RESUMO
The need for total knee arthroplasty is increasing considerably and one of the goals is to achieve post-surgical coronal alignment. Robotic surgical assistance achieves a functional alignment, which is a hip-knee-ankle angle of 0°. However, it is not possible to provide robotic assisted surgery to all our patients so we must include the full-length hip-to-ankle AP weight-bearing radiograph in preoperative planning to obtain a "safe zone" alignment, which is a post-surgical hip-knee-ankle Angle of 0 ± 3°. How can we achieve a "safe zone" alignment total knee arthroplasty in patients with extra-articular deformity?
La necesidad de artroplastia total de rodilla está aumentando considerablemente y uno de los objetivos es lograr la alineación coronal postquirúrgica. La asistencia quirúrgica robