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Charre D, An JS, Khakha R, Kley K, Şahbat Y, Ollivier M. 'One millimetre equals one degree' is a major source of inaccuracy in planning osteotomies around the knee for metaphyseal deformities compared to the digital planning. Knee Surg Sports Traumatol Arthrosc 2024; 32:987-999. [PMID: 38431800 DOI: 10.1002/ksa.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The objective of this study was to compare the accuracy of virtually performed osteotomies around the knee. The comparison was made between the Miniaci method (method 1), considered the gold standard planning, with the widely held dogma that one degree of correction required equates to one millimetre of opening/closing (method 2). METHODS This retrospective cross-sectional study was conducted between December 2018 and September 2022 in patients aged at least 15 years with metaphyseal knee deformity. Osteotomy planning was performed in methods 1 and 2 utilising calibrated long-leg alignment X-rays in the frontal plane. In both methods, the desired correction was defined by the Fujisawa point. The error % in measurement (ratio method 1/method 2) and the difference in millimetres (method 1 - method 2) between the two methods were analysed. RESULTS A total of 107 osteotomies with 27 (25.2%) distal femoral osteotomies, 54 (50.5%) proximal tibial osteotomies and 26 (24.3%) double-level osteotomies were performed virtually with a mean hip-knee-ankle angle of 176.4 ± 6.6. In distal femur osteotomy, the mean error % between methods 1 and 2 was 38.9 ± 16.7% and 22.4 ± 16.8% for the opening and closing groups, respectively. In proximal tibial osteotomies, the mean error % was 22.7 ± 15.6% and 9 ± 10.8% for the opening and closing groups, respectively. In double-level osteotomy, the mean error % of femur-based corrections was 34.9 ± 19% and 19.5 ± 21% for the opening and closing groups, respectively, and the mean error of the tibial-based corrections was 26.4 ± 12.1% for the opening group and 10.8 ± 10% for the closing group, respectively. CONCLUSION Planning one millimeter per degree of desired correction for osteotomies around the knee in metaphyseal deformities is a major source of error when compared with digital planning using the Miniaci method. This was seen most frequently with osteotomies of the distal femur and all opening wedge osteotomies. LEVEL OF EVIDENCE Level Ⅲ, retrospective cross-sectional study.
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Affiliation(s)
- Dimitri Charre
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
| | - Jae-Sung An
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
- Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Kristian Kley
- Harley Street Specialist Hospital, London, UK
- Orthopädie Maximilium, Donauwörth, Germany
| | - Yavuz Şahbat
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
- Erzurum Regional Training and Research Hospital, Orthopaedic Surgery and Traumatology, Erzurum, Turkey
| | - Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
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Sterneder CM, Faschingbauer M, Haralambiev L, Kasparek MF, Boettner F. Why Kinematic Alignment Makes Little Sense in Valgus Osteoarthritis of the Knee: A Narrative Review. J Clin Med 2024; 13:1302. [PMID: 38592153 PMCID: PMC10932440 DOI: 10.3390/jcm13051302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the aim of restoring the patient's native alignment and minimizing the need for soft tissue releases. Our previous studies showed that MA with standardized soft tissue release produces reproducible results, and that the preoperative phenotype does not influence the results of patients with valgus osteoarthritis. These data suggest that there is no functional advantage to preserving valgus alignment in patients with valgus osteoarthritis. Many patients with valgus osteoarthritis present with a compromised medial collateral ligament and leaving the knee in valgus could increase the risk of secondary instability. The current literature supports MA TKA with soft tissue release as the gold standard. While using more sophisticated enabling technologies like robotic surgery might allow for aiming for very slight (1-2°) valgus alignment on the femoral side, any valgus alignment outside this range should be avoided. This review paper summarizes our current knowledge on the surgical techniques of TKA in patients with valgus osteoarthritis.
