CORRECTION OF VARUS KNEE WITH REDUCTION OSTEOTOMY DURING TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUWeiping , XIEJie , LIMingqing , ZENGMin , LEIPengfei , WANGLong ,  HUYihe

Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P. R. China;

Corresponding author：

HUYihe, Email: xy_huyh@163.com

Keywords：

Total knee arthroplasty; Reduction osteotomy of tibial plateau; Knee varus deformity; Osteoarthritis

DOI：

10.7507/1002-1892.20150311

Video：

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Objective To evaluate the effectiveness of reduction osteotomy for correction of varus knee during total knee arthroplasty. Methods A retrospective analysis was made on the clinical data of 16 patients (24 knees) who received reduction osteotomy for correcting varus knee during total knee arthroplasty between May 2010 and July 2012. There were 2 males (3 knees) and 14 females (21 knees), with an average age of 67 years (range, 57-79 years). The disease duration ranged from 3 to 15 years (mean, 9.1 years). The Knee Society Score (KSS) was 38.71±10.04 for clinical score and 50.31±14.31 for functional score. The range of motion (ROM) of the knee was (91.88±13.01)°. The tibiofemoral angle was (9.04±4.53)° of varus deformity. Reduction osteotomy was applied to correct varus knee. Results The operation time was 85-245 minutes (mean, 165.5 minutes); the obvious blood loss was 10-800 mL (mean, 183.1 mL); the hospitalization time was 8-22 days (mean, 13.6 days). All incisions healed by first intention. No neurovascular injury or patellar fracture occurred. The follow-up duration ranged from 37 to 62 months (mean, 48 months). The tibiofemoral angle was corrected to (3.92±1.89)° of valgus at 48 hours after operation. The lower limb alignment recovered to normal. The X-ray films showed no evidence of obvious radiolucent line, osteolysis, or prosthesis subsidence. The results of KSS were significantly improved to 84.21±6.49 for clinical score and 85.31±6.95 for functional score (t=20.665, P=0.000; t=9.585, P=0.000); and ROM of the knee was significantly increased to (105.83±11.29)° (t=8.333, P=0.000) at last follow-up. Conclusion The effectiveness of reduction osteotomy for varus knee deformity during total knee arthroplasty is satisfactory. Proper alignment, ROM, and function of knee can be achieved.

Citation： SUWeiping, XIEJie, LIMingqing, ZENGMin, LEIPengfei, WANGLong, HUYihe. CORRECTION OF VARUS KNEE WITH REDUCTION OSTEOTOMY DURING TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(12): 1453-1456. doi: 10.7507/1002-1892.20150311 Copy

1.	Chang CB, Koh IJ, Seo ES, et al. The radiographic predictors of symptom severity in advanced knee osteoarthritis with varus deformity. Knee, 2011, 18(6):456-460.
2.	Lo GH, Tassinari AM, Driban JB, et al. Cross-sectional DXA and MR measures of tibial periarticular bone associate with radiographic knee osteoarthritis severity. Osteoarthritis Cartilage, 2012, 20(7):686-693.
3.	Mullaji AB, Shetty GM. Correction of varus deformity during TKA with reduction osteotomy. Clin Orthop Relat Res, 2014, 472(1):126-132.
4.	Li S, Chen Y, Su W, et al. Systematic review of patellar resurfacing in total knee arthroplasty. Int Orthop, 2011, 35(3):305-316.
5.	Radcliff KE, Orozco FR, Quinones D, et al. Preoperative risk stratification reduces the incidence of perioperative complications after total knee arthroplasty. J Arthroplasty, 2012, 27(8 Suppl):77-80.e1-8.
6.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the knee society clinical rating system. Clin Orthop Relat Res, 1989, (248):13-14.
7.	蒋青, 宋知非, 骆东山, 等. 双下肢全长负重位X线片在全膝关节置换术中的应用价值. 中华骨科杂志, 2002, 22(5):284-287.
8.	Mullaji AB, Padmanabhan V, Jindal G. Total knee arthroplasty for profound varus deformity:technique and radiological results in173 knees with varus of more than 20 degrees. J Arthroplasty, 2005, 20(5):550-561.
9.	Bäthis H, Perlick L, Blum C, et al. Midvastus approach in total knee arthroplasty:a randomized, double-blinded study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7):545-550.
10.	Sodha S, Kim J, McGuire KJ, et al. Lateral retinacular release as a function of femoral component rotation in total knee arthroplasty. J Arthroplasty, 2004, 19(4):459-463.
11.	Teeny SM, Krackow KA, Hungerford DS, et al. Primary total knee arthroplasty in patients with severe varus deformity. A comparative study. Clin Orthop Relat Res, 1991, (273):19-31.
12.	Seo JG, Moon YW, Jo BC, et al. Soft tissue balancing of varus arthritic knee in minimally invasive surgery total knee arthroplasty:comparison between posterior oblique ligament release and superficial MCL release. Knee Surg Relat Res, 2013, 25(2):60-64.
13.	张福江, 高志国, 于建华. 选择性松解膝内侧副韧带浅层在膝内翻全膝关节置换术中的应用. 中国修复重建外科杂志, 2008, 22(5):627-628.
14.	Koh HS, In Y. Semimembranosus release as the second step of soft tissue balancing in varus total knee arthroplasty. J Arthroplasty, 2013, 28(2):273-278.
15.	Liu F, Yue B, Gadikota HR, et al. Morphology of the medial collateral ligament of the knee. J Orthop Surg Res, 2010, 5:69.
16.	Dixon MC, Parsch D, Brown RR, et al. The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone. J Arthroplasty, 2004, 19(1):19-22.

