Influence of the Post-operative Axis on the Clinical Results of Total Knee Replacement for Severe Varus Deformities: Does a Slight Residual Varus Improve the Results?

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2018 Aug 16

PMID 30109405

Citations 6

Authors

Dominique Saragaglia

Loic Sigwalt

Ramsay Refaie

Brice Rubens-Duval

Gabriel Lateur

Regis Pailhe

Affiliations

Soon will be listed here.

Abstract

Purpose: Some recent articles have suggested that in the case of large varus deformity, it may be advantageous to leave some residual post-operative varus as a means of improving functional outcome. The objective of this study is to compare the results of total knee replacement (TKR) performed for significant varus deformity (HKA < 170°) where there is a residual post-operative varus (HKA < 180°) to the results of TKR for significant varus deformity with either neutral post-operative (HKA = 180°) or mild valgus post-operative alignment (HKA > 180°).

Methods: This series was made up of 208 knees. The mean pre-operative HKA angle was 166 ± 3° (154-169°), of which 150 were followed up for a mean 8.5 years (58 lost to follow-up). Based on post-operative radiographs, two groups were formed: group 1 (88 knees) in which post-operative alignment was 177.8 ± 1° (175-179°) and group 2 (62 knees) in which post-operative alignment was 181 ± 1° (180-184°).

Results: The mean international knee society (IKS) score for group 1 was 178.8 ± 22 points (113-200) and 181.7 ± 22 points (95-200) for group 2. Oxford knee score was 20.4 ± 9 points (12-45) in group 1 and 19.2 ± 9 (12-50) in group 2. The results were slightly better in group 2 (in slight valgus) but this difference was not statistically significant (p = 0.44 and 0.4).

Conclusion: The results of knee replacement performed for severe varus deformity are not adversely affected by post-operative valgus alignment. There is in fact a trend towards superior results for neutral or valgus alignment than slight residual varus, but this difference was not statistically significant.

Citing Articles

Large angular correction of arithmetic coronal alignment is associated with residual lateral laxity after total knee arthroplasty in varus knees for Japanese patients.

Itou J, Kuwashima U, Itoh M, Okazaki K J Exp Orthop. 2024; 11(3):e12100.

PMID: 39416973 PMC: 11481397. DOI: 10.1002/jeo2.12100.

Mid-Term Clinical and Radiological Results at a Tertiary Care Hospital in Türkiye: Is Residual Varus Really Important After Mechanically-Aligned Total Knee Arthroplasty?.

Aydin A, Gursu S, Yapici F, Gur V Cureus. 2023; 15(2):e35066.

PMID: 36942192 PMC: 10024572. DOI: 10.7759/cureus.35066.

Comparison of Outcomes After Total Knee Arthroplasty Involving Postoperative Neutral or Residual Mild Varus Alignment: A Systematic Review and Meta-analysis.

Wan X, Yang Y, Wang D, Xu H, Huang C, Zhou Z Orthop Surg. 2021; 14(2):177-189.

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Degree of coronal alignment correction can't predict knee function in total knee replacement.

Zhu S, Zhang X, Chen X, Wang Y, Li S, Qian W BMC Surg. 2021; 21(1):383.

PMID: 34717621 PMC: 8557487. DOI: 10.1186/s12893-021-01372-3.

Association of HSS score and mechanical alignment after primary TKA of patients suffering from constitutional varus knee that caused by combined deformities: a retrospective study.

Zhang Z, Chai W, Zhao G, Zhang Q, Chen Z, Wang X Sci Rep. 2021; 11(1):3130.

PMID: 33542300 PMC: 7862289. DOI: 10.1038/s41598-021-81285-6.

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