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

Abstract

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...

Extra-articular Deformity Correction via Clamshell Osteotomy of the Tibia With Simultaneous Bilateral Total Knee Arthroplasty

“…Thrombosis prevention is managed with anticoagulants until discharge. Outpatient follow-ups with periodic radiographs at three months (Figures 7, 8) and at one-year follow-up (Figures 9, 10,11), confirmed maintenance of alignment without complications. By one-year of follow-up, the patient had achieved bony union at all osteotomy sites with well-fixed components and restoration of mechanical alignment.…”

“…This is due to the fact that the knee is a hinge joint that only moves in the sagittal plane, making deviations readily hidden. When there is flexion deformity rather than recurvatum, it is more crucial to restore the sagittal mechanical axis [ 11 ]. With 15 knees, Madelaine and Villa [ 16 ] reported in 2014 that the mean mechanical axis (MA) was corrected from 19.2° preoperatively to 10° postoperatively.…”

“…All patients displayed complete correction of translation, rotation, and joint-line orientation angles, as well as correction to within 4° in the coronal and sagittal planes and 2 cm in the limb-length discrepancy [ 9 ]. When there is an extra-articular deformity, alignment can be restored through intraarticular correction using soft tissue balancing and prosthesis placement, osteotomy at the deformity location, or osteotomy away from the deformity [ 11 ].…”