1. Chang CB, Koh IJ, Seo ES, et al. The radiographic predictors of symptom severity in advanced knee osteoarthritis with varus deformity. Knee, 2011, 18(6):456-460.
2. Lo GH, Tassinari AM, Driban JB, et al. Cross-sectional DXA and MR measures of tibial periarticular bone associate with radiographic knee osteoarthritis severity. Osteoarthritis Cartilage, 2012, 20(7):686-693.
3. Mullaji AB, Shetty GM. Correction of varus deformity during TKA with reduction osteotomy. Clin Orthop Relat Res, 2014, 472(1):126-132.
4. Li S, Chen Y, Su W, et al. Systematic review of patellar resurfacing in total knee arthroplasty. Int Orthop, 2011, 35(3):305-316.
5. Radcliff KE, Orozco FR, Quinones D, et al. Preoperative risk stratification reduces the incidence of perioperative complications after total knee arthroplasty. J Arthroplasty, 2012, 27(8 Suppl):77-80.e1-8.
6. Insall JN, Dorr LD, Scott RD, et al. Rationale of the knee society clinical rating system. Clin Orthop Relat Res, 1989, (248):13-14.
7. 蒋青, 宋知非, 骆东山, 等. 双下肢全长负重位X线片在全膝关节置换术中的应用价值. 中华骨科杂志, 2002, 22(5):284-287.
8. Mullaji AB, Padmanabhan V, Jindal G. Total knee arthroplasty for profound varus deformity:technique and radiological results in173 knees with varus of more than 20 degrees. J Arthroplasty, 2005, 20(5):550-561.
9. Bäthis H, Perlick L, Blum C, et al. Midvastus approach in total knee arthroplasty:a randomized, double-blinded study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7):545-550.
10. Sodha S, Kim J, McGuire KJ, et al. Lateral retinacular release as a function of femoral component rotation in total knee arthroplasty. J Arthroplasty, 2004, 19(4):459-463.
11. Teeny SM, Krackow KA, Hungerford DS, et al. Primary total knee arthroplasty in patients with severe varus deformity. A comparative study. Clin Orthop Relat Res, 1991, (273):19-31.
12. Seo JG, Moon YW, Jo BC, et al. Soft tissue balancing of varus arthritic knee in minimally invasive surgery total knee arthroplasty:comparison between posterior oblique ligament release and superficial MCL release. Knee Surg Relat Res, 2013, 25(2):60-64.
13. 张福江, 高志国, 于建华. 选择性松解膝内侧副韧带浅层在膝内翻全膝关节置换术中的应用. 中国修复重建外科杂志, 2008, 22(5):627-628.
14. Koh HS, In Y. Semimembranosus release as the second step of soft tissue balancing in varus total knee arthroplasty. J Arthroplasty, 2013, 28(2):273-278.
15. Liu F, Yue B, Gadikota HR, et al. Morphology of the medial collateral ligament of the knee. J Orthop Surg Res, 2010, 5:69.
16. Dixon MC, Parsch D, Brown RR, et al. The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone. J Arthroplasty, 2004, 19(1):19-22.

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Chinese Journal of Reparative and Reconstructive Surgery

CORRECTION OF VARUS KNEE WITH REDUCTION OSTEOTOMY DURING TOTAL KNEE ARTHROPLASTY

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