Total Knee Arthroplasty with Extra- or Intra-Articular Correction Technique for Arthritic Knees with Extra-Articular Deformity of the Femur or Tibia: A Report of Three Cases

Abstract

This study reports 3 patients who underwent total knee arthroplasty combined with extra-or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia.Key words : arthroplasty, replacement, knee; fractures, ununited introduction It is difficult to obtain optimal mechanical alignment through total knee arthroplasty (TKA) in patients with knee deformity, because the deformity (canal sclerosis, crooked canal, or retained hardware) may prevent the use of an intramedullary guide. Distortion of an anatomic landmark secondary to a previous trauma or treatment can make TKA more challenging and the outcome less satisfactory.1,2 The deformity can be corrected using an intra-or extra-articular Total knee arthroplasty with extra-or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia: a report of three cases Piti Rattanaprichavej, Artit Laoruengthana Naresuan University, Thailand Address correspondence and reprint requests to: Piti Rattanaprichavej, Naresuan University, Thailand. Email: pt-rp@hotmail.com Surgery 2016;24(1):116-20 correction technique with a conventional instrument, computer-assisted navigation system, or patientspecific instrument. This study reports 3 patients who underwent TKA combined with extra-or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia. Journal of Orthopaedic case reportsA single surgeon performed all 3 TKAs under spinal anaesthesia with a femoral nerve block through the median parapatellar approach using conventional instruments and a fixed bearing, posterior-stabilised prosthesis. Preoperative planning was performed to determine the corrective osteotomy, cutting line so as not to endanger the collateral ligament attachment, amount of bone lost, and need for expanding stems or augments. Intra-operatively, prosthesis orientation, lower-limb alignment, and soft-tissue balance were checked using fluoroscopy. Postoperatively, standing radiograph of the knee was obtained at 1, 3, 6, and 12 months. Knee Society knee and function scores were assessed. The mean follow-up duration was 35 Vol. 24 No. 1, April 2016 TKA with extra-or intra-articular correction technique for deformity of the femur or tibia 117 (range, 29-39) months.

Extra-articular deformities in arthritic knees-a grueling challenge for arthroplasty surgeons: An evidence-based update

“…Similar strategies have also been reported for tibial nonunion. 55 Good outcomes were also reported by Radke and Radke in 10 knees with EADs ≥ 15° where mean preoperative KSS and functional scores improved from 28 and 46.5 to 80.6 and 76 respectively. Devoid of any nonunions, their study cited advantages of EAC such as preservation of collaterals, precise restoration of axes and avoidance of managing bone defects.…”

“…Nonunion of osteotomy sites is a potential concern for EAC. 55 As a preventive measure, the osteotomy should be carried out through the metaphysis (which has the best healing potential), perfectly reduced with no interposing cement, fixed with rigid, rotationally stable osteosynthesis and reinforced with a rod through the osteotomy site. 13 , 14 Hazratwala et al .…”

Accelerometer-Based Navigation versus Conventional Total Knee Arthroplasty for Posttraumatic Knee Osteoarthritis

“… 19) Generally, the deformed bony anatomy, crooked medullary canal, and retained hardware that preclude an insertion of a conventional system can be overcome by some surgical strategies. 27 28) For instance, Paredes-Carnero et al 29) reported a significant improvement of KSKS, KSFS, and ROM after intra-articular correction for extra-articular deformity (EAD) in 9 TKAs by altering the IM entry point. Loures et al 30) reported significant improvement of Knee Society Score in 25 knees with PTOA, and the mean MA was corrected from 9.3° of valgus to 0.6° of varus alignment with 20% outlier noted, when an EM reference guide of a conventional system was chosen.…”