Total knee arthroplasty in severe genu valgus. Five to 14 years followup.
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Published:
Aug 6, 2016
Keywords:
genu valgus, deformity, severe, TKA, release, surgical technique.
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Abstract
Introduction: valgus malalignment is a complex, multiplanar deformity characterized by bone alterations and soft-tissue abnormalities. Several surgical techniques have been described for valgus knee, and the sequence of tight lateral structures release and necessity of constrained prosthesis were addressed. Total Knee Arthroplasty (TKA) in valgus deformity remains a surgical challenge for orthopaedic surgeons. The objectives of the study were to evaluate our mid and long-term results in the surgical treatment of severe valgus disease, and describe the applied surgical technique. Materials and Methods: a clinic-radiographic classification was developed, and patients treated for severe genu valgus were discriminated. We retrospectively evaluated 42 TKA in 39 patients, with an average follow-up of 9,2 years. Knee Society Score (KSS) was used for clinical evolution, and the last control best quality radiography was considered for radiographic evaluation. Survivorship analysis contemplated need for revision for any reason and for mechanical failure.Results: postoperative average KSS was 83,3, with marked improvement in parameters pain and range of movement. Constrained implants were utilized in 16,7% of cases. Postoperative alignment was on average 5,9°. Two patients underwent revision surgery, having achieved a prosthetic survivorship for mechanical failure of 97,6%. We did not have any revision because of infection.Conclusion: a meticulous physical examination and proper preoperative radiographs are mandatory. The decision of using a constrained device is done intraoperative. Appropriate soft-tissue release is extremely significant. Despite the surgical technique, a constrained prosthesis utilization is limited. We recommend our technique as a low-demanding procedure, with encouraging mid and long-term results.Key words: valgus, deformity, severe, TKA, release, surgical technique.
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Pesciallo, C. A., Lopreite, F. A., Simesen de Bielke, H., Garabano, G., Otero, D. F., Robador, N., Oviedo, A., & Del Sel, H. (2016). Total knee arthroplasty in severe genu valgus. Five to 14 years followup. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(3), 177-189. https://doi.org/10.15417/378
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Clinical Research
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References
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3.- Elkus M, Ranawat C, Rasquinha V, Babhulkar S, Rossi R, Ranawat A. Total Knee Arthroplasty for Severe Valgus Deformity. J Bone Joint Surg (Am). 2004;86(12): 2671-2676.
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5.- Ranawat C, Rose H, Rich D. Total condylar knee arthroplasty for valgus and combined valgus-flexion deformity of the knee. A.A.O.S.: Instructional lectures. 1994.
6.- Whiteside L. Selective Ligament Release in Total Knee Arthroplasty of the Knee in Valgus. Clin Orthop Relat Res. 1999;367:130-140.
7.- Healy W, Iorio R, Lemos D. Medial Reconstruction During Total Knee Arthroplasty for Severe Valgus Deformity. Clin Orthop Relat Res. 1998;356:161-169.
8.- Krackow K. The technique of Total Knee Arthroplasty. St Louis, Mosby-Year Book. 1990;352-359.
9.- Krackow K, Jones M, Teeny S, Hungerford D. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res. 1991;273:9-18.
10.- Betancourt Pérez R. Abordaje lateral para reemplazo total de rodilla en valgos severos estructurados. Descripción de una nueva técnica y reporte preliminar de casos. Revista Colombiana de Ortopedia y Traumatología. 2008;22(3):178-184.
11.- Lootvoet L, Blouard E, Himmer O, Ghosez J. Prothese Totale du genou sur grand genu valgum revue retrospective de 90 genoux operes par abord antero-externe. Acta Ortopaedica Belgica. 1997;63(4):278-286.
12.- Ritter M, Faris G, Faris P, Davis K. Total Knee Arthroplasty in Patients with Angular Varus or Valgus Deformities of > 20°. Journal Arthrosplasty. 2004;19:862-866.
13.- Insall J, Scott W, Ranawat C. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg (Am). 1979;61:173-80.
14.- Lombardi A, Doods K, Berend K, Mallory T, Adams J. An Algorithmic Approach to Total Knee Arthroplasty in the Valgus Knee. J Bone Joint Surg (Am). 2004;86:62-71.
15.- Whiteside L. Correction of ligament and bone defects in total arthroplasty of the severely valgus knee. Clin Orthop. 1993;288:234-45.
16.- Buechel F. A sequential three-step lateral release for correcting fixed valgus deformities during total knee arthroplasty. Clin Orthop. 1990;260:170-5.
17.- Stern S, Moeckel B, Insall J. Total knee arthroplasty in valgus knees. Clin Orthop. 1991;273:5-8.
18.- Fiddian N, Blakeway C, Kumar A. Replacement arthroplasty of the valgus knee. A modified lateral capsular approach with repositioning of vastus lateralis. J Bone Joint Surg (Br). 1998;80:859-61.
19.- Keblish P. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop. 1991;271:52-62.
20.- Krackow K, Mihalko W. Flexion-extension joint gap changes after lateral structure release for valgus deformity correction in total knee arthroplasty: a cadaveric study. J Arthroplasty. 1999;14:994-1004.
2.- Ranawat A, Ranawat C, Elkus M, Rasquinha V, Rossi R, Babhulkar S. Total Knee Arthroplasty for Severe Valgus Deformity. Surgical Technique. J Bone Joint Surg (Am). 2005;87(1):271-284.
3.- Elkus M, Ranawat C, Rasquinha V, Babhulkar S, Rossi R, Ranawat A. Total Knee Arthroplasty for Severe Valgus Deformity. J Bone Joint Surg (Am). 2004;86(12): 2671-2676.
4.- Engh G. The Difficult Knee. Clin Orthop Relat Res. 2003;416:58-63.
5.- Ranawat C, Rose H, Rich D. Total condylar knee arthroplasty for valgus and combined valgus-flexion deformity of the knee. A.A.O.S.: Instructional lectures. 1994.
6.- Whiteside L. Selective Ligament Release in Total Knee Arthroplasty of the Knee in Valgus. Clin Orthop Relat Res. 1999;367:130-140.
7.- Healy W, Iorio R, Lemos D. Medial Reconstruction During Total Knee Arthroplasty for Severe Valgus Deformity. Clin Orthop Relat Res. 1998;356:161-169.
8.- Krackow K. The technique of Total Knee Arthroplasty. St Louis, Mosby-Year Book. 1990;352-359.
9.- Krackow K, Jones M, Teeny S, Hungerford D. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res. 1991;273:9-18.
10.- Betancourt Pérez R. Abordaje lateral para reemplazo total de rodilla en valgos severos estructurados. Descripción de una nueva técnica y reporte preliminar de casos. Revista Colombiana de Ortopedia y Traumatología. 2008;22(3):178-184.
11.- Lootvoet L, Blouard E, Himmer O, Ghosez J. Prothese Totale du genou sur grand genu valgum revue retrospective de 90 genoux operes par abord antero-externe. Acta Ortopaedica Belgica. 1997;63(4):278-286.
12.- Ritter M, Faris G, Faris P, Davis K. Total Knee Arthroplasty in Patients with Angular Varus or Valgus Deformities of > 20°. Journal Arthrosplasty. 2004;19:862-866.
13.- Insall J, Scott W, Ranawat C. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg (Am). 1979;61:173-80.
14.- Lombardi A, Doods K, Berend K, Mallory T, Adams J. An Algorithmic Approach to Total Knee Arthroplasty in the Valgus Knee. J Bone Joint Surg (Am). 2004;86:62-71.
15.- Whiteside L. Correction of ligament and bone defects in total arthroplasty of the severely valgus knee. Clin Orthop. 1993;288:234-45.
16.- Buechel F. A sequential three-step lateral release for correcting fixed valgus deformities during total knee arthroplasty. Clin Orthop. 1990;260:170-5.
17.- Stern S, Moeckel B, Insall J. Total knee arthroplasty in valgus knees. Clin Orthop. 1991;273:5-8.
18.- Fiddian N, Blakeway C, Kumar A. Replacement arthroplasty of the valgus knee. A modified lateral capsular approach with repositioning of vastus lateralis. J Bone Joint Surg (Br). 1998;80:859-61.
19.- Keblish P. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop. 1991;271:52-62.
20.- Krackow K, Mihalko W. Flexion-extension joint gap changes after lateral structure release for valgus deformity correction in total knee arthroplasty: a cadaveric study. J Arthroplasty. 1999;14:994-1004.