The Effectiveness of Medial Femoral Epicondyle Up-Sliding Osteotomy to Correct Severe Valgus Deformity in Primary Total Knee Arthroplasty

Mou, Ping; Zeng, Yi; Yang, Jing; Zhong, Hongshan; Yin, Senlin; Li, Rui-Bo

doi:10.1016/j.arth.2018.04.045

Cited by 12 publications

(15 citation statements)

References 29 publications

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“…20 However, lateral sliding osteotomy enlarges the joint space and requires a thicker insert, which may lead to joint instability and peroneal nerve paralysis. [1][2][3]20 Zhong et al 12 and Mou et al 9 described an upward sliding osteotomy of the medial condyle of the femur, followed by screw fixation, with satisfactory clinical results. Mou et al 9 followed up 28 patients who underwent TKAs with their LCL and POP preserved during lateral soft tissue release for an average of 54 months.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3]20 Zhong et al 12 and Mou et al 9 described an upward sliding osteotomy of the medial condyle of the femur, followed by screw fixation, with satisfactory clinical results. Mou et al 9 followed up 28 patients who underwent TKAs with their LCL and POP preserved during lateral soft tissue release for an average of 54 months. However, the MCL was so strong that nearly half of the cases followed up had malunions, even with screw fixation.…”

Section: Discussionmentioning

confidence: 99%

“…5 –7 However, when nonrestrictive prostheses are used, after releasing the lateral structures, the MCL needs to be advanced. Several techniques are used to tighten the MCL, 3,8 –12 such as cutting the MCL at midsubstance and imbrication, moving the tibial attachment of the MCL to the distal tibia, and removing the femoral attachment of the MCL to the proximal femur. There are three methods to perform the last one: sliding the osteotomy of the medial epicondyle and fixing with screws 9 ; recessing the MCL with a bone block from the femoral epicondyle and replanting overhead 10 ; removing the MCL from the epicondyle and resetting with a surgical staple.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Tightening medial collateral ligament during total knee arthroplasty for patients with fixed valgus deformity: A novel technique

Cheng

Wang

Zhang

et al. 2019

J Orthop Surg (Hong Kong)

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Background: This study aimed to explore a new surgical technique for gap balance by tightening the medial collateral ligament (MCL) in total knee arthroplasty (TKA) in patients with fixed valgus deformity. Materials and Methods: A prospective analysis was performed on 15 patients (16 knees) with a fixed valgus deformity that was corrected by tightening the MCL during TKA. A single surgeon performed all the 16 TKAs using nonconstrained posterior substituting implant, with two knees treated with long-stem tibial prosthesis. Clinical scores, knee stability, and radiographic evaluations were recorded preoperatively and postoperatively. Results: Complete weight-bearing could be carried out under the protection of the brace postoperatively. At the third month after surgery, X-rays showed the brace was not worn. The mean follow-up was 26.6 months (range 12-42 months). The average preoperative mechanical axis was 15.4 + 2.3 (range 11-25), and postoperatively it was 0.6 + 0.1 (range 0-2). No complication relative to the technique occurred. Conclusion: This new surgical technique has demonstrated excellent early clinical results and can be a good supplement for fixed valgus knee arthroplasty. Level of Evidence: III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Tightening medial collateral ligament during total knee arthroplasty for patients with fixed valgus deformity: A novel technique

Cheng

Wang

Zhang

et al. 2019

J Orthop Surg (Hong Kong)

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“…However, in some severe xed valgus deformities, the medial and lateral soft tissue tension remained asymmetric, almost all due to medial laxity. We performed a medial condylar sliding osteotomy to reconstruct medial/lateral soft tissue balance, as described in detail by Mou et al (2018). At each step, the balance of extension and exion gaps was carefully assessed to determine the structures and extent of ligament release.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Therefore, it is necessary to discuss the severe valgus deformity separately. Furthermore, several studies have shown that lowrestricted knee prosthesis are suitable for these special deformities with extensive soft tissue release (Nikolopoulos et al 2011, Miyasaka et al 1997, Mou et al 2018).…”

Section: Introductionmentioning

confidence: 99%

Mid-term Outcome of Total Knee Arthroplasty with Low-restricted Posterior-stabilized Prosthesis in Patients with Severe Fixed Valgus Deformity: A Case-Control Study

Gou

Shi

Liu

et al. 2020

Preprint

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Background: The intraoperative soft tissue balance in primary total knee arthroplasty (TKA) is particularly difficult to perform in patients with severe fixed valgus deformity above 20°, which may have an adverse effect on clinical outcomes. The purpose of our study was to determine whether the TKA with low-restricted posterior-stabilized prosthesis in patients with severe fixed valgus deformity could be as successful as in those with no preoperative deformities by comparing perioperative evaluations and mid-term outcomes.Methods: 45 patients (group A) with severe valgus deformity were treated by TKA with low-restricted posterior- stabilized knee prosthesis; 90 patients (group B) without severe valgus deformity were treated with same surgery and were classified to match the cases in group A. The perioperative evaluations, clinical and radiographic outcomes were compared between the two groups. The postoperative stability was measured by the Kneelax 3 Arthrometer.Results: The mean follow-up time was 7.64 years. There was no significant difference in age, gender, BMI between the two groups. There was no revision for any reason in either group. The mean operation time and blood transfusion rate were 114 minutes and 46.7% in group A, while 81 minutes and 11.1% in group B, respectively. There were significant differences in both parameters between the two groups (p<0.001). The incidence of residual valgus in group A was 20% and the complication rate was 22.2%, while 3.3% and 4.4% in group B, respectively. The incidence of residual valgus and the complication rate was significantly higher in group A than in group B (p=0.004). However, there was no statistical difference in Hospital for Special Surgery (HSS) score, range of motion, component fixation, or knee stability at the most recent follow-up. Conclusion: Although total knee arthroplasty for severe fixed valgus deformity increases the difficulty of operation and the complication rate in perioperative period, low-restricted posterior-stabilized knee prosthesis with proper alignment and soft tissue balance can have satisfactory mid-term outcomes. Level of evidence: Case-control study, Level III.

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Sliding Condylar Osteotomy for Managing Severe Deformities in Total Knee Arthroplasty

2022

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The Effectiveness of Medial Femoral Epicondyle Up-Sliding Osteotomy to Correct Severe Valgus Deformity in Primary Total Knee Arthroplasty

Cited by 12 publications

References 29 publications

Tightening medial collateral ligament during total knee arthroplasty for patients with fixed valgus deformity: A novel technique

Tightening medial collateral ligament during total knee arthroplasty for patients with fixed valgus deformity: A novel technique

Mid-term Outcome of Total Knee Arthroplasty with Low-restricted Posterior-stabilized Prosthesis in Patients with Severe Fixed Valgus Deformity: A Case-Control Study

Sliding Condylar Osteotomy for Managing Severe Deformities in Total Knee Arthroplasty

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