All types of component malrotation affect the early patient-reported outcome measures after total knee arthroplasty

PURPOSE@#Outcomes following total knee arthroplasty (TKA), whether clinical, radiological or survival analysis, have been well-studied. Still, there are some concerns about patient satisfaction with the outcome of the surgery and factors that might contribute to a suboptimal result. This study aims to determine if there is correlation between primary TKA malalignment and early patient-reported outcome measures (PROMs).@*MATERIALS AND METHODS@#Sixty patients, who had primary TKA and a minimum of 2 years of follow up, were recruited for a detailed clinical and radiological examination. Knee alignment was measured in the coronal, sagittal and axial planes. Normal and the outlier measurements of the patients' knees were defined and the clinical results (PROMs) compared to see if there was a statistically significant difference.@*RESULTS@#Correlation between postoperative limb malalignment in the coronal and the sagittal planes and PROMs was not significant. Conversely, there was significant negative correlation between all types of malrotation and PROMs.@*CONCLUSIONS@#Although malalignment has been linked to inferior outcome and implant survival, our results showed that coronal and sagittal limb malalignment has no significant effect on early PROMs. However, all types of component rotational malalignment significantly worsen early PROMs.

Total knee replacement in severe deformities

Total knee replacement in severe deformities is a challenging procedure. Varus and flexion are the commonest deformities seen. Thorough soft tissue release and balancing is the key to a successful outcome. We tried to correct these cases without the need for expensive augments and specialized prosthesis. Our study included 30 knees in 23 patients with severe flexion and varus deformities. The average preoperative varus deformity was 20° [range, 14-38°] and the average flexion deformity was 15.6° [range, 5-30°]. Bone graft was used in 8 cases [26%] and tibial stems in 2 cases [6%]. No constrained prosthesis was used. The average follow up was 31 months [range, 8-65 months]. The average postoperative range of flexion was 115° [range, 90-147°], range of extansion between 0-6° and the average varus correction was 26° [range, 12-42°]. At the final follow up, we had 15 excellent, 12 good, 2 fair and 1 poor functional result, giving a 90% success rate. Our techniques resulted in restoration of alignment and stability without the need for wedges or constrained prosthesis with encouraging early and mid-term results