CLINICAL OBSERVATION OF ROTATING-PLATFORM PROSTHESIS FOR VALGUS KNEE DEFORMITY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUJian ,  SUNJunying , ZHAOXijiang , WANGTao , XUNing , WANGuoyang , YINHaibo , LIUYong

Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P. R. China;

Corresponding author：

SUNJunying, Email: sun_Junying@hotmail.com

Keywords：

Total knee arthroplasty; Valgus knee deformity; Rotating-platform prosthesis

DOI：

10.7507/1002-1892.20160109

Video：

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Objective To investigate the effectiveness of rotating-platform prosthesis for valgus knee deformity in total knee arthroplasty (TKA). Methods A retrospective analysis was made on the clinical date of 25 cases (28 knees) of valgus deformity undergoing primary TKA by using Gemini MK II rotating-platform prosthesis. There were 6 males (7 knees) and 19 females (21 knees), aged from 47 to 82 years, with an average age of 64.8 years. The unilateral knee was involved in 22 cases and the bilateral knees in 3 cases. The causes included osteoarthritis in 20 cases (22 knees), rheumatoid arthritis in 4 cases (5 knees), and traumatic arthritis in 1 case (1 knee). The disease duration was 2-22 years (mean, 10.4 years). The main clinical symptoms were arthralgia combined with limited movement. According to the Keblish grade, there were 13 knees of mild deformity, 11 knees of moderate deformity, and 4 knees of severe deformity. Results All incisions healed by first intension. No complications of infection, cutaneous necrosis, deep venous thrombosis, and pulmonary embolism occurred. The postoperative follow-up duration was 12-60 months (mean, 25.4 months). Medial instability and palsies of nervus peroneus communis occurred in 1 and 2 cases respectively, and all were cured after symptomatic treatment. No patellar and polysthylene insert dislocation, prosthetic loosening or infection was observed. The Hospital for Special Surgery (HSS) score, femoral tibial angle, maximun flexion and extension angles, knee range of motion, and patellar score were significantly improved at last follow-up when compared with preoperative ones (P<0.01). Conclusion The rotating-platform prosthesis for valgus deformity can obtain satisfactory effectiveness, but it requires precise soft tissue balancing technology, and the long-term effectiveness remains further observation.

Citation： GUJian, SUNJunying, ZHAOXijiang, WANGTao, XUNing, WANGuoyang, YINHaibo, LIUYong. CLINICAL OBSERVATION OF ROTATING-PLATFORM PROSTHESIS FOR VALGUS KNEE DEFORMITY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(5): 541-545. doi: 10.7507/1002-1892.20160109 Copy

