. These equivalent early results are encouraging for systematic use of the lateral approach in moderately valgus knees.
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Affiliation(s)
- Stanislas Gunst
- Albert Trillat Center, Groupement Hospitalier Nord, Université de Lyon, Lyon, France.
| | - Vincent Villa
- Albert Trillat Center, Groupement Hospitalier Nord, Université de Lyon, Lyon, France
| | - Robert Magnussen
- Department of Orthopaedic Surgery, The Ohio State University Medical Center, Columbus, OH, USA
| | - Elvire Servien
- Albert Trillat Center, Groupement Hospitalier Nord, Université de Lyon, Lyon, France
| | - Sebastien Lustig
- Albert Trillat Center, Groupement Hospitalier Nord, Université de Lyon, Lyon, France
| | - Philippe Neyret
- Albert Trillat Center, Groupement Hospitalier Nord, Université de Lyon, Lyon, France
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Rawal J, Devany AJ, Jeffery JA. Arthroplasty in the Valgus Knee: Comparison and Discussion of Lateral vs Medial Parapatellar Approaches and Implant Selection. Open Orthop J 2015; 9:94-7. [PMID: 26157523 PMCID: PMC4483534 DOI: 10.2174/1874325001509010094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/18/2015] [Accepted: 02/20/2015] [Indexed: 11/22/2022] Open
Abstract
Constrained implants are frequently used for primary total knee arthroplasty (TKA) in patients with moderate and severe genu-valgum (>10˚). This deformity presents corrective challenges for ligament release. The lateral-parapatellar approach has been advocated as an alternative to the traditional medial-parapatellar approach. Claimed advantages include better access for release of tight ligamentous structures, without requirement for release of the medial-collateral ligament. We present our comparative experience of the use of an unconstrained knee-replacement prosthesis inserted by the lateral-parapatellar approach in comparison to a constrained-knee prosthesis inserted via the medial-parapatellar approach. 49 primary total knee-replacements in 48 (6 males, 42 females) patients were performed; 32 through a lateral-parapatellar approach (group L) using an unconstrained-prosthesis and 17 through a medial-parapatellar approach more often requiring a constrained-prosthesis (group M). Mean preoperative valgus angle was 18.5 (range 11-34˚). Patient demographics (p=0.7) and valgus correctability were similar between the two groups. There was no significant difference in the mean post-operative valgus angle. This was 4.2˚ (range 1-9.5˚) using the lateral-parapatellar approach and 5.3˚ (range 0.3-10˚), p=0.12, using the medial-parapatellar approach. Transient common peroneal injury occurred in 2 patients, both group L, in the presence of valgus angles of greater than 20˚. To date no joints have been revised, or are unstable. The use of a lateral-parapatellar approach, appropriate soft tissue release, and an unconstrained PCL-preserving implant, yielded in all cases a stable, well aligned knee arthroplasty. This represents a viable alternative to the constrained-prosthesis using a medial-parapatellar approach in patients with moderate and severe genu-valgum.
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Affiliation(s)
- Jai Rawal
- Department of Orthopaedics and Trauma, Queen Elizabeth Hospital, King's Lynn, PE30 4ET, UK
| | - Adam J Devany
- Department of Orthopaedics and Trauma, Queen Elizabeth Hospital, King's Lynn, PE30 4ET, UK
| | - James A Jeffery
- Department of Orthopaedics and Trauma, Queen Elizabeth Hospital, King's Lynn, PE30 4ET, UK
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Huang TW, Kuo LT, Peng KT, Lee MS, Hsu RWW. Computed tomography evaluation in total knee arthroplasty: computer-assisted navigation versus conventional instrumentation in patients with advanced valgus arthritic knees. J Arthroplasty 2014; 29:2363-8. [PMID: 24439997 DOI: 10.1016/j.arth.2013.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/11/2013] [Accepted: 12/11/2013] [Indexed: 02/01/2023] Open
Abstract
Arthritic knees with advanced valgus deformity present with soft tissue and osseous anomalies that make total knee arthroplasty (TKA) difficult. We conducted a retrospective chart review of 41 patients (51 knees) to determine whether computer-assisted surgery-TKA (CAS-TKA) is superior to TKA using conventional guiding systems. A significantly higher rate of lateral retinaculum release as well as outlier of sagittal mechanical axes and position of the femoral component (femoral flexion and femoral rotational angle) was recorded in the conventional TKA group versus the CAS-TKA group. Both groups had significant postoperative improvement in clinical performance, but results did not differ significantly between groups. Despite its radiographic benefit, CAS-TKA showed no significant benefit over TKA in short-term clinical functional outcomes when performed by an experienced surgeon.