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Affiliation(s)
- Christian Manuel Sterneder
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Maximilian F. Kasparek
- Department of Orthopedics, Evangelisches Krankenhaus, Hans-Sachs Gasse 10-12, 1180 Vienna, Austria
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Cochrane NH, Kim BI, Holland CT, Seyler TM, Ryan SP, Bolognesi MP, Wellman SS. Ultracongruent Polyethylene Liners Do Not Affect Survival of Total Knee Arthroplasty for Valgus Deformity. J Arthroplasty 2024:S0883-5403(24)00109-8. [PMID: 38355064 DOI: 10.1016/j.arth.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Valgus knee deformity is observed in nearly 10% of patients undergoing total knee arthroplasty (TKA). The degree of polyethylene constraint required to balance a valgus knee remains controversial, and historically, posterior-stabilized (PS) designs have been favored. This study evaluated the survivorship of TKA done in valgus knees based on implant design and specifically compared posterior-stabilized (PS) and ultracongruent (UC) liners. METHODS A total of 549 primary TKAs performed on valgus knees by fellowship-trained arthroplasty surgeons from 2013 to 2019 were reviewed. Demographics, comorbidities, degrees of preoperative deformity, implants used, and all-cause revisions until final follow-up were recorded. Cox regression analyses evaluated survival to all-cause revision in each cohort. The mean follow-up was 4.9 years (range, 2 to 9). RESULTS There were 403 UC liners compared to 146 PS liners. There was no difference in patient age (68 versus 67 years; P = .30), body mass index (30.9 versus 30.4; P = .36), or degree of deformity (8.6 versus 8.8 degrees; P = .75) between the cohorts. At final follow-up, there were 5 revisions in the PS cohort (3.4%) versus 11 revisions in the UC cohort (2.7%) (P = .90). The most common reason for revision in both cohorts was periprosthetic joint infection (4 PS; 8 UC). Multivariable regression analyses controlling for age, body mass index, Elixhauser comorbidity score, sex, and degree of deformity demonstrated UC polyethylene liners were not associated with revision (hazard ratio 0.76; 95% confidence interval [CI] 0.26 to 2.21; P = .62). There was no difference in eight-year survivorship to all-cause revision, including aseptic and septic failure. CONCLUSIONS Alternative polyethylene liners from the historically utilized PS liners for TKA for valgus deformity did not reduce survivorship. With modern polyethylene designs, UC inserts can be utilized for this deformity without increasing the risk of failure.
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Affiliation(s)
- Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Billy I Kim
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Christopher T Holland
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Pasquinelly A, Blood D, Elattar O, Hanna M. Optimal Sequence of Corrective Surgeries for Concomitant Valgus Knee and Rigid Pes Planus Deformities: The Knee-First Approach. Arthroplast Today 2023; 24:101265. [PMID: 38023651 PMCID: PMC10652122 DOI: 10.1016/j.artd.2023.101265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
In patients requiring surgical correction of ipsilateral valgus knee and rigid pes planovalgus deformities, the optimal operative sequence is controversial. Growing evidence suggests these 2 deformities are related in etiology and interrelated in disease course. We present the case of a 72-year-old female with concomitant valgus knee and rigid pes planovalgus deformities successfully treated with total knee arthroplasty followed by triple arthrodesis and Achilles lengthening. Surgical correction of these deformities must be carefully planned between the operating surgeons to avoid over- or under-correction of alignment that could further impact gait. In contrast with the limited available literature, the authors recommend correction at the knee first and the foot and ankle second. Further prospective studies are needed to elucidate the best operative sequence in these patients.
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Affiliation(s)
- Adam Pasquinelly
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Dalton Blood
- Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Osama Elattar
- Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Maged Hanna
- Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
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Wang Y, Geng L, Zhao R, Yang J, Cheng L, Xin P, Wang Y, Zhang G. Extra-articular biceps tendon supplement release in total knee arthroplasty for valgus deformity combined with severe flexion contracture. J Orthop Res 2023; 41:2433-2441. [PMID: 37186321 DOI: 10.1002/jor.25578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
To investigate the efficacy of extra-articular biceps tendon supplement (EBS) release in the treatment of valgus knee with severe flexion contracture. We retrospectively studied 27 patients who received EBS release for valgus knee combined with severe flexion contracture from 2018 to 2021. The full-length radiograph of the lower limbs in a standing position was taken before and after the operation, and the tibiofemoral angles before and after the operation were measured on the full-length radiograph of the lower limbs. Knee joint motion measurement and KSS scoring were performed before and after the operation (3 months, 6 months, and 1 year), and the obtained data were compared before and after the operation to evaluate clinical results. Compared with preoperation, postoperative HKA (p < 0.01), ROM at 3 months (p < 0.01), 6 months (p < 0.01), and 1 year (p < 0.01) were significantly improved, and KSS scores at 3 months (p < 0.01), 6 months (p < 0.01), and 1 year (p < 0.01) were significantly improved. Our EBS release has good clinical results for the treatment of valgus knee with severe flexion contracture.
