Total knee arthroplasty in the treatment of knee valgus deformity

doi:10.3969/j.issn.2095-4344.2888

Abstract

Abstract:

BACKGROUND: The cases of knee valgus deformity are rare and the operation is difficult. At present, the technical specifications of osteotomy and soft tissue balance at home and abroad are not uniform.

OBJECTIVE: To investigate the curative effect of total knee arthroplasty in the treatment of knee valgus deformity.

METHODS: A retrospective analysis of patients with primary knee arthroplasty for knee valgus admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2010 to August 2016 was performed. Individualized soft tissue release, precise osteotomy, appropriate prosthesis, and surgical approach were selected according to the patient’s condition. Western Ontario and McMaster Universities Osteoarthritis Index, knee society score, femorotibial angle, knee motion range, and EQ-5D scale score were evaluated before and 3 years after operation. X-ray films were reviewed regularly to observe whether the knee joint was loose or displaced. Survival rate and complications were recorded.

RESULTS AND CONCLUSION: (1) A total of 32 patients (32 knees) were enrolled. The follow-up period was 3-9 years. (2) The clinical and functional scores of knee society during the 3-year follow-up were significantly higher than those before surgery, and the differences were statistically significant (P < 0.05). There were no differences in clinical and functional scores of knee society in different deformity groups before surgery. The clinical and functional scores of knee society in different deformity groups at 3 years after operation were significantly different (P < 0.05). The mild deformity group and the moderate deformity group had higher scores than the severe deformity group. (3) The EQ-5D at 3 years after surgery was significantly increased than that before surgery, and the difference was statistically significant (P < 0.05). There were no differences in EQ-5D in different deformity groups before surgery. There were statistically significant differences in EQ-5D in different deformity groups at 3 years after operation. The mild deformity group and the moderate deformity group had better improvement than the severe deformity group. (4) Western Ontario and McMaster Universities Osteoarthritis Index at 3 years after surgery was significantly lower than that before surgery, and the difference was statistically significant (P < 0.05). There were no differences in Western Ontario and McMaster Universities Osteoarthritis Index between different deformity groups before surgery. There were statistically significant differences in Western Ontario and McMaster Universities Osteoarthritis Index in different deformity groups after surgery (P < 0.05). The mild deformity group and the moderate deformity group had lower index than the severe deformity group. (5) Knee motion range increased significantly after replacement. Compared with preoperatively, the difference was statistically significant (P < 0.05). There was no difference in knee motion range between different deformity groups after surgery (P > 0.05). (6) During the follow-up, the knee prosthesis was well fixed, no loosening or dislocation, no obvious deep vein thrombosis, no prosthesis infection. The survival rate of the prosthesis was 100%. (7) Under the guidance of individualized soft tissue balance technique and precise osteotomy, the selection of appropriate knee prosthesis for total knee arthroplasty in the treatment of knee valgus deformity is safe and effective, and the medium- and long-term results are satisfactory.

Key words: bone, joint, prosthesis, total knee replacement, valgus knee, osteotomy, soft tissue balance, deformity

CLC Number:

Zhang Zhaoming, Lin Tianye, Chen Leilei, Yang Peng, Xu Jingli, Chen Zhenqiu, He Wei, Zhang Qingwen. Total knee arthroplasty in the treatment of knee valgus deformity[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(33): 5277-5282.

Figures/Tables 7

References

[1] WILLIOT A, ROSSET P, FAVARD L, et al. Total knee arthroplasty in valgusknee. Orthop Traumatol Surg Res. 2010;96(4 Suppl): S37-S42.

[2] KRACKOW KA, JONES MM, TEENY SM, et al. Primary total knee arthroplasty in patients with fxed valgus deformity. Clin Orthop Relat Res.1991;273:9-18.

[3] RANAWAT AS, RANAWAT CS, ELKUS M, et al. Total knee arthroplasty forsevere valgus deformity. J Bone Joint Surg (Am).2005; 87 Suppl 1(Pt2):271-284.

[4] SAKU SA, MADANAT R, MÄKINEN TJ. Reasons and risk factors for ninety day re-admission following primary total knee arthroplasty in a high-volume centre. Int Orthop. 2017.