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Affiliation(s)
- Tsan-Wen Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Liang-Tseng Kuo
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Ti Peng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Mel S Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Chang Gung University, Taoyuan, Taiwan
| | - Robert Wen-Wei Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Chang Gung University, Taoyuan, Taiwan
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Total knee arthroplasty in the valgus knee. INTERNATIONAL ORTHOPAEDICS 2013; 38:273-83. [PMID: 24366186 DOI: 10.1007/s00264-013-2227-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 11/24/2013] [Indexed: 12/20/2022]
Abstract
Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10% of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique.
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Satish BRJ, Ganesan JC, Chandran P, Basanagoudar PL, Balachandar D. Efficacy and mid term results of lateral parapatellar approach without tibial tubercle osteotomy for primary total knee arthroplasty in fixed valgus knees. J Arthroplasty 2013; 28:1751-6. [PMID: 23702269 DOI: 10.1016/j.arth.2013.04.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/18/2013] [Accepted: 04/22/2013] [Indexed: 02/07/2023] Open
Abstract
The lateral parapatellar approach, despite providing direct access to the pathological area has not been widely accepted for knee arthroplasty in valgus deformities. We performed a modified lateral (Keblish) approach which consisted of coronal z plasty of lateral retinaculum, quadriceps snip, titrated sequential lateral release and closure with expanded lateral structures in 32 arthritic fixed valgus knees. In 30 knees, either tendon of popliteus or lateral collateral ligament or both could be preserved. At an average follow-up of 5 years, the valgus alignment improved from 25.4° (11°-60°) to 4° (0°-10°) and knee society score improved from 34 to 95 points. There was no late instability or revisions. This approach is rational, eliminates patella maltracking, is applicable in severe deformities and with titrated release, can preserve the posterolateral knee stabilizers that are necessary for long term implant survival.
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Chou WY, Siu KK, Ko JY, Chen JM, Wang CJ, Wang FS, Wong T. Preoperative templating and computer-assisted total knee arthroplasty for arthritic valgus knee. J Arthroplasty 2013; 28:1781-7. [PMID: 23518428 DOI: 10.1016/j.arth.2012.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 09/05/2012] [Accepted: 09/23/2012] [Indexed: 02/01/2023] Open
Abstract
We reported the functional outcomes, component alignment and optimal thickness of the tibial inserts and joint line changes of 21 arthritic valgus knee deformities using preoperative templating and computer-assisted total knee arthroplasty(TKA). The osseous cut was modified using a novel preoperative templating technique. Soft tissue balance and component implantation were implemented with the aid of a computed tomography-free navigation system. The arthritic valgus knees had clinical, and functional improvement of the knee Society scores and Lysholm scores postoperatively, at an average of 37.8 ± 7.2 months. The mean anatomic axis (15.2° ± 4.5° vs. 6.1° ± 1.4°) and mechanical axis (8.3° ± 5.2° vs. 0.28° ± 1.6°) were also significantly improved postoperatively. The mean thickness of tibial inserts and joint line changes was 10.7 ± 1.46 mm and 0.1 ± 1.4 mm. This computer-assisted technique with preoperative radiographic templating is an alternative strategy to improve TKA results in arthritic valgus knees.
