Total Knee Arthroplasty in Patients With Valgus Deformity

Abstract

Background: Valgus deformity (more than 10°valgus on anatomical measurement) is seen in about 10% of patients undergoing total knee arthroplasty (TKA). Valgus deformity is a challenge for the surgeons both for gap balancing and constraint choice. Objectives: The aim of this study was to describe a surgical technique to perform TKA in valgus knee. Patients and Methods: We retrospectively reviewed 32 primary TKA in 27 patients (25 females and 2 males), with valgus knee deformity performed since 2006 to 2014. All procedures have been done by the senior author. In the balancing stage of each procedure, the iliotibial band has been released completely in the first step, and then step by step pie crusting of other lateral structures has been done as needed. Preoperative and postoperative data were obtained retrospectively through chart review and review of radiographs. All patients were clinically examined by the senior author. Preoperative and postoperative knee society scores (KSSs) and functional knee society score (functional KSS) were obtained accordingly. Results: The patients had an average age of 68 years (range, 52 -83 years) with an average postoperative follow-up period of 47.5 months (range, 12 -100 months). The average KSS improved significantly postoperatively from 42 (range, 20 -69) to 90 (range, 67 -99) (P < 0.0001). The average functional KSS improved significantly (P < 0.0001) from 51.4 (range, 35 -70) to 85.5 (range, 45 -100) during follow-up. An average preoperative range of motion also improved by 15.6 degrees during the last follow-up visit (P < 0.001). We had no complication in our patients. Conclusions:The results of our study show that complete release of the iliotibial band and step by step pie-crusting of other lateral structures correct valgus deformities in a safe and simple manner with high success rate and less constrained prosthesis.

Management of proximal tibial stress fracture associated with advanced knee osteoarthritis: A systematic review

“…17 (2018) Case series 26.3 15 65 0.07 31 TKA Jabalameli et al. 14 (2018) Case series 24 16 68.10 0 – TKA Soundarrajan et al. 15 (2018) Case series 28 20 64 0.18 31.2 TKA, ORIF + TKA in 2 nonunion/mal-union cases Pan et al.…”

“…One of non-English language articles was translated into English using Google chrome translate, and was included in our study. 12 Nine studies were analyzed, including a prospective comparative analysis, 13 4 prospective case series, 12 , 14 , 15 , 16 and 4 retrospective case series. 7 , 8 , 17 , 18 Their sample size ranged from 8 to 62 cases.…”

“…17 (2018) 16.00 – 31.50 87.60 16.50 91.30 – – Jabalameli et al. 14 (2018) 20.90 – – 86.40 84.00 – – Soundarrajan et al. 15 (2018) 18.27 −1.80 21.90 82.80 15.50 76.80 – – Pan et al.…”

“…In 7 studies, cases without coronal malalignment and acute stress fractures were managed by TKA with long tibial stem. 8 , 12 , 14 , 15 , 16 , 17 , 18 Likewise, in 3 studies the authors utilized this option even for tibial fracture non-union/mal-union. 14 , 17 , 18 The potential advantages of this approach have been less trauma to soft tissue sleeve and can treat tibial fracture and knee osteoarthritis with single procedure.…”

“…17 (2018) 2 2 0 2 0 2 2 0 – – – – 10 Jabalameli et al. 14 (2018) 2 2 2 2 0 2 2 0 – – – – 12 Soundarrajan et al. 15 (2018) 2 2 2 2 0 2 2 0 – – – – 12 Pan et al.…”