Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity.

OBJECTIVE: Our purpose was to review senior author results of TKA in patients with extra-articular angular deformities (correction of mechanical axis was performed without an additional procedure for osteotomy). METHODS: Results of TKA in nine knees with osteoarthritis and associated extra-articular angular deformity of femur were reviewed retrospectively. This group was compare with a with a control group of 20 patients diagnosed with osteoarthritis that underwent TKA without extra-articular deformity. Angulation of deformity in patients was 19° in coronal plane (range 15°-25°) and 12° in sagittal plane (range 8°-5°). Knee Score (KS) and Functional Score (FS) were measured pre and post-surgery, likewise arc flexion was reported. Results in KS and FS were correlationed with extra-articular angulation. RESULTS: Duration of follow-up averaged 55 months (range, 48-63 months). KS Average and FS increased from 50.5 and 38.4 points, preoperatively, to 96.5 and 84.4 points, respectively, at time of following-up. No statistically significant differences in any postoperative parameters were found between the postoperative group of extra-articular deformities and the control group were found. Positive correlation was obtained between deformity degrees and KS. Arc of motion averaged 86° preoperatively and 118° at time of following-up. No total knee arthroplasty was revised. CONCLUSION: In our opinion, best management for extra-articular deformities associated to osteoarthritis is to carry out a knee replacement without corrective osteotomy on condition that planification allow to us avoid ligaments insertions, using an extensive soft-tissue balancing in conjunction with a minimally constrained TKA.

Management of severe valgus knee by total unconstrained arthroplasty: A comparative study with long-term follow-up. / Tratamiento de valgos severos de rodilla mediante artroplastia total no constreñida: estudio comparativo con seguimiento a largo plazo.

OBJECTIVE: To evaluate the use of unconstrained implants in the correction of large valgus deformities using total knee arthroplasty (TKA). MATERIAL AND METHOD: A total of 817 primary TKA operated between 1998 and 2006 were retrospectively assessed. 50 TKA were selected (group A) in 49 patients, with a minimum deformity of 15° of valgus, 41 cases were included. Another 50 ATR were selected (group B), with a maximum deformity of 15° of varus, finally including 44 cases in 42 patients. The same surgeon performed every operation. The minimum follow-up time was 10 years. The Knee Society Score (KS and FS), the Oxford Knee Score (OKS) and the Range of Mobility (ROM), both preoperative and postoperative at 1,.5 and 10 years, as well as radiographic evolution and complications were evaluated. RESULTS: Preoperative values of KS, FS and OKS were lower in group A (P<.0001, P<.01 and P<.05, respectively), but not ROM. Postoperatively, KS, FS, OKS and ROM were not different between the groups, neither year, nor 5, nor 10 years. There were also no radiological or complications between the two groups. DISCUSSION: The use of non-constricted implants in severe valgus was not inferior to the mild varus, implying, in addition, a saving in economic terms, with excellent postoperative results. CONCLUSIONS: Correction of severe valgus deformities can be performed with non-constrained primary implants, without obtaining worse results than those obtained in mild deformities.