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Affiliation(s)
- Wen-Yi Chou
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Sekiya H, Takatoku K, Takada H, Sugimoto N, Hoshino Y. Lateral approach is advantageous in total knee arthroplasty for valgus deformed knee. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 24:111-5. [PMID: 23412262 PMCID: PMC3889827 DOI: 10.1007/s00590-012-1137-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/08/2012] [Indexed: 01/15/2023]
Abstract
Introduction For the total knee arthroplasty in valgus deformed knee, superiority of the medial or lateral approach is still controversial. We compared the short-term result of two approach groups. Materials and methods Forty-seven knees in rheumatoid arthritis with valgus deformity from 6° to 24° were randomly divided into two group; medial approach (24 knees) and lateral approach (24 knees). We used Scorpio NRG PS for all knees. Median postoperative periods were 43 months in both groups. We compared the surgical time, and alignment on standing radiograph, range of motion (ROM) pre/postoperatively, and degrees of soft-tissue release procedure, and lateral laxity measured by stress radiograph immediately after operation and at final follow-up. Result Pre/postoperative alignment, surgical time, lateral laxity, and preoperative ROM had no significant in two groups; however, postoperative flexion was superior in lateral approach group 123.8°, 109° in medial approach group. All cases required iliotibial band (ITB) release at Gerdy’s tubercle, 83 % ITB at joint level, 21 % lateral collateral ligament (LCL), 17 % popliteus tendon (PT) in medial approach group, and 88 % ITB at Gerdy’s tubercle, 46 % ITB at joint level, 13 % LCL, 4 % PT in lateral approach group. Discussion In the valgus knee, lateral structures are tight. Lateral approach can directly adjust the tight structure, and also less vascular compromise to the patella than medial approach with lateral patellar release. Less invasiveness to the quadriceps muscle in lateral approach could result into better range of motion after the surgery.
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Affiliation(s)
- Hitoshi Sekiya
- Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Tochigi, Shimotuke, 3290498, Japan,
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Choi HR, Burke D, Malchau H, Kwon YM. Utility of tibial tubercle osteotomy in the setting of periprosthetic infection after total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2012; 36:1609-13. [PMID: 22581352 DOI: 10.1007/s00264-012-1541-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 03/30/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE This study reports radiographic and clinical treatment outcomes of tibial tubercle osteotomy (TTO) used for two-stage revision total knee arthroplasty (TKA) in the setting of periprosthetic infection. METHODS Thirty-six patients with 51 TTOs used for infected TKA were retrospectively analysed from 2000 to 2010. In 15 of 36 patients, TTO was used in a sequential manner during both first and second stage procedures. The mean follow-up period was 57 months (range seven-126 months). RESULTS The mean pre-operative range of knee motion was 40° (range 10-90°), and at latest follow-up it was 92° (range 50-140°). The Knee Society knee scores and function scores were 47 and 9 pre-operatively and 82 and 72 at latest follow-up, respectively. Bony union was achieved in all cases except one nonunion of an avulsion fragment of the osteotomy segment without functional deterioration. CONCLUSIONS TTO can be a useful extensile surgical approach for treatment of infected TKA with satisfactory clinical and radiographic outcomes.
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Affiliation(s)
- Ho-Rim Choi
- Department of Orthopaedic Surgery, Massachusetts General Hospital, The Harris Orthopedic Laboratory, Harvard Medical School, Boston, MA, USA
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Clinical comparison of valgus and varus deformities in primary total knee arthroplasty following midvastus approach. J Arthroplasty 2012; 27:604-12. [PMID: 21890315 DOI: 10.1016/j.arth.2011.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 06/14/2011] [Indexed: 02/01/2023] Open
Abstract
The purpose of this retrospective study was to compare clinical parameters in preoperative, perioperative, and postoperative categories between valgus and varus deformities in primary total knee arthroplasty (TKA) following midvastus approach. We compared 83 patients (83 TKAs in valgus) with 949 patients (1084 TKAs in varus), with a mean follow-up of 72 months. In valgus deformity, mean age and body mass index at TKA were younger and smaller with more percentage of patellar subluxation. Cutting thickness from distal femur, tibial plateau, and lateral aspect of posterior femur were significantly different. The incidence of lateral release was 10.8% in valgus and 2.1% in varus. Although several significant differences were observed in preoperative and perioperative categories, the postoperative functional results were similarly evaluated by Knee Society knee and function scores.
