High Medium-Term Survivorship of Cruciate-Retaining Total Knee Arthroplasties (110 Knees) for Valgus Deformity

Abstract

The main purpose of this article is to evaluate the clinical outcomes and survivorship of cruciate-retaining (CR) knee arthroplasties for valgus deformity. This article is retrospective consecutive series of 110 valgus knees using CR implants with a minimum 2-year follow-up. Deformity correction was achieved using stepwise sequential soft tissue releases (iliotibial band, popliteus tendon, lateral collateral release through sliver femoral condylar osteotomy). Demographic data, range of movement, and degrees of deformity were collected. The Oxford Knee Score (OKS) was used as patients' reported outcome measure at final follow-up. One-hundred and four patients (110 knees) were included (87 females/17 males) with mean age of 68.7 years. Primary diagnosis was osteoarthritis in 85 patients and rheumatoid arthritis in 19 patients. Mean follow-up was 5.5 years (median: 5 years; range: 2–14 years). Preoperative valgus deformity was measured radiographically using the mechanical tibiofemoral angle with a mean 18.6° (standard deviation [SD]: 7.5; range: 11–38°). At final follow-up, mechanical tibiofemoral angle was 3.8° (SD: 1.97; range: 2–8°). A p-value was <0.0001 and mean OKS was 42 (SD: 5.4; range: 36–48) suggesting satisfactory patients' reported outcomes with no implant revision for any cause. CR implants for valgus knees using staged soft tissue releases including sliver condylar osteotomy had excellent medium-term survivorship and satisfactory patient reported outcome measures. The Level of Evidence for this study is IV.

Common peroneal nerve palsy after TKA in valgus deformities; a systematic review

“…The obtained overall CPNP ratio of 1.9% in this study falls within the known range of TKA-V (0.3% -9.5%) [3,[9][10][11][12][13][14][15][16][17]. Other systematic review reported a range of 0.01% to 4.3%, like the one of Carender et al [2] and Rodríguez-Merchán et al [50].…”

“…An increased anatomical femorotibial angle (aFTA) of > 10° is commonly used to define a valgus knee [6][7][8]. In the literature, the reported CPNP incidence after TKA in valgus deformities with an aFTA > 10° (TKA-V) ranges between 0.3-9.5% [3,[9][10][11][12][13][14][15][16][17]. Injury of the common peroneal nerve (CPN) can be caused by indirect damage due to stretch or ischaemia after correction, or by direct injury due to laceration of the CPN during lateral soft tissue release (STR) [8,11,12,[18][19][20].…”

Modified MCL Indentation Technique in Total Knee Arthroplasty With Severe Type II Valgus Deformity

“…At present, no consensus has been reached on the treatment of type II valgus deformity [12,13]. Compared with that on the medial side of the knee, the controllability of the release on the lateral side of the knee is imperfect, owing to the lack of soft tissue sleeve.…”