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Affiliation(s)
- Yiming Wang
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Lei Geng
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Runkai Zhao
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Jianfeng Yang
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Long Cheng
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Peng Xin
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yan Wang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Guoqiang Zhang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
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Streck LE, Faschingbauer M, Brenneis M, Boettner CS, List K, Kasparek MF, Boettner F. Individual Phenotype Does Not Impact the Outcome of Mechanical Aligned Total Knee Arthroplasties for Valgus Osteoarthritis. Medicina (Kaunas) 2023; 59:1852. [PMID: 37893570 PMCID: PMC10608527 DOI: 10.3390/medicina59101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: There is an ongoing discussion about the best alignment targets in total knee arthroplasty (TKA). Mechanical alignment has been the standard in TKA for years. Alongside the development of various classification systems to describe the native alignment of the knee (knee phenotype), kinematic alignment restoring the individual phenotype of the knee has been advocated more recently. Alignment in TKA becomes even more challenging in knees with preoperative deformities such as valgus osteoarthritis. Materials and Methods: The study retrospectively evaluated 158 knees in 135 patients who underwent TKA with a mechanical alignment target for valgus osteoarthritis. Pre- and postoperative hip knee angle, lateral distal femur angle, and medial proximal tibial angle/tibial plate angle (pre-/postoperative) were measured on standing hip-to-ankle radiographs. Knees were grouped according to the coronal plane alignment of the knee (CPAK) classification. Preoperative and postoperative range of motion and patient-related outcome measures (WOMAC, UCLA, SF-12, pain) were assessed. Results: There was no difference in outcome for mechanically aligned TKA between the different CPAK phenotypes, suggesting that mechanical alignment is an appropriate target for the different phenotypes analyzed in the study. Remaining valgus alignment was associated with decreased postoperative UCLA scores and decreased improvement in SF-12 scores (p = 0.011/p = 0.028). Within CPAK III, mechanical aligned TKA showed better postoperative UCLA Scores than TKA with valgus alignment (p = 0.015). The individual knee phenotype in patients with valgus osteoarthritis did not influence the outcome of mechanical aligned TKA operated with standardized soft-tissue release.
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Affiliation(s)
- Laura E. Streck
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Marco Brenneis
- The Complex Joint Reconstruction Centre at Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
| | - Cosima S. Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Kilian List
- Department of Orthopedics, University of Wuerzburg, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Maximilian F. Kasparek
- Department of Orthopedics, Evangelisches Krankenhaus, Hans-Sachs Gasse 10-12, 1180 Vienna, Austria
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Yang D, Wu XD, Zhou Y, Yin X, Huang Y, Shao H, Tang H. Correlation between tibial valgus deformity and aspect ratio of resected tibial surface in female Chinese patients undergoing total knee arthroplasty. Front Surg 2023; 9:1079981. [PMID: 36684171 PMCID: PMC9852758 DOI: 10.3389/fsurg.2022.1079981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/07/2022] [Indexed: 01/09/2023] Open
Abstract
Background Morphology of the resected tibial surface is the reference for tibial component design, selection, and implantation in total knee arthroplasty (TKA). This comparative study sought to answer whether valgus deformity of the tibia would affect the morphology of the resected tibial surface in TKA. Methods Thirty-one female Chinese patients with valgus tibias were retrospectively and consecutively identified from a single-center registration database. Thirty-one patients with well-aligned tibias were matched in terms of gender, height, and weight. Weight-bearing full-length radiographs and computed tomography images of the whole lower limb were obtained for every case. Tibial resection was mimicked perpendicular to the mechanical axis of the tibia in the frontal plane with 3° of posterior slope and a cut level individualized by the actual intraoperative cut. On the resected surface, mediolateral dimension (MLD), medial anteroposterior dimensions (mAPD), and lateral anteroposterior dimensions (lAPD) were measured, and aspect ratios (AR) were calculated. We compared the AR between the two groups. Results The aspect ratio of resected tibial surface positively correlated with tibial valgus alignment. Patients with valgus tibias had significantly smaller AR (MLD/mAPD) for the medial plateau (1.50 ± 0.06 vs. 1.54 ± 0.07, P = 0.032). However, the AR for the lateral plateau was similar between the two groups (1.63 ± 0.08 vs. 1.65 ± 0.07, P = 0.328). Conclusion This difference in morphology of resected tibial surface between valgus and well-aligned tibias should be considered in tibial component design, as well as in the selection and placement of TKA implants for knees with valgus tibias.
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Dudek P, Marczak D, Okoń T, Grzelecki D, Szneider J, Kowalczewski J. Lateral or Medial Parapatellar Surgical Approach to the Valgus Osteoarthritic Knee? A Retrospective Single-Center Study. J Clin Med 2022; 11:jcm11195953. [PMID: 36233820 PMCID: PMC9572376 DOI: 10.3390/jcm11195953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Aims: Total knee arthroplasty in patients with fixed valgus deformity is a demanding procedure. The aim of this study was to compare the clinical results of using the lateral approach [LA] versus the medial approach [MA] in the treatment of fixed valgus knee deformities. Methods: This single-center study compared the results of 143 consecutive patients with fixed valgus deformity (mean 21.55° valgus, mean age 68.2 years) undergoing LA Total Knee Arthroplasty [TKA] to 50 patients (mean 16.58° valgus, mean age 67.2 years) undergoing MA TKA. The mean follow-up period was 5.1 years (2−10 years). Data was collected from operative notes, routine postoperative visits, and radiological findings. Apart from a radiological evaluation, patients were clinically assessed both pre- and postoperatively using the Knee Society Score [KSS]. Descriptive statistics together with the Kolmogorov-Smirnov test, the Student’s t-test for independent samples, and the Mann-Whitney U test were used. The level of significance in this study was α = 0.05. Results: In the LA group, the KSS Knee was significantly higher than in the MA group [85.31 vs. 77.42, respectively, p-value < 0.001]. The difference was also in the KSS total but with no statistical significance [155.17 vs. 149.22, p-value 0.087]. The surgery time in the LA group was shorter than in the MA group [81 vs. 91 min, respectively, p-value—0.002]. The complication rate after surgery was higher in the MA group than in the LA group (14% vs. 9%, respectively). Conclusions: The lateral approach is a good alternative to the standard medial parapatellar approach in the treatment of fixed valgus knee deformities. A higher postoperative KSS Knee, shorter surgery time, and similar complication rate make the lateral approach a valuable option for treating patients with osteoarthritis and fixed valgus knee deformity.