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Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy. Knee Surg Sports Traumatol Arthrosc 2011; 19:1834-42. [PMID: 21484391 DOI: 10.1007/s00167-011-1474-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 02/24/2011] [Indexed: 01/14/2023]
Abstract
PURPOSE Primary TKA in valgus knees with a deformity of more than ten degrees may prove challenging, since bone and soft tissue abnormalities make accurate axis restoration, component orientation and joint stability attainment a difficult task. The purpose of this study was to determine which approach is optimal in these patients, by comparing the standard medial parapatellar approach to a lateral parapatellar combined with a tibial tubercle osteotomy (TTO). METHODS Forty-four valgus knees--with an axis deviation ranging from 15 to 36 degrees (mean 24°)--were dealt with primary TKA and followed up for a minimum period of 7 years. Lateral parapatellar arthrotomy combined with TTO was performed in 22 individuals (Group A) and a standard medial parapatellar capsulotomy in the remaining patients (Group B). The International Knee Society System Score (IKSS) was used for clinical evaluation. Radiological assessment was performed yearly postoperatively using long films for assessment of the anatomical axis. RESULTS The postoperative IKSS scores showed no significant statistical difference between groups A and B (P < 0.05). In the alignment parameter, however, residual valgus deviation occurred in 9% of patients from Group A and in 32% from Group B. No late-onset instability was displayed. CONCLUSION Lateral parapatellar approach combined with TTO may prove highly beneficial in significant valgus deformities, as the anatomical axis is restored accurately and soft tissue release of the lateral contracted structures facilitated to an important extent.
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Clinical and radiographic outcomes of minimally invasive total knee arthroplasty through a lateral approach. Knee Surg Sports Traumatol Arthrosc 2011; 19:973-9. [PMID: 21085929 DOI: 10.1007/s00167-010-1323-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE With increasing confidence and surgical experience, minimally invasive surgery (MIS) in total knee arthroplasty (TKA) is now being applied to more complicated cases. The present study assessed the feasibility of MIS-TKA using a lateral approach for valgus knees. METHODS Subjects comprised 26 patients with valgus knees who underwent MIS-TKA using a lateral subvastus approach. Five cases required a 1-cm snip of vastus lateralis obliquus, to shift the patella medially without eversion. Clinical scores and radiographic parameters of lateral MIS-TKA were examined and compared with those of 26 medial MIS-TKAs matched for preoperative patient characteristics. RESULTS The lateral MIS-TKA group showed slightly longer operative time and larger skin incision than the medial MIS-TKA group. Nevertheless, myoglobin index and pain on a visual analog scale on postoperative day 7 were significantly lower in the lateral MIS-TKA group than in the medial MIS-TKA group. Postoperative improvement of clinical scores was quite comparable between lateral and medial MIS-TKA groups. Radiographic assessment revealed that tibiofemoral mechanical axis aligned within ±3° from ideal in 24 of 26 patients after lateral MIS-TKA. MIS technique-related complications occurred in only 1 patient presenting with subsidence of the tibial component, due to malpositioning of the tibial component. CONCLUSION From the perspectives of postoperative pain, clinical scores, radiographic accuracy, and postoperative complication rate, lateral MIS-TKA achieved comparable or superior results to medial MIS-TKA. This technique may offer a promising technical option that can be utilized for most patients with valgus knee deformity.