1.	Pour AE, Parvizi J, Slenker N, et al. Rotating hinged total knee replacement:use with caution. J Bone Joint Surg (Am), 2007, 89(8):1735-1741.
2.	Koskinen E, Remes V, Paavolainen P, et al. Results of total knee replacement with a cruciate-retaining model for severe valgus deformity-a study of 48 patients followed for an average of 9 years. Knee, 2011, 18(3):145-150.
3.	Kim YH, Kim JS, Choe JW, et al. Long-term comparison of fixedbearing and mobile-bearing total knee replacements in patients younger than fifty-one years of age with osteoarthritis. J Bone Joint Surg (Am), 2012, 94(10):866-873.
4.	Ball ST, Sanchez HB, Mahoney OM, et al. Fixed versus rotating platform total knee arthroplasty:a prospective, randomized, singleblind study. J Arthroplasty, 2011, 26(4):531-536.
5.	Lizaur-Utrilla A, Sanz-Reig J, Trigueros-Rentero MA. Greater satisfaction in older patients with a mobile-bearing compared with fixed-bearing total knee arthroplasty. J Arthroplasty, 2012, 27(2):207-212.
6.	Aggarwal AK, Agrawal A. Mobile vs fixed-bearing total knee arthroplasty performed by a single surgeon:a 4-to 6.5-year randomized, prospective, controlled, double-blinded study. J Arthroplasty, 2013, 28(10):1712-1716.
7.	Post ZD, Matar WY, van de Leur T, et al. Mobile-bearing total knee arthroplasty:better than a fixed-bearing? J Arthroplasty, 2010, 25(6):998-1003.
8.	Scuderi GR, Tria AJ Jr. Surgical technique in total knee arthroplasty//Keblish PA. The lateral approach. New York:Springer, 2002:137-148.
9.	曾金才, 孙俊英, 杨立文, 等. 关节内置管局部浸润镇痛在全膝关节置换术的应用. 中国矫形外科杂志, 2009, 17(21):1609-1612.
10.	Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg (Br), 1996, 78(2):226-228.
11.	Ewald FC. The Knee Society total arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res, 1989, (248):9-12.
12.	Naudie DD, Rorabeck CH. Managing instability in total knee arthroplasty with constrained and linked implants. Instr Course Lect, 2004, 53:207-215.
13.	Rosenberg AG, Vemer JJ, Galante JO. Clinical results of total knee revision using the Total Condylar III prosthesis. Clin Orthop Relat Res, 1991, (273):83-90.
14.	Hui FC, Fitzgerald RH Jr. Hinged total knee arthroplasty. J Bone Joint Surg (Am), 1980, 62(4):513-519.
15.	Smith H, Jan M, Mahomed NN, et al. Meta-analysis and systematic review of clinical outcomes comparing mobile bearing and fixed bearing total knee arthroplasty. J Arthroplasty, 2011, 26(8):1205-1213.
16.	Harrington MA, Hopkinson WJ, Hsu P, et al. Fixed-vs mobilebearing total knee arthroplasty:does it make a difference? -a prospective randomized study. J Arthroplasty, 2009, 24(6 Suppl):24-27.
17.	Price AJ, Rees JL, Beard D, et al. A mobile-bearing total knee prosthesis compared with a fixed-bearing prosthesis. A multicentre single-blind randomised controlled trial. J Bone Joint Surg (Br), 2003, 85(1):62-67.
18.	Mahoney OM, Kinsey TL, D'Errico TJ, et al. The John Insall Award:no functional advantage of a mobile beating posterior stabilized TKA. Clin Orthop Relat Res, 2012, 470(1):33-44.
19.	Fisher J, McEwen H, Tipper J, et al. Wear-simulation analysis of rotating-platform mobile-bearing knees. Orthopedics, 2006, 29(9 Suppl):S36-41.
20.	McEwen HM, Barnett PI, Bell CJ, et al. The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech, 2005, 38(2):357-365.
21.	Komistek RD, Dennis DA, Mahfouz MR, et al. In vivo polyethylene bearing mobility is maintained in posterior stabilized total knee arthroplasty. Clin Orthop Relat Res, 2004, (428):207-213.
22.	Ranawat CS, Komistek RD, Rodriguez JA, et al. In vivo kinematics for fixed and mobile-bearing posterior stabilized knee prostheses. Clin Orthop Relat Res, 2004, (418):184-190.
23.	Krackow KA, Mihalko WM. Flexion-extention joint gap change after lateral structure release for valgus deformity correction in tatol knee arthroplasty:a cadaveric study. J Arthroplasty, 1999, 14(8):994-1004.
24.	Mihalko WM, Miller C, Krackow KA. Total knee arthroplasty ligament balancing and gap kinematics with posterior cruciate retention and sacrifice. Am J Orthop (Belle Mead NJ), 2000, 29(8):610-616.
25.	Whiteside LA. Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res, 1999, (367):130-140.
26.	Engh GA. The difficult knee:severe varus and valgus. Clin Orthop Relat Res, 2003, (416):58-63.
27.	Laskin RS, Maruyama Y, Villaneuva M, et al. Deep-dish congruent tibial component use in total knee arthroplasty:a randomized prospective study. Clin Orthop Relat Res, 2000, (380):36-44.
28.	Kim YH, Kim DY, Kim JS. Simultaneous mobile- and fixedbearing total knee replacement in the same patients. A prospective comparison of mid-term outcomes using a similar design of prosthesis. J Bone Joint Surg (Br), 2007, 89(7):904-910.

