Simultaneous Femoral and Tibial Osteotomies During Total Knee Arthroplasty for Severe Extra-Articular Deformity

Moyad, Thomas F

doi:10.1055/s-0030-1247722

Cited by 21 publications

(16 citation statements)

References 8 publications

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“…The osteotomy can be stabilized in different ways [5,9,10,14,19], but stems are our first choice. In these cases it is important to have modular prosthesis that allow to choose the stem that better fills the medulary canal, in order to optimize the post-surgical stability of the osteotomy.…”

Section: Discussionmentioning

confidence: 99%

“…There is a wide range of opinions regarding which is the most appropriate way to correct the axis of a limb with extra-articular deformity when performing a TKA [1,3,[7][8][9][10][11]. However, there is certain consensus in the fact that if the femoral deformity in the coronal or sagital plane is over 20° or if the tibial deformity exceeds 30°, the correction performed only by means of intraarticular "unusual" bone cuts and the consequent release of soft tissues might generate a complex instability.…”

Section: Introductionmentioning

confidence: 99%

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Total Knee Arthroplasty Associate with Extra-Articular Deformity

Vedoya¹,

Garabano²,

Sel³

2017

MOJOR

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Introduction: Satisfactory longterm results on total knee arthroplasty (TKA) depend on restitution of the limb's mechanical axis, correct positioning of the prosthesis, and appropriate balance of soft tissue. Patients with osteoarthritis of the knee associated with femoral or tibial extra-articular deformity require thorough preoperative planning in order to decide if the axis correction can be made through "unusual" intra-articular bone cuts or if it should be associated to an osteotomy.Methods: 22 TKA were performed in 20 patients with osteoarthritis of the knee associated to significant extra-articular deformity of post-traumatic etiology in 8 cases and post-osteotomy in 14 (8 femoral and 6 tibial). Results:In all cases the limb's axis was corrected through a TKA with "unusual" intra articular bone cuts, without need of an osteotomy. The clinical and functional evaluation was made through the Knee Society scoring system. The average score for clinical evaluation was of 24.3 points preoperatively and 86 points one year after surgery. As to the functional score, it improved from 34 points preop to 85.3 points one year after surgery. Discussion:There is not an undisputable criteria regarding the treatment of patients with symptomatic osteoarthritis of the knee associated with severe extra-articular deformity. Correction of the extra-articular deformity by intra articular "unusual" bone cuts at the time of TKA is indicated if these cuts do not affect the femoral insertions of the collateral ligaments of the knee. This method can be applied to angular deformities up to 20º in the femur and up to 30º in the tibia. Through this technique, we have achieved good results, after more than 7 year of follow up, in 20 among 22 of the operated patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Total Knee Arthroplasty Associate with Extra-Articular Deformity

Vedoya¹,

Garabano²,

Sel³

2017

MOJOR

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“…Some articles reported aetiology of EAD due to malunited osteotomy. Relative less number of cases reported with Paget disease [6) Hypophosphatemic rickets [7] , Congenital dysplasia [8] , Postpolio sequelae [9,10] . While performing TKA in a knee with complex deformity the surgeon must understand the quantity and quality of the deformity, which exerts direct and indirect impact over the joint.…”

Section: Should All the Deformity Be Corrected?mentioning

confidence: 99%

Total knee arthroplasty in patients with extra-Articular deformity: A critical analysis

Gokulakrishnan¹,

Balaji²,

Ashraf³

2018

Int. J. Orthop. Sci.

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Total knee arthroplasty is the standard of care for the patients with severe degenerative joint disease. There are still controversies among surgeons about restoring alignment in knee with Extra Articular Deformity. Some author reports corrective osteotomy to align anatomical axis there by restoring mechanical axis indirectly, while others restores mechanical axis directly using special instruments. We conduct a qualitative analysis of outcome in restoring mechanical axis directly and indirectly by, Post op alignment, Perioperative morbidity, Advantages and disadvantages of devises used for osteotomy fixation, Merits and demerits of navigation and Period of rehabilitation. Twenty five articles have been identified with Extra Articular Deformity. Twelve are evaluating outcome of single stage corrective osteotomy coupled with Total Knee Arthroplasty, two studies about dual stage Corrective osteotomy with Total Knee Arthroplasty. Seven are restoring mechanical axis by intra articular correction using computer assisting navigation, and three achieving Mechanical axis by intra articular correction using Patient Specific Instrumentation, and remaining one is a comparative study between intra articular correction with Extra Articular Deformity. Our review shows that average preoperative deformity is slightly higher (>20* in coronal plane) in Extra articular correction group than Intra articular correction. But restoration of mechanical axis is superior with intra articular correction than with corrective osteotomy, more over complications like delay in rehabilitation, non-union, delayed union, and infections at osteotomy site are reported in extra articular correction which are not there with deformities corrected intra-articularly. Considering overall outcome, extra-articular deformity corrected by intra-articular resection carries good postoperative alignment with less complication rate. But not sufficient studies are available to support intra articular correction in knee with higher degree of extra articular deformity. As most of the studies with intra articular correction of extra articular deformity provides encouraging results not much studies supporting it with higher extra articular deformity.Keywords: Knee arthroplasty, Deformity correction knee arthroplasty, intra articular correction, Extra articular correction IntroductionThe incidence of knee osteoarthritis are increasing in trend, with view to upgrade quality of mobility and restore function patient with symptomatic OA often require total knee arthroplasty. In many case studies TKA shows excellent results with minimal complication rate. But in situations like pre-existing deformity of bone or soft tissue pathology can lead to raise the complication rate from 5% to 41% [1] . Aiming to improve the result of total knee arthroplasty in special situation clinical researches and technological researches are being made throughout the world. Success of total knee arthroplasty depends on number of factors starts with a) Patient selection, b) Appropriate p...

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“…We advise in all cases the use of a long tibial stem to bridge the osteotomy site and gain a measure of distal fixation [18]. Vielpeau et al [19], in a study of 14 patients treated by combined osteotomy and long-stemmed TKA without additional fixation, reported a normal mechanical axis in 70 %, a mean KSS of 90.2 and a global score of 170.…”

Section: Technical Improvementsmentioning

confidence: 99%