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Girard J, Amzallag M, Pasquier G, Mulliez A, Brosset T, Gougeon F, Duhamel A, Migaud H. Total knee arthroplasty in valgus knees: predictive preoperative parameters influencing a constrained design selection. Orthop Traumatol Surg Res 2009; 95:260-6. [PMID: 19481514 DOI: 10.1016/j.otsr.2009.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/04/2008] [Accepted: 04/21/2009] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In valgus knees, ligament balance might remain a challenge at total knee prostheses implantation; this leads some authors to systematically propose the use of constrained devices (constrained condylar knee or hinge types...). It is possible to adapt the selected level of constraints, by reserving higher constraints to cases where it is not possible to obtain final satisfactory balance: less than 5 degrees of residual frontal laxity in extension in each compartment, and a tibiofemoral gap difference not in excess to 3 mm between flexion and extension. HYPOTHESIS It is possible to establish preoperative criteria that can predict a constrained design prosthetic implantation at surgery. MATERIALS AND METHODS A consecutive series of 93 total knee prostheses, implanted to treat a valgus deformity of more than 5 degrees was retrospectively analysed. Preoperatively, full weight bearing long axis AP views A-P were performed: hip knee angle (HKA) averaged 195 degrees (186 degrees to 226 degrees), 36 knees had more than 15 degrees of valgus, and 19 others more than 20 degrees of valgus. Laxity was measured by stress radiographies with a Telos system at 100 N. Fifty-two knees had preoperative laxity in the coronal plane of more than 10 degrees. Fourteen knees had more than 5 degrees laxity on the convex (medial) side, 21 knees had more than 10 degrees laxity on the concave (lateral) side. Statistical assessment, using univariate analysis, identified the factors that led, at surgery, to an elevated constraint selection level; these factors of independence were tested by multivariate analysis. Logistical regression permitted the classification of the said factors by their odds ratios (OR). RESULTS High-constraints prostheses (CCK type) numbered 26 out of 93 implantations; the other total knee prostheses were regular posterostabilized (PS) prostheses. Statistically, the preoperative factors that led to the choice of a constrained prosthesis were: (1) valgus severity as measured by HKA (PS=193 degrees, CCK=198 degrees), (2) increased posterior tibial slope (PS=4.8 degrees, CCK=6.5 degrees), (3) low patellar height (using Blackburne and Peel index PS=0.89, CCK=0.77), (4) severity of laxity in valgus (PS=2.3 degrees, CCK=4.3 degrees). Among all these factors, the only independent one was laxity in valgus (convex side laxity) (p=0.0008). OR analysis showed a two-fold increased probability of implanting an elevated constraints prosthesis for each one degree increment of laxity in valgus. DISCUSSION This study demonstrated that it was not the valgus angle severity but rather the convex medial side laxity that increased the frequency of constrained prostheses implantation. Other factors, as a low patellar height or an elevated posterior tibial slope, when associated, potentiate this possible prosthetic switch (to higher constraints) and should make surgeons aware, in these situations, of encountering difficulties when establishing ligament balance. LEVEL OF EVIDENCE IV Therapeutic retrospective study.
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Affiliation(s)
- J Girard
- C and D Orthopaedic Units, University Department of Orthopaedics and Traumatology, Lille 2 University Faculty of Medicine, Roger-Salengro Hospital, Lille Regional University Hospital Center, 59037 Lille cedex, France. j girard
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Boyer P, Boublil D, Magrino B, Massin P, Huten D. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. INTERNATIONAL ORTHOPAEDICS 2008; 33:1577-83. [PMID: 19066890 DOI: 10.1007/s00264-008-0698-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 09/28/2008] [Accepted: 10/19/2008] [Indexed: 12/28/2022]
Abstract
The purpose of this work was to document eleven years of experience in knee replacement for fixed knee valgus through a lateral approach with special emphasis on the balancing procedures. At a mean follow-up of seven years, only one revision for sepsis was required in this series of 63 knee replacements. The mean knee score improved from 37 (range 20-45) to 91 (range 65-100) at the last review (p < 0.01) while the function score increased from 29.5 (range 0-50) to 78.7 (range 10-100) (p = 0.01). The mean mechanical axis (HKA) was 14.7 degrees of valgus preoperatively and 1 degrees of valgus postoperatively. After the iliotibial band was automatically released in the approach, only four of 63 knees required additional release for tightness in extension. These results underline the appeal of the lateral approach with the automatic release of the iliotibial band. If required, additional ligament release is recommended step-by-step after bone section to avoid postoperative instability.