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Affiliation(s)
- Piotr Dudek
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
- Correspondence:
| | - Dariusz Marczak
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
| | - Tomasz Okoń
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
| | - Dariusz Grzelecki
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
| | - Jan Szneider
- Centre of Postgraduate Medical Education, Department of Orthopaedics, 01-813 Warsaw, Poland
| | - Jacek Kowalczewski
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
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Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. HSS J 2022; 18:297-306. [PMID: 35645636 PMCID: PMC9096991 DOI: 10.1177/15563316211051295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022]
Abstract
Background: Distal femoral varus osteotomy (DFVO) is an effective surgical intervention for the management of symptomatic valgus malalignment of the knee. Because it preserves the native knee joint and its ligamentous stability, DFVO is preferred to total knee arthroplasty (TKA) in the young, active population. Purpose: We sought to assess return to work (RTW) and return to sport (RTS) rates following DFVO for valgus malalignment of the knee. Methods: For this systematic review, we searched EMBASE, MEDLINE, and Web of Science from inception through December 31, 2020. English language studies of all levels of evidence explicitly reporting on RTS and RTW rates following DFVO for valgus malalignment of the knee were eligible for inclusion. Results: Seven studies and 127 patients were included in our analysis. Mean age was 32.4 ± 8.8 years with men comprising 46.7% ± 22.3% of study populations. The mean RTS rate was 87.2% ± 10.7%, with a return to preoperative activity levels rate of 65.4% ± 26.8%. The mean RTW rate was 81.8% ± 23.3%, with a return to preoperative activity levels of 72.8% ± 18.1%. The mean reoperation rate was 35.6% ± 18.8% within a mean follow-up period of 5.5 ± 1.9 years. Conclusions: This systematic review of low-level studies found DFVO to be a safe and effective procedure for the management of genu valgum in young, active populations, with most patients returning to sport and/or work, although not all at their preoperative activity levels. A paucity of data surrounds RTS and RTW rates following DFVO. Future studies should explicitly report both return to activity rates and whether patients returned to their preoperative activity levels.
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Affiliation(s)
- Hassaan Abdel Khalik
- Michael G. DeGroote School of Medicine,
McMaster University, Hamilton, ON, Canada,Hassaan Abdel Khalik, BSc, MMI, Michael G.
DeGroote School of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada.
| | - Darius L. Lameire
- Michael G. DeGroote School of Medicine,
McMaster University, Hamilton, ON, Canada
| | - Luc Rubinger
- Division of Orthopaedic Surgery,
McMaster University, Hamilton, ON, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery,
McMaster University, Hamilton, ON, Canada
| | - Vickas Khanna
- Division of Orthopaedic Surgery,
McMaster University, Hamilton, ON, Canada
| | - Olufemi R. Ayeni
- Division of Orthopaedic Surgery,
McMaster University, Hamilton, ON, Canada
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Abstract
AIMS The aim of this study was to determine the association between knee alignment and the vertical orientation of the femoral neck in relation to the floor. This could be clinically important because changes of femoral neck orientation might alter chondral joint contact zones and joint reaction forces, potentially inducing problems like pain in pre-existing chondral degeneration. Further, the femoral neck orientation influences the ischiofemoral space and a small ischiofemoral distance can lead to impingement. We hypothesized that a valgus knee alignment is associated with a more vertical orientation of the femoral neck in standing position, compared to a varus knee. We further hypothesized that realignment surgery around the knee alters the vertical orientation of the femoral neck. METHODS Long-leg standing radiographs of patients undergoing realignment surgery around the knee were used. The hip-knee-ankle angle (HKA) and the vertical orientation of the femoral neck in relation to the floor were measured, prior to surgery and after osteotomy-site-union. Linear regression was performed to determine the influence of knee alignment on the vertical orientation of the femoral neck. RESULTS The cohort included 147 patients who underwent knee realignment-surgery. The mean age was 51.5 years (SD 11). Overall, 106 patients underwent a valgisation-osteotomy, while 41 underwent varisation osteotomy. There was a significant association between the orientation of the knee and the coronal neck-orientation. In the varus group, the median orientation of the femoral neck was 46.5° (interquartile range (IQR) 49.7° to 50.0°), while in the valgus group, the orientation was 52.0° (IQR 46.5° to 56.7°; p < 0.001). Linear regression analysis revealed that HKA demonstrated a direct influence on the coronal neck-orientation (β = 0.5 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002). Linear regression also showed that realignment surgery was associated with a significant influence on the change in the coronal femoral neck orientation (β = 5.6 (95% CI 1.5 to 9.8); p = 0.008). CONCLUSION Varus or valgus knee alignment is associated with either a more horizontal or a more vertical femoral neck orientation in standing position, respectively. Subsequently, osteotomies around the knee alter the vertical orientation of the femoral neck. These aspects are of importance when planning osteotomies around the knee in order to appreciate the effects on the adjacent hip joint. The concept may be of even more relevance in dysplastic hips. Cite this article: Bone Jt Open 2021;2(12):1057-1061.
