Total knee arthroplasty in extra articular deformities: A series of 36 knees

Abstract

Background:The presence of extra articular deformities either in the femur or the tibia with arthritis of the knee makes total knee arthroplasty (TKA) technically demanding. The purpose of this study is to report outcomes with Total Knee Arthroplasty in patients with arthritis of the knee associated with extra articular deformity by intraarticular resection and soft tissue balancing.Materials and Methods:Thirty six knees (32 patients) who had arthritis of the knee associated with extra articular deformity, underwent total knee arthroplasty between 1999 and 2006 were included in this retrospective analysis. All patients had intraarticular resection with soft tissue balancing to correct the deformity. Full length weight bearing anteroposterior X-rays, Knee society scores, and Knee range of motion was recorded pre- and postoperatively.Results:The mean period of followup was 85 months (range 42-120 months). The deformities amenable to correction by intraarticular resection in our series were Femur- Coronal plane 11°-18° (mean 16.2°) Saggital plane 0°-15° (mean 10.1°) Tibia - Coronal plane 12°-24° (mean 21°). There was an improvement in the range of motion from mean of 54° preoperatively to 114° postoperatively (P value < 0.05). The Knee Society- Knee Score improved from 37 points to 85 points postoperatively (P value < 0.05). The functional score improved from a mean value of 19 to a mean of 69.5 at followup (P < 0.01). The preoperative hip knee ankle angle in the coronal plane improved from a mean of 14° ± 2° varus (26° varus to 4° valgus) to a mean of 2° ± 0.6° varus (6° varus to 2° valgus).Conclusion:With a good preoperative planning and templating, intraarticular bone resection and good soft tissue balancing both in flexion and extension, correction would be possible in majority of extraarticular deformities.

Total Knee Arthroplasty in Patients with Distal Femoral Malunion: A Case Report

“…The closer the deformity is to the joint, the greater impact the deformity has on the orientation of resection thus the farther deformity from the knee joint may be less in need of corrective osteotomy than those that are closer to the knee joint. 7,12 For TKR with extraarticular deformity, options include two-stage osteotomy, one-stage osteotomy, and one-stage intra-articular correction. 8 A two-stage osteotomy can be performed for extra-articular deformities that are thought to be too severe for intra-articular correction.…”

“…12 The vast majority of these deformities can be managed by intra-articular resection and careful ligamentous balancing. 7,9 Any planned resection that would compromise the integrity of the collateral ligament must be dealt with either by an osteotomy or by using metallic augmentation on the deficient side and limiting the resection on the prominent side to preserve the collateral ligament Resection much greater than 10 mm may jeopardize the origin of the collateral ligaments on the femoral side or affect the strength of the tibial bone stock on the tibial side.…”

Planning a total knee arthroplasty through an application for mobile devices: case report

“…PLLR is an adequate imaging exam for the planning of TKAs, as it allows the identification of extra-articular deformities and the estimation of the AFA, MFA, MTA, and AMFA. 8 …”

Total Knee Replacement in Genu Valgum

“…The main disadvantage of the medial approach is that it is more difficult to reach the posterolateral corner during the lateral soft tissue release [11,12] . Some authors reported that when a medial approach is performed in a valgus knee, the results have been inferior compared to varus deformity [13][14][15] .…”