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. 2016 Jan 12;2(1):26-36.
doi: 10.1016/j.artd.2015.11.002. eCollection 2016 Mar.

Total knee arthroplasty in patients with extra-articular deformity

Kaushik Hazratwala  1 , Brent Matthews  1 , Matthew Wilkinson  1 , Sergio Barroso-Rosa  1
Affiliations

Total knee arthroplasty in patients with extra-articular deformity

Kaushik Hazratwala et al. Arthroplast Today. .

Abstract

Multiple acceptable options are available for the correction of distal femoral deformity associated with knee arthritis. The treatment modality should be chosen based on the extent of deformity and attention to preservation of the collateral ligaments. Surgical options range from osteotomy alone, arthroplasty with intra-articular correction, or arthroplasty with extra-articular correction. Different implant choices and fixation methods for the osteotomy possess advantages and disadvantages which need to be considered carefully. In addition to discussing principles of management based on current literature, this article includes a case report using a previously undescribed technique using corrective osteotomy, intramedullary nail fixation, and total knee arthroplasty with computer navigation.

Keywords: Computer navigation; Corrective femoral osteotomy; Distal femoral deformity; Total knee arthroplasty.

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Figures

Figure 1
Figure 1
(a) A standing frontal plane photograph, taken preoperatively. (b) A standing lateral plane photograph taken preoperatively.
Figure 2
Figure 2
(a) A lateral radiograph of the right knee, demonstrating 38° of recurvatum, taken preoperatively. (b) An anterior-posterior radiograph of the right knee taken preoperatively. (c) A long-leg standing anterior-posterior radiograph taken preoperatively, demonstrating 13° varus alignment.
Figure 3
Figure 3
Intraoperative photograph of the osteotomy with the IM nail in situ.
Figure 4
Figure 4
Stryker Precision navigation system native knee parameters before any bony resections.
Figure 5
Figure 5
Stryker Precision navigation system recording the dynamic preoperative knee assessment graph.
Figure 6
Figure 6
Stryker Precision navigation system navigation image of the resection level of the proximal tibia.
Figure 7
Figure 7
Stryker Precision navigation system recording the distal femoral resection.
Figure 8
Figure 8
Stryker Precision navigation system recording the posterior condyle resection. AP, anterior posterior axis; TEA, trans epicondylar axis.
Figure 9
Figure 9
Stryker Precision navigation system recording the flexion gap balance.
Figure 10
Figure 10
Stryker Precision navigation system confirming alignment with definitive implants.
Figure 11
Figure 11
Intraoperative photograph after osteotomy, arthroplasty, and bone graft.
Figure 12
Figure 12
Final alignment curve - post osteotomy and post arthroplasty.
Figure 13
Figure 13
Photograph taken in frontal plane at 6 months postoperatively.
Figure 14
Figure 14
Photograph taken in the sagittal plane at 6 months postoperatively.
Figure 15
Figure 15
Anteroposterior knee radiograph taken at 6 months postoperatively.
Figure 16
Figure 16
Lateral knee radiograph taken at 6 weeks postoperatively.
Figure 17
Figure 17
Lateral knee radiograph taken at 6 months postoperatively, with evidence of osteotomy union.
Figure 18
Figure 18
Anterior-posterior long-leg radiograph taken at 6 months postoperatively.
See this image and copyright information in PMC

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