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. 2018 Apr-Jun;9(2):125-132.
doi: 10.1016/j.jcot.2017.01.004. Epub 2017 Jan 22.

Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity

X Paredes-Carnero  1 , J Escobar  2 , J M Galdo  3 , J G Babé  2
Affiliations

Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity

X Paredes-Carnero et al. J Clin Orthop Trauma. 2018 Apr-Jun.

Abstract

Objective: Our purpose was to review senior author results of TKA in patients with extra-articular angular deformities (correction of mechanical axis was performed without an additional procedure for osteotomy).

Methods: Results of TKA in nine knees with osteoarthritis and associated extra-articular angular deformity of femur were reviewed retrospectively. This group was compare with a with a control group of 20 patients diagnosed with osteoarthritis that underwent TKA without extra-articular deformity. Angulation of deformity in patients was 19° in coronal plane (range 15°-25°) and 12° in sagittal plane (range 8°-5°). Knee Score (KS) and Functional Score (FS) were measured pre and post-surgery, likewise arc flexion was reported. Results in KS and FS were correlationed with extra-articular angulation.

Results: Duration of follow-up averaged 55 months (range, 48-63 months). KS Average and FS increased from 50.5 and 38.4 points, preoperatively, to 96.5 and 84.4 points, respectively, at time of following-up. No statistically significant differences in any postoperative parameters were found between the postoperative group of extra-articular deformities and the control group were found. Positive correlation was obtained between deformity degrees and KS. Arc of motion averaged 86° preoperatively and 118° at time of following-up. No total knee arthroplasty was revised.

Conclusion: In our opinion, best management for extra-articular deformities associated to osteoarthritis is to carry out a knee replacement without corrective osteotomy on condition that planification allow to us avoid ligaments insertions, using an extensive soft-tissue balancing in conjunction with a minimally constrained TKA.

Keywords: Arthroplasty planning; Extra-articular deformities; Knee; Soft-tissues balancing; Total knee arthroplasty.

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Figures

Fig. 1
Fig. 1
A, B and C: Case 8 is a patient with a proximal femoral fracture when he was 20 years old (in the Spanish Civil War). This are the preoperative images which show an extraarticular femoral deformity of 25° of the varus, and 15° of recurvatum.
Fig. 2
Fig. 2
A, B and C: Images of the case 8 postoperative, after to be implante an Insall arthroplasty which returned the axis to 6° of valgus.
Fig. 3
Fig. 3
A, B and C: These images belong to the patient 2, which had a distal femoral fracture in the childhood, and it show a extraarticular deformity with 24° of varus and 10° of antecurvatum. On the images preoperative was made the planning of surgery.
Fig. 4
Fig. 4
Aand B: These are the postoperative images (patient 2) with a Nex-Gen arthroplasty that got a physiological alignment.
Fig. 5
Fig. 5
Aand B: These images are the preoperative Rx of number 4 case, which received a distal osteotomy in his childhood. The extraarticular deformity is of 16° of varus.
Fig. 6
Fig. 6
Aand B: These images are postoperatives (case 4), and it shows the correct alignment with 6° of valgus in its axis.
Fig. 7
Fig. 7
Aand B: These images corresponding to the patient number 6, with a distal femoral fracture that finished in an extra-articular deformity of 21° of varus.
Fig. 8
Fig. 8
Aand B: Postoperative images of patient number 6 with a correctly aligmnent.
See this image and copyright information in PMC

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