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Affiliation(s)
- P Boyer
- Department of Orthopaedic Surgery, Bichat Hospital, GHU Nord, Assistance Publique-Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France.
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Clarke HD, Fuchs R, Scuderi GR, Scott WN, Insall JN. Clinical results in valgus total knee arthroplasty with the "pie crust" technique of lateral soft tissue releases. J Arthroplasty 2005; 20:1010-4. [PMID: 16376256 DOI: 10.1016/j.arth.2005.03.036] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Numerous methods for creating symmetric flexion and extension gaps during knee arthroplasty in valgus knees have been proposed, and no consensus exists about the optimal technique. The "pie crust" technique for lateral soft tissue releases has been used extensively, yet few clinical results have been published. In this study, the clinical outcomes of 24 consecutive knees in 24 patients in whom this method was used in conjunction with a cemented posterior-stabilized prosthesis were evaluated. At a mean of 54 months' (range 24-69 months) follow-up, the knees were performing well with a mean Knee Society score of 97 (range 87-100) and mean range of motion of 121 degrees (range 100 degrees -145 degrees). Importantly, there were no clinical failures or cases of postoperative instability and no cases of radiographic loosening or wear.
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Sato H, Ishibashi Y, Tsuda E, Sasaki K, Toh S. Total knee arthroplasty for gonarthrosis with patellar dislocation. J Orthop Sci 2005; 10:656-60. [PMID: 16307194 DOI: 10.1007/s00776-005-0948-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 06/17/2005] [Indexed: 02/09/2023]
Affiliation(s)
- Hideki Sato
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Khan RJK, Keogh A, Fick DP, Wood DJ. Surgical approaches in total knee arthroplasty. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Riaz JK Khan
- University of Western Australia; Trauma and Orthopaedics; 1/14-16 Hamersley Street Cottesloe Perth Western Australia Australia 6011
| | | | - Daniel P Fick
- University of Western Australia; Orthopaedics; 17a Pearse St Cottesloe WA Australia 6011
| | - David J Wood
- Perth Orthopaedic Institute; Trauma and Orthopaedics; Perth Australia
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Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg Am 2004; 86:2671-6. [PMID: 15590852 DOI: 10.2106/00004623-200412000-00013] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In 1985, the senior author (C.S.R.) developed a new soft-tissue release technique to balance valgus knees to avoid unacceptably high rates of late-onset instability and the need for primary constrained implants. This report describes the soft-tissue release technique and its long-term results when performed in primary total knee arthroplasty in patients with a severe valgus knee deformity. METHODS Four hundred and ninety consecutive total knee arthroplasties were performed by one surgeon between January 1988 and December 1992. In this group, seventy-one patients (eighty-five knees) had a valgus deformity of > or =10 degrees . Thirty-two patients (thirty-six knees) died, and four patients (seven knees) were lost to follow-up, leaving thirty-five patients (forty-two knees) followed for a minimum of five years. These twenty-seven women and eight men had a mean age of sixty-seven years at the time of the index operation. The technique included an inside-out soft-tissue release of the posterolateral aspect of the capsule with pie-crusting of the iliotibial band and resection of the proximal part of the tibia and distal part of the femur to provide a balanced, rectangular space. Cemented, posterior stabilized implants were used in all knees. Clinical and radiographic evaluations were performed at one, five, and ten years postoperatively. RESULTS The mean modified Knee Society clinical score improved from 30 points preoperatively to 93 points postoperatively, and the mean functional score improved from 34 to 81 points. The mean range of motion was 110 degrees both preoperatively and postoperatively. The mean coronal alignment was corrected from 15 degrees of valgus preoperatively to 5 degrees of valgus postoperatively. Three patients underwent revision surgery because of delayed infection, premature polyethylene wear, and patellar loosening in one patient each. There were no cases of delayed instability. CONCLUSIONS The inside-out release technique to correct a fixed valgus deformity in patients undergoing primary total knee arthroplasty is reproducible and provides excellent long-term results. LEVEL OF EVIDENCE Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mark Elkus