1. Pour AE, Parvizi J, Slenker N, et al. Rotating hinged total knee replacement:use with caution. J Bone Joint Surg (Am), 2007, 89(8):1735-1741.
2. Koskinen E, Remes V, Paavolainen P, et al. Results of total knee replacement with a cruciate-retaining model for severe valgus deformity-a study of 48 patients followed for an average of 9 years. Knee, 2011, 18(3):145-150.
3. Kim YH, Kim JS, Choe JW, et al. Long-term comparison of fixedbearing and mobile-bearing total knee replacements in patients younger than fifty-one years of age with osteoarthritis. J Bone Joint Surg (Am), 2012, 94(10):866-873.
4. Ball ST, Sanchez HB, Mahoney OM, et al. Fixed versus rotating platform total knee arthroplasty:a prospective, randomized, singleblind study. J Arthroplasty, 2011, 26(4):531-536.
5. Lizaur-Utrilla A, Sanz-Reig J, Trigueros-Rentero MA. Greater satisfaction in older patients with a mobile-bearing compared with fixed-bearing total knee arthroplasty. J Arthroplasty, 2012, 27(2):207-212.
6. Aggarwal AK, Agrawal A. Mobile vs fixed-bearing total knee arthroplasty performed by a single surgeon:a 4-to 6.5-year randomized, prospective, controlled, double-blinded study. J Arthroplasty, 2013, 28(10):1712-1716.
7. Post ZD, Matar WY, van de Leur T, et al. Mobile-bearing total knee arthroplasty:better than a fixed-bearing? J Arthroplasty, 2010, 25(6):998-1003.
8. Scuderi GR, Tria AJ Jr. Surgical technique in total knee arthroplasty//Keblish PA. The lateral approach. New York:Springer, 2002:137-148.
9. 曾金才, 孙俊英, 杨立文, 等. 关节内置管局部浸润镇痛在全膝关节置换术的应用. 中国矫形外科杂志, 2009, 17(21):1609-1612.
10. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. J Bone Joint Surg (Br), 1996, 78(2):226-228.
11. Ewald FC. The Knee Society total arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res, 1989, (248):9-12.
12. Naudie DD, Rorabeck CH. Managing instability in total knee arthroplasty with constrained and linked implants. Instr Course Lect, 2004, 53:207-215.
13. Rosenberg AG, Vemer JJ, Galante JO. Clinical results of total knee revision using the Total Condylar III prosthesis. Clin Orthop Relat Res, 1991, (273):83-90.
14. Hui FC, Fitzgerald RH Jr. Hinged total knee arthroplasty. J Bone Joint Surg (Am), 1980, 62(4):513-519.
15. Smith H, Jan M, Mahomed NN, et al. Meta-analysis and systematic review of clinical outcomes comparing mobile bearing and fixed bearing total knee arthroplasty. J Arthroplasty, 2011, 26(8):1205-1213.
16. Harrington MA, Hopkinson WJ, Hsu P, et al. Fixed-vs mobilebearing total knee arthroplasty:does it make a difference? -a prospective randomized study. J Arthroplasty, 2009, 24(6 Suppl):24-27.
17. Price AJ, Rees JL, Beard D, et al. A mobile-bearing total knee prosthesis compared with a fixed-bearing prosthesis. A multicentre single-blind randomised controlled trial. J Bone Joint Surg (Br), 2003, 85(1):62-67.
18. Mahoney OM, Kinsey TL, D'Errico TJ, et al. The John Insall Award:no functional advantage of a mobile beating posterior stabilized TKA. Clin Orthop Relat Res, 2012, 470(1):33-44.
19. Fisher J, McEwen H, Tipper J, et al. Wear-simulation analysis of rotating-platform mobile-bearing knees. Orthopedics, 2006, 29(9 Suppl):S36-41.
20. McEwen HM, Barnett PI, Bell CJ, et al. The influence of design, materials and kinematics on the in vitro wear of total knee replacements. J Biomech, 2005, 38(2):357-365.
21. Komistek RD, Dennis DA, Mahfouz MR, et al. In vivo polyethylene bearing mobility is maintained in posterior stabilized total knee arthroplasty. Clin Orthop Relat Res, 2004, (428):207-213.
22. Ranawat CS, Komistek RD, Rodriguez JA, et al. In vivo kinematics for fixed and mobile-bearing posterior stabilized knee prostheses. Clin Orthop Relat Res, 2004, (418):184-190.
23. Krackow KA, Mihalko WM. Flexion-extention joint gap change after lateral structure release for valgus deformity correction in tatol knee arthroplasty:a cadaveric study. J Arthroplasty, 1999, 14(8):994-1004.
24. Mihalko WM, Miller C, Krackow KA. Total knee arthroplasty ligament balancing and gap kinematics with posterior cruciate retention and sacrifice. Am J Orthop (Belle Mead NJ), 2000, 29(8):610-616.
25. Whiteside LA. Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res, 1999, (367):130-140.
26. Engh GA. The difficult knee:severe varus and valgus. Clin Orthop Relat Res, 2003, (416):58-63.
27. Laskin RS, Maruyama Y, Villaneuva M, et al. Deep-dish congruent tibial component use in total knee arthroplasty:a randomized prospective study. Clin Orthop Relat Res, 2000, (380):36-44.
28. Kim YH, Kim DY, Kim JS. Simultaneous mobile- and fixedbearing total knee replacement in the same patients. A prospective comparison of mid-term outcomes using a similar design of prosthesis. J Bone Joint Surg (Br), 2007, 89(7):904-910.

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