[5] OHMORI T, KABATA T, KAJINO Y, et al. The accuracy of the"projected surgical transepicondylar axis" relative to the"true surgical transepicondylar axis" in total knee arthroplasty. Knee. 2017;24(6): 1428-1434.

[6] 廖红兴,刘展亮,李晓彬,等.个体化全膝关节置换术治疗膝外翻畸形术后随访分析[J].医学信息,2014,27(12):315-316.

[7] BODENDORFER BM, KOTLER JA, ZELENTY WD, et al. Outcomes and predictors of success for arthroscopic lysis of adhesions for the stiff total knee arthroplasty. Orthopedics. 2017;40(6):e1062-e1068.

[8] LIN K, BAO L, WANG J, et al. Validation of the Chinese (Mandarin) Version of the Oxford Knee Score in Patientswith Knee Osteoarthritis. Clin Orthop Relat Res. 2017;475(12):2992-3004.

[9] 王亚康,郭建斌,王涛,等.铰链膝假体在重度外翻膝全膝关节置换术中的应用[J].实用骨科杂志,2018,24(8):701-705.

[10] GUERREIRO JPF, BADARO BS, BALBINO JRM, et al. Application of tranexamic acid in total knee arthroplasty- Prospective randomized trial. Open Orthop J. 2017; 11(15): 1049-1057.

[11] 马涛,郝林杰,宋伟,等.髌旁外侧入路全膝关节置换术治疗膝外翻畸形的疗效分析[J].中国骨与关节损伤杂志, 2019,34(8):792-795.

[12] CHUN KC, LEE SH, BAIK JS, et al. Clinical and radiological results of cruciate-retaining total knee arthroplasty with the NexGen®-CR system: comparison of patellar resurfacing versus retention with more than 14 years of follow-up. J Orthop Surg Res. 2017; 12(1): 144.

[13] INSALL J, SCOTT WN, RANAWAT CS. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am.1979;61(2):173-180.

[14] WHITESIDE LA. Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res. 1999;367(367):130-140.

[15] AGLIETTI P, BUZZI R, GIRON F, et al. The Insall-Burstein posterior stabilized total knee replacement in the valgus knee. Am J Knee Surg. 1996;9(1):8-12.

[16] GAILLARD R, LORDING T, LUSTIG S, et al. Total knee Arthroplasty after varus distal femoral osteotomy vs native knee: Similar results in a case control study. Knee Surg Sports Traumatol Arthrosc. 2017;25(11): 3522-3529.

[17] 王斌,韩守江,张合,等.3D打印截骨导板辅助股骨内侧髁上闭合楔形截骨治疗膝外翻[J].实用骨科杂志,2019,25(12):1128-1132.

[18] GWAM CU, CHUGHTAI M, KHLOPAS A, et al. Short-tomidterm Outcomes of revision total knee arthroplasty patients With a total stabilizer knee system. J Arthroplasty. 2017;32(8):2480-2483.

[19] XIE K, LYONS ST. Soft tissue releases in total knee Arthroplasty for valgus deformities. J Arthroplasty. 2017; 32(6): 1814-1818.

[20] ZHOU X, WANG M, LIU C, et al. Total knee arthroplasty for severe valgus knee deformity. Chin Med J Engl). 2014;127(6): 1062-1066.

[21] HINO K, KUTSUNA T, WATAMORI K, et al. Varus-valgus stability at 90° flexion correlates with the stability at midflexion range more widely than that at 0° extension in posterior-stabilized total knee arthroplasty. Arch Orthop Trauma Surg. 2017;137(10): 1429-1434.

[22] HERNÁNDEZ-VAQUERO D, SANDOVAL-GARCÍA MA. Hinged total knee arthroplasty in the presence of ligamentous deficiency.Clin Orthop Relat Res. 2010;468(5): 1248-1253.

[23] 王亚康,郭建斌,王涛,等.铰链膝假体在重度外翻膝全膝关节置换术中的应用[J].实用骨科杂志,2018,24(8):701-705.