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Affiliation(s)
- Sufian S Ahmad
- Department of Trauma and Reconstructive Surgery, University of Tübingen, Tübingen, Germany.,Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Luise Weinrich
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gregor M Giebel
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Myriam R Beyer
- Department of Trauma and Reconstructive Surgery, University of Tübingen, Tübingen, Germany
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Konrads
- Department of Trauma and Reconstructive Surgery, University of Tübingen, Tübingen, Germany
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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: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Palanisami D, George MJ, Hussain AM, Md C, Natesan R, Shanmuganathan R. Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking? J Orthop Surg (Hong Kong) 2020; 27:2309499019867006. [PMID: 31470760 DOI: 10.1177/2309499019867006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Tibial bowing in valgus knees with arthritis can lead to component malplacement during total knee arthroplasty (TKA). Incidence of valgus knees with medial tibial bowing, its effect on tibial component placement during primary TKA and methods to improve accuracy of the component placement were studied. METHODS Full-length weight-bearing alignment radiograph was taken in 117 patients (149 knees) with valgus deformity undergoing TKA. In these cases, the proximal tibial reference for extramedullary jig placement was planned preoperatively with reference to the tibial spines and classified as four zones. RESULTS The mean preoperative hip-knee-ankle (HKA) angle was 192.9° (180.3-234.5°). Bowing >3° was considered significant (p < 0.001) and at this level of bowing, the proximal tibial reference was shifted from centre to medial. Tibial bowing <3° was considered straight and >3° as tibia valga. Tibia was bowed in 70 knees (46.97%). Severity of valgus deformity had strong positive correlation with the tibia valga (p < 0.001). The post-operative medial proximal tibial angle (MPTA) and HKA angle were 91.63° (87.9-95.7°) and 182.6° (178.1-189.7°), respectively. The mean MPTA and post-operative HKA angle in bowed and straight tibiae were 90.35° versus 89.78° (p = 0.547) and 181.5° versus 180.7° (p = 0.5716), respectively, and the difference was not statistically significant. CONCLUSION Medial tibial bowing is very common in valgus knees. Tibia valga has a strong positive correlation with the severity of valgus deformity. Accurate tibial component placement can be achieved with a medialized reference point for extramedullary tibial cutting jig in knees with significant tibia valga. The study has been registered in clinical trials registry - India (CTRI/2018/03/012283).
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Affiliation(s)
| | - Melvin J George
- Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | | | - Chunchesh Md
- Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Rajkumar Natesan
- Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Gołębiowska-Sosnowska J, Synder M, Gołębiowski P, Wojciechowska K, Niedzielski J. Prevalence of Lower Limb Defects in Children in Chosen Kindergartens of the Łódź Agglomeration. Ortop Traumatol Rehabil 2019; 21:447-456. [PMID: 32100718 DOI: 10.5604/01.3001.0013.7403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Posture disorders not treated in early childhood may lead to serious diseases and dysfunctions later. The aim of the study was to assess the incidence of lower limb defects in pre-school children. MATERIAL AND METHODS The study covered 513 children (252 girls and 261 boys) aged 4-6, in chosen kinder-gartens of the Łódź agglomeration . The child's body posture was assessed using a visual method based on the Kasperczyk scoring scale in own modification. RESULTS Foot defects occurred in the examined group with a frequency of 85.58% (439/513): in 4-year-olds: 82.59%, in 5- and 6-year-olds: 87.5%. Foot defects were more common in girls in the entire study group (86.9 vs. 84.29%), in 4-year-olds (87.88 vs. 77.45%) and 6-year-olds (88.89 vs. 86.25%), and in boys in the 5-year-olds group (91.14 vs. 83.95%). Defects of the knee joints, including varus and valgus knee, occurred in the study group with a frequency of 52.83% (271/513): in 4-year-olds: 56.72%, in 5-year-olds: 45.63% and in 6-year-olds: 55.26%. Defects were more frequent in girls in the entire study group (54.37 vs. 51.34) and in 4-year-olds (58.59 vs. 54.90%), and in boys in the 5-year-old group (50.63 vs. 40.74%). In the 6-year-olds group, the defects were statistically significantly more common in girls than boys (63.89 vs. 47.5%, p = 0.0442). CONCLUSION A high percentage of lower limb defects rate at more than half of the examined pre-school children population is disturbing and requires effective systemic action.
