Correction of severe valgus deformity of knee osteoarthritis with non-constrained total knee arthroplasty implant: A case report

Progress in Computer-Assisted Navigation for Total Knee Arthroplasty in Treating Knee Osteoarthritis with Extra-Articular Deformity

Total knee arthroplasty (TKA) is a well-established treatment for end-stage knee osteoarthritis. However, in patients with concomitant extra-articular deformities, conventional TKA techniques may lead to unsatisfactory outcomes and higher complication rates. This review summarizes the application of navigated TKA for treating knee osteoarthritis with extra-articular deformities. The principles and potential benefits of computer navigation systems, including improved component alignment, soft tissue balancing, and restoration of mechanical axis, are discussed. Research studies demonstrate that navigated TKA can effectively correct deformities, relieve pain, and improve postoperative joint function and quality of life compared with conventional methods. The advantages of navigated TKA in terms of surgical precision, lower complication rates, and superior functional recovery are highlighted. Despite challenges like the learning curve and costs, navigated TKA is an increasingly indispensable tool for achieving satisfactory outcomes in TKA for knee osteoarthritis patients with extra-articular deformities.

Appraisal of Clinical Improvement With Total Knee Arthroplasty in Valgus Knee Deformities: A Case Series

Introduction This case series explores the efficacy of unassisted total knee arthroplasty (TKA) in addressing valgus knee deformity secondary to osteoarthritis. The study aims to evaluate functional outcomes pre- and post-surgery using the Knee Society Score (KSS) and radiological assessments in short-term follow-up. Six patients underwent TKA and were evaluated retrospectively. Statistical analysis revealed significant improvements in the angle of deformity, KSS, and range of motion postoperatively. The study underscores the success of TKA in correcting valgus deformity, improving knee function, and enhancing patient satisfaction. TKA is a highly successful treatment for osteoarthritis, providing functional recovery and improved quality of life. However, valgus knee deformity presents a challenge in TKA, affecting approximately 10% of patients. This study aims to assess the functional outcomes of TKA for valgus deformity using KSS and radiological evaluation in short-term follow-up. Materials and methods A retrospective observational study was conducted from November 2022 to December 2023, involving six patients with valgus knee deformity secondary to osteoarthritis. TKA was performed with no technological assistance, and patients were assessed pre- and post-surgery using KSS and radiological measurements. Statistical analysis was performed using paired t-tests. Case description Six patients with grade two valgus deformity underwent technology-unassisted TKA. The postoperative assessment revealed significant improvements in the tibiofemoral angle, KSS, and range of motion. The medial parapatellar approach for TKA was utilized with a standard unconstrained primary TKA prosthesis, resulting in successful correction of deformity and improved knee alignment. Discussion TKA is a widely performed and reliable surgical intervention, with valgus knee deformity posing specific challenges. This study demonstrates the effectiveness of conventional TKA in correcting valgus deformity, improving knee function, and enhancing patient satisfaction in a very small case series. Comparison with previous studies supports the findings of the pre-existing literature, highlighting the importance of appropriate surgical approach and patient selection. Conclusion TKA utilizing a medial parapatellar approach proved effective in our small case series in correcting valgus deformity, improving knee function, and enhancing patient satisfaction. Short-term follow-up reveals significant improvements in stability, posture, and KSS scores. Further assessments and longer-term follow-up are warranted to confirm the long-term effectiveness of this approach.

Total Knee Replacement in a Young Patient with Valgus Knee Osteoarthritis: A Case Report

Introduction

Valgus deformity is characterized by an outward angulation of the knee joint. The most common cause of valgus deformity is osteoarthritis (OA), a prevalent progressive joint disease that causes chronic pain and functional limitations. Total knee replacement (TKR) is rarely done in patients with grade-I valgus deformity and young age. To the best of our knowledge, this is the first case report of its kind.

Case Report

A 34-year-old man presented to us with 15 years of persistent, progressively worsening right knee pain that was interfering with his daily activities. No non-operative treatment could alleviate his severe pain. Physical examination revealed a positive valgus stress test, limited knee extension, and an asymmetrical gait. He was diagnosed with a grade-I valgus deformity of the right osteoarthritic knee. History, physical examination, and radiological findings confirmed the diagnosis. In consideration of severe pain and impaired quality of life, we opted to perform TKR using a medial parapatellar approach. Regular follow-ups were done after the procedure. He experienced no pain or recurrence of deformity. He was very satisfied with the result. His Western Ontario and McMaster Universities OA Index score at 12 months following surgery was 5, indicating a favorable outcome.

Conclusion

This case exhibits the effectiveness of TKR in treating grade-I valgus deformity of the osteoarthritic knee with severe pain in a young adult, resulting in improved pain alleviation, mobility, joint alignment, and overall quality of life.

A case series of total knee arthroplasty with a non-constrained implant in 2nd and 3rd degree valgus deformity in knee osteoarthritis and medial collateral ligament insufficiency

INTRODUCTION

Osteoarthritis is one of the leading causes of disability and the most common degenerative disease of the knee that causes enormous pain. As many as 10-15 % of patients requiring total knee arthroplasty (TKA) present with valgus knee deformity. When fully constrained TKA is not possible, the surgeon must use a different method to achieve a good result.

CASE DESCRIPTION

A 56-year-old female with 3rd degree (48-degree) and a 62-year-old male with 2nd degree valgus knee (13-degree) with painful osteoarthritis were examined. Both have valgus thrust gait and medial collateral ligament (MCL) laxity and underwent TKA using non-constrained implants. During surgical exposure, MCL insufficiency was found in both patients, and MCL augmentation was performed. Post-operative assessment and 4-month follow-up were done through clinical and radiological parameters using the knee scoring system.

DISCUSSION

A good outcome could still be achieved with a primary TKA implant in severe and moderate valgus knees with MCL insufficiency using MCL augmentation. The primary TKA implant proved to improve clinical and radiological parameters after 4 months of follow-up. Clinically, both patients no longer felt pain in their knees and were able to walk with better stability. Radiologically, there was a much-reduced valgus degree. The results were the first case went from 48-degree to 2-degree and the second case went from 13-degree to 6-degree.

CONCLUSION

Knee osteoarthritis with valgus deformity and MCL insufficiency present surgical challenges during TKA. It is still possible to use in severe or moderate valgus with MCL insufficiency, which was proven by satisfactory clinical and radiological findings. Although a non-constrained option is not ideal, it is still the first choice in certain cases.