【Abstract】 Objective To investigate the surgical technique and the cl inical results of total knee arthroplasty (TKA)in treating end-stage gonarthrosis combined with valgus knee deformity. Methods Between November 1998 and October2010, 64 patients (72 knees) with end-stage gonarthrosis combined with valgus knee deformity underwent TKA by a medialparapatellar approach. Of the 64 patients, 18 were male and 46 were female with an average age of 62.5 years (range, 23-82 years),including 44 cases (49 knees) of osteoarthritis, 17 cases (20 knees) of rheumatoid arthritis, 2 cases (2 knees) of haemophilicarthritis, and 1 case (1 knee) of post-traumatic arthritis. Bilateral knees were involved in 8 cases, and single knee in 56 cases. Theflexion and extension range of motion (ROM) of the knee joint was (82.2 ± 28.7)°; the femur-tibia angle (FTA) was (18.0 ± 5.8)°;according to Knee Society Score (KSS) criterion, the preoperative cl inical score was 31.2 ± 10.1 and functional score was37.3 ± 9.0. According to Krackow’s classification, there were 65 knees of type I and 7 knees of type II. By medial parapatellarapproach, conventional osteotomy and Ranawat soft tissue release were performed in all cases. Prosthesis of preserved posteriorcruciate l igament were used in 7 cases (7 knees), posterior stabil ize prosthesis in 54 cases (60 knees), constrained prosthesisin 4 cases (5 knees). Results Incisions healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient withhaemophilic arthritis, severe valgus deformity (FTA was 41°), and flexion contracture (20°), which was cured after 1 year ofconservative treatment. Revison surgery was performed in 1 case of deep infection at 2 years after surgery. All the patients werefollowed up 4.9 years on average (range, 1-13 years). At last follow-up, the FTA was (7.0 ± 2.5)°, showing significant differencewhen compared with preoperative value (t=15.502, P=0.000). The KSS cl inical score was 83.0 ± 6.6 and functional score was85.1 ± 10.5, the flexion and extension ROM of the knee joint was (106.1 ± 17.0)°, all showing significant differences whencompared with preoperative values (P lt; 0.05). Five patients had 12-15° valgus knee deformity, but the function of the affectknees were good. Conclusion TKA is an effective way for the patients with end-stage gonarthrosis combined with valgusknee deformity by medial parapatellar approach combined with conventional osteotomy and Ranawat soft tissue release. Thecorrection of deformity and improvement of joint function can be achieved significantly. The cl inical result is satisfactory.
ObjectiveTo explore the surgical technique and effectiveness of sliding osteotomy of medial femur condyle in handling soft tissue balance of severe valgus deformity in total knee arthroplasty (TKA). MethodsBetween June 2008 and February 2014, 18 cases (19 knees) of severe valgus knees undergoing sliding osteotomy of medial femur condyle in primary TKA were included. Of the 18 patients, 6 were male and 12 were female with an average age of 52.3 years (range, 29-72 years), including 3 cases (3 knees) of osteoarthritis, 11 cases (12 knees) of rheumatoid arthritis, 3 cases (3 knees) of post-traumatic arthritis, and 1 case (1 knee) of deformities in skeletal dysplasia. Before surgery, the tibial-femur angle (TFA) was (33.0±2.9)°; the Hospital for Special Surgery (HSS) score was 41.6±7.7; the Knee Society Score (KSS) lateral stability score was 6.0±5.4. All cases were rated as type II according to Krackow classification of valgus knee. During primary TKA, sliding osteotomy of medial femur condyle was performed via a medial parapatellar approach. ResultsIncision healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient, which was cured after 6 months of conservative treatment. Eighteen cases were followed up 19 months to 7 years, with an average of 5.7 years. All patients had no complications of deep vein thrombosis, deep infection, and prosthesis loosening. X-ray films showed that bone healing was achieved in all cases at 6 months. At last follow-up, the TFA was (4.8±1.8)°, showing significant difference when compared with preoperative value (t=62.61, P=0.00). The HSS score was 87.2±10.5 and the KSS lateral stability score was 12.4±3.1, all showing significant differences when compared with preoperative scores (t= —33.35, P=0.00; t= —6.83, P=0.00). ConclusionSliding osteotomy of medial femur condyle is effective for correcting severe valgus knee deformity during TKA. Satisfactory joint function and stability may be achieved.
ObjectiveTo investigate the effectiveness of rotating-platform prosthesis for valgus knee deformity in total knee arthroplasty (TKA). MethodsA 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. ResultsAll 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). ConclusionThe 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.