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Affiliation(s)
- Justyna Gołębiowska-Sosnowska
- CSK, Uniwersytet Medyczny w Łodzi, Polska / Central University Hospital, Medical University of Lodz, Poland Pracownia Fizjoterapii Pediatrycznej Kliniki Chirurgii i Urologii Dziecięcej, Centrum Pediatrii im.M. Konopnickiej / Pediatric Physiotherapy Outpatient Clinic of the Department of Pediatric Surgery and Urology, M. Konopnicka Pediatrics Center
| | - Marek Synder
- Katedra i Klinika Ortopedii i Ortopedii Dziecięcej, CSK, Uniwersytet Medyczny w Łodzi, Polska / Department of Orthopedics and Pediatric Orthopedics, Central University Hospital, Medical University of Lodz, Poland
| | - Piotr Gołębiowski
- CSK, Uniwersytet Medyczny w Łodzi, Polska / Central University Hospital, Medical University of Lodz, Poland Pracownia Fizjoterapii Pediatrycznej Kliniki Chirurgii i Urologii Dziecięcej, Centrum Pediatrii im.M. Konopnickiej / Pediatric Physiotherapy Outpatient Clinic of the Department of Pediatric Surgery and Urology, M. Konopnicka Pediatrics Center
| | - Klaudia Wojciechowska
- CSK, Uniwersytet Medyczny w Łodzi, Polska / Central University Hospital, Medical University of Lodz, Poland Pracownia Fizjoterapii Pediatrycznej Kliniki Chirurgii i Urologii Dziecięcej, Centrum Pediatrii im.M. Konopnickiej / Pediatric Physiotherapy Outpatient Clinic of the Department of Pediatric Surgery and Urology, M. Konopnicka Pediatrics Center
| | - Jerzy Niedzielski
- Uniwersytet Medyczny w Łodzi, Polska / Medical University of Lodz, Poland Klinika Chirurgii i Urologii Dziecięcej, Centrum Pediatrii im.M.Konopnickiej CSK / Department of Pediatric Surgery and Urology, M. Konopnicka Pediatrics Center, Central University Hospital
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14
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Xu G, Fu X, Tian P, Bahat D, Huang Y, Li Z. The lateral and medial approach in total arthroplasty for valgus knee: a meta-analysis of current literature. J Comp Eff Res 2019; 9:35-44. [PMID: 31777265 DOI: 10.2217/cer-2019-0111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To compare the lateral and medial approaches of total knee arthroplasty (TKA) in the valgus knee. Materials & methods: An electronic search from the PubMed, Embase, Web of Science and Cochrane library was performed according to 'TKA', 'valgus', 'knee' and 'approach'. Subsequently, manual search was conducted from the reference lists in the identified studies. Results: Four randomized controlled trials and five cohorts were included. Better knee society score and function was noticed in patients after lateral approach. Similar postoperative valgus deformity, operative time, blood loss, Western Ontario and McMaster Universities Osteoarthritis Index, range of motion, pain and total complications in both groups. Conclusion: Compared with the medial approach for TKA in valgus knee, current data shows superior results after TKA by the lateral approach.
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Affiliation(s)
- Guijun Xu
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin 300211, PR China
| | - Xin Fu
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin 300211, PR China
| | - Peng Tian
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Street, Hexi District, Tianjin 300211, PR China
| | - Daniel Bahat
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Yuting Huang
- Department of Medicine, University of Maryland Medical Center Midtown Campus 827 Linden Ave, Baltimore, MD 21201, USA
| | - Zhijun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, PR China
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Zainul-Abidin S, Lim B, Bin-Abd-Razak HR, Gatot C, Allen JC, Koh J, Howe TS. Periprosthetic Fractures after Total Knee Arthroplasty: the Influence of Pre-Operative Mechanical Factors versus Intraoperative Factors. Malays Orthop J 2019; 13:28-34. [PMID: 31467648 PMCID: PMC6702975 DOI: 10.5704/moj.1907.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: Periprosthetic fractures are a devastating complication following total knee arthroplasty. Little is known about the effect of mechanical factors on the incidence of periprosthetic fractures. The aim of this study was to examine the correlation between pre-operative mechanical factors, like side of surgery, coronal alignment and pre-operative range of motion and intra-operative factors, and the incidence of a periprosthetic fracture, following primary total knee arthroplasty (TKA). Materials and Methods: Forty-two patients with periprosthetic fractures (PPF) after primary TKA were identified from our hospital arthroplasty registry. These patients were matched two-to-one for gender and age at primary knee arthroplasty to 84 patients without PPF. The incidence of periprosthetic fracture with regards to laterality, coronal alignment and pre-operative range of motion was analysed. Intra-operative factors like implant type, patellar resurfacing and notching were also analysed using logistic regression. Results: Coronal alignment, pre-operative range of motion and patella resurfacing were not significant predictors of periprosthetic fractures. Anterior femoral notching was found to be significantly higher in the fracture group with an odds ratio of 17. Left sided surgery was also significantly higher in the periprosthetic fracture group. Conclusion: Periprosthetic fractures are 17 times more likely to occur in a knee with anterior femoral notching. Preoperative factors like coronal alignment and poor preoperative range of motion do not seem to increase the risk of periprosthetic fractures after TKA.
