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. 2018 Nov;13(3):179-184.
doi: 10.1007/s11751-018-0310-5. Epub 2018 Mar 20.

Extra-articular deformity correction using Taylor spatial frame prior to total knee arthroplasty

Gautam J K Tawari  1 , Rajan Maheshwari  2 , Sanjeev S Madan  2
Affiliations

Extra-articular deformity correction using Taylor spatial frame prior to total knee arthroplasty

Gautam J K Tawari et al. Strategies Trauma Limb Reconstr. 2018 Nov.

Abstract

A good long-term outcome following a total knee arthroplasty relies on restoration of the mechanical axis and effective soft tissue balancing of the prosthetic knee. Arthroplasty surgery in patients with secondary osteoarthritis of the knee with an extra-articular tibial deformity is a complex and challenging procedure. The correction of mal-alignment of the mechanical axis is associated with unpredictable result and with higher revision rates. Single-staged deformity correction and replacement surgery often result in the use of constraint implants. We describe our experience with staged correction of deformity using a Taylor Spatial Frame (TSF) followed by total knee arthroplasty in these patients and highlight the advantage of staged approach. The use of TSF fixator for deformity correction prior to a primary total knee arthroplasty has not been described in the literature. We describe three cases of secondary osteoarthritis of the knee associated with multiplanar tibial deformity treated effectively with a total knee arthroplasty following deformity correction and union using a TSF. All patients had an improved Knee Society score and Oxford Knee score postoperatively and were satisfied with their replacement outcome. Staged deformity correction followed by arthroplasty allows the use of standard primary arthroplasty implants with predicable results and flexible aftercare. This approach may also provide significant improvement of patient symptoms following correction of deformity resulting in deferment of the arthroplasty surgery.

Keywords: Osteoarthritis; Staged surgery; Tibial deformity; Tibial non-union; Total knee arthroplasty.

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Conflict of interest statement

Conflict of interest

There are no conflicts of interest related to the authors involved in the study.

Ethical consideration

The study does not contain any identifiable patient data. It did not require any ethical committee review.

Informed consent

Consent from the patients involved was still obtained and documentation made in their case notes.

Figures

Fig. 1
Fig. 1
Case 1: a Radiograph showing established proximal tibial non-union following stress fracture, failed treatment of internal fixation and bone graft augmentation. b Radiograph showing frame fixation for treatment of proximal tibial non-union and deformity correction. c, d Orthogonal radiographs showing union of the stress fracture. e, f Orthogonal radiographs showing total knee replacement in situ performed as a staged procedure
Fig. 2
Fig. 2
Case 2: a, b Orthogonal radiographs of tibial malunion deformity used for deformity correction planning. c, d Orthogonal radiographs showing Taylor spatial frame application with corrective tibial osteotomy away form the CORA. e, f Orthogonal radiograph showing realignment of the mechanical axis and healing of the osteotomy site with an established ankle arthrodesis. g, h Orthogonal radiographs showing total knee replacement in situ performed as a staged procedure
Fig. 3
Fig. 3
Case 3: a, b Orthogonal radiographs showing supramalleolar tibial deformity. c, d Orthogonal radiographs showing application of Taylor spatial frame and tibial osteotomy for correction of deformity. e, f Orthogonal radiographs showing realignment of mechanical axis with healing of the osteotomy site after removal of frame. g, h Orthogonal radiographs showing total knee replacement in situ performed as a staged procedure
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