- Department of Orthopedic Surgery, Lenox Hill Hospital, 130 East 77th Street, William Black Hall 11th Floor, New York, NY 10021, USA
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Clarke HD, Schwartz JB, Math KR, Scuderi GR. Anatomic risk of peroneal nerve injury with the "pie crust" technique for valgus release in total knee arthroplasty. J Arthroplasty 2004; 19:40-4. [PMID: 14716649 DOI: 10.1016/j.arth.2003.09.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Peroneal nerve damage can occur during total knee arthroplasty because of indirect or direct injury. The potential for direct laceration injury exists when performing the "pie crust" lateral soft-tissue release in a valgus knee. To assess this risk, the axial, magnetic resonance images of 60 adult knees were evaluated. The distance from the peroneal nerve to the tibia was measured at the level of the standard tibial resection. At this level, the lateral gastrocnemius muscle is interposed between the capsule and the nerve. The mean nerve to bone distance was 1.49 cm (0.91-2.18 cm). These results suggest that the peroneal nerve is adequately protected at the posterolateral corner of the knee but that the "pie crust" release should be performed carefully.
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Affiliation(s)
- Henry D Clarke
- Insall Scott Kelly Institute for Orthopaedics & Sports Medicine, Beth Irael Medical Cener-Singer Division, New York, New York 10128, USA
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37
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Pons i Cabrafiga M, Álvarez Goenaga F, Solana i Carné J, Viladot i Pericé R. Abordaje lateral en artroplastia total de rodilla con genu valgo marcado. Rev Esp Cir Ortop Traumatol (Engl Ed) 2003. [DOI: 10.1016/s1888-4415(03)76081-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Robbins GM, Masri BA, Garbuz DS, Duncan CP. Preoperative planning to prevent instability in total knee arthroplasty. Orthop Clin North Am 2001; 32:611-26, viii. [PMID: 11689374 DOI: 10.1016/s0030-5898(05)70231-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Several factors can lead to persistent instability after total knee arthroplasty, including bone and soft tissue loss, preexisting ligamentous laxity, and poor operative technique. Achieving stability should not be equated with making the knee extremely tight, without any natural laxity.
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Affiliation(s)
- G M Robbins
- Division of Reconstructive Orthopaedics, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Tsai CL, Chen CH, Liu TK. Lateral approach without ligament release in total knee arthroplasty: new concepts in the surgical technique. Artif Organs 2001; 25:638-43. [PMID: 11531716 DOI: 10.1046/j.1525-1594.2001.025008638.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A lateral approach without ligament release was performed in 475 primary total knee arthroplasties (TKAs) in 344 patients and 50 revision TKAs in 39 patients. Deformities of the genu varum or valgum were corrected by accurate bone cut; no ligament releases were required other than to achieve adequate exposure. A lateral approach allowed both self-centering of the extensor mechanism and knee closure in complete flexion. Better range of motion was achieved. More than 90 degree active flexion usually occurred 3 days postoperatively. Postoperative roentgenograms showed all knees had good varus and valgus stability, which was sustained with time, except 1 with late genu recurvatum due to inadequate polyethylene thickness and the other with a broken tibial base plate. Complications such as disruption of patellar blood supply and knee instability, more frequently observed in the medial approach with ligament release, did not occur. The results suggest that this new technique is safe and may give better outcomes.
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Affiliation(s)
- C L Tsai
- Department of Orthopedic Surgery, National Taiwan University Hospital, Medical College, No. 7, Chung-Shan South Road, Taipei, Taiwan, Republic of China
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Hendel D, Weisbort M. Modified lateral approach for knee arthroplasty in a fixed valgus knee--the medial quadriceps snip. ACTA ORTHOPAEDICA SCANDINAVICA 2000; 71:204-5. [PMID: 10852330 DOI: 10.1080/000164700317413210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D Hendel
- Department of Orthopedics, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petach Tikva, Israel.
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