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Affiliation(s)
- S Zainul-Abidin
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,Centre for Quantitative Medicine, DukeNUS Medical School, Singapore
| | - Btj Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,Centre for Quantitative Medicine, DukeNUS Medical School, Singapore
| | - H R Bin-Abd-Razak
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,Centre for Quantitative Medicine, DukeNUS Medical School, Singapore
| | - C Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,Centre for Quantitative Medicine, DukeNUS Medical School, Singapore
| | - J C Allen
- Centre for Quantitative Medicine, DukeNUS Medical School, Singapore
| | - Jsb Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,Centre for Quantitative Medicine, DukeNUS Medical School, Singapore
| | - T S Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,Centre for Quantitative Medicine, DukeNUS Medical School, Singapore
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16
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Mou P, Zeng Y, Yang J, Zhong H, Yin SJ, Li RB. The Effectiveness of Medial Femoral Epicondyle Up-Sliding Osteotomy to Correct Severe Valgus Deformity in Primary Total Knee Arthroplasty. J Arthroplasty 2018; 33:2868-2874. [PMID: 29805102 DOI: 10.1016/j.arth.2018.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND While many surgical techniques can achieve neutral limb alignment and soft tissue balance in severe valgus deformity during total knee arthroplasty (TKA), few published reports concern medial femoral epicondyle up-sliding osteotomy. METHODS A prospective investigation was conducted of patients with severe valgus deformities who underwent medial femoral epicondyle up-sliding osteotomy. Clinical measurements, radiological evaluation, and complication data were recorded. RESULTS Using posterior-stabilized prostheses, 26 patients underwent 28 TKAs performed by the same surgeon using medial femoral epicondyle up-sliding osteotomy to balance the soft tissue. On average, the follow-up was 54 ± 18 months, and the patient age was 63 ± 11 years. All knees were type II according to Krackow's classification. Varus-valgus knee motion was prohibited with the protection of long-leg knee brace for 3 months. At the last follow-up, the Knee Society function score, Hospital for Special Surgery knee-rating scale, and range of motion were 94 ± 6, 91 ± 4, and 116° ± 8°, respectively. All knees were stable laterally, whereas 2 knees had mild medial laxity and the others were stable. The hip-knee-ankle angle, femorotibial angle, condylar-hip angle, plateau-ankle angle, and valgus angle were 179.9° ± 3.4°, 172.9° ± 3.6°, 89.8° ± 2.5°, 90.2° ± 1.1°, and 7.3° ± 3.5°, respectively. CONCLUSION Medial femoral epicondyle up-sliding osteotomy during TKA in patients with severe valgus deformities facilitates the restoration of lower limb alignment, soft tissue balance, and knee stability.
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Affiliation(s)
- Ping Mou
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yi Zeng
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jing Yang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hang Zhong
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Shi-Jiu Yin
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Rui-Bo Li
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Yang D, Shao H, Zhou Y, Tang H, Guo S. Location of the Common Peroneal Nerve in Valgus Knees-Is the Reported Safe Zone for Well-Aligned Knees Applicable? J Arthroplasty 2017; 32:3539-43. [PMID: 28648707 DOI: 10.1016/j.arth.2017.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Lateral soft-tissue release can jeopardize the common peroneal nerve (CPN) in total knee arthroplasty for valgus knees. Previous studies reporting safe zones to protect the CPN were based on well-aligned knees. We conducted this study to compare the localization of the CPN in well-aligned knees and in valgus knees. METHODS We conducted a consecutive 3-dimensional radiographic study on magnetic resonance images of 58 well-aligned knees and 39 valgus knees. We measured the distance between the CPN and the tibia, as well as the mediolateral, anteroposterior, and angular location of the CPN. We compared the results between well-aligned knees and valgus knees. RESULTS We found that there is an increased distance between the CPN and the tibia at the level of the tibial cut, but not at the joint line in valgus knees. It is safer to release the posterolateral capsule at the tibial side than at the level above this. The angular location and the mediolateral or anteroposterior location of the CPN in valgus knees are similar to those of well-aligned knees. CONCLUSION The location of the CPN in valgus knees is similar to that in well-aligned knees. The previously reported safe zone in well-aligned knees is applicable in valgus knees to protect the CPN.
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18
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Hatayama K, Terauchi M, Saito K, Hagiwara K, Higuchi H. Tibial Tubercle in Valgus Osteoarthritic Knees Is More Laterally Positioned Than in Varus Knees. J Arthroplasty 2016; 31:2303-7. [PMID: 27155995 DOI: 10.1016/j.arth.2016.03.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The tibial tubercle (TT) is the most reliable landmark of the tibial component rotation in total knee arthroplasty. However, there is no report comparing the position of the TT between valgus and varus osteoarthritic knees. METHODS Using preoperative computed tomography, we measured the TT-posterior cruciate ligament (PCL) distance representing the degree of lateralization of the TT and the angle between Akagi's anteroposterior (AP) axis and the dorsal condylar line (DCL) of the tibia in 36 valgus and 40 varus osteoarthritic knees and compared them. RESULTS The mean TT-PCL distances in valgus and varus knees were 26.1 (18.2-36.8) and 17.2 mm (10.3-22.6), respectively, with a significant difference (P < .001). Twenty-four of 36 valgus knees (67%) had abnormal TT-PCL (>24 mm). The mean AP-DCL angles in valgus and varus knees were 103° (95.8°-114.8°) and 93.2° (85.3°-99.6°), respectively, with a significant difference (P < .001). CONCLUSION The TT in valgus knees was significantly more laterally positioned than in varus knees. Also, Akagi's AP axis in valgus knees was significantly more externally rotated relative to the DCL of the tibia than in varus knees. Attention is necessary to correct rotational alignment without posterolateral overhang of the tibial component during total knee arthroplasty, particularly for valgus knees.
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Affiliation(s)
- Kazuhisa Hatayama
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Gunma Chuo Hospital, Maebashi, Gunma, Japan
| | - Masanori Terauchi
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Gunma Chuo Hospital, Maebashi, Gunma, Japan
| | - Kenichi Saito
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Keiichi Hagiwara
- Department of Orthopaedic Surgery, Zensyukai Hospital, Maebashi, Gunma, Japan
| | - Hiroshi Higuchi
- Department of Orthopaedic Sports Surgery, Asakura Sports Rehabilitation Clinic, Maebashi, Gunma, Japan
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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: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Radulescu R, Badila A, Japie I, Ciobanu T, Manolescu R. Primary total knee arthroplasty in severe valgus knee. J Med Life 2013; 6:395-8. [PMID: 24868248 PMCID: PMC4034316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 09/30/2013] [Indexed: 11/18/2022] Open
Abstract
AIM Outcome of primary total arthroplasty for osteoarthritis of the knee with valgus deformity. MATERIALS AND METHODS Between 2005 and 2007, 28 primary total knee replacements were performed for osteoarthritis of the knee with valgus deformity. 21 cases were women and 7 men with a mean age of 66.6 years (extremes 54-81). The clinical and radiological evaluations were done considering the knee range of motion, Knee Society Score (KSS) and femorotibial angle measured on the frontal standing long leg X-rays. Preoperatively, the knee valgus deformity angle was 6 to 15 degrees in 14 cases, 15 to 25 degrees in 10 cases and over 25 degrees in 4 cases. RESULTS After a mean follow-up time of 14 months (extremes 7-29), the knee range of motion improved from a mean of 71 degrees (extremes 52-87) preoperatively to a mean of 95 degrees (extremes 78-110) postoperatively. The KSS value improved from 21.3 points (extremes 1-33) preoperatively to 80.7 points (extremes 70-92) postoperatively and the frontal femorotibial angle from a mean value of 21 degrees (extremes 11-39) of valgus before surgery, to a mean of 9 degrees (extremes 0-12) of valgus after surgery. CONCLUSIONS Long leg AP view X-ray examination in standing position is mandatory. The standard medial parapatellar approach is appropriate in this type of arthroplasty even if significant knee valgus deviations are present because it avoids the lateral approach complications. Postoperatively, one can get an aligned and stable knee if a judicious and progressive periarticular soft tissues balancing is achieved, in both flexion and extension position.
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Affiliation(s)
- R Radulescu
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest,Department of Orthopedic Surgery, Bucharest University Emergency Hospital, Romania
| | - A Badila
- Department of Orthopedic Surgery, Bucharest University Emergency Hospital, Romania
| | - I Japie
- Department of Orthopedic Surgery, Bucharest University Emergency Hospital, Romania
| | - T Ciobanu
- Department of Orthopedic Surgery, Bucharest University Emergency Hospital, Romania
| | - R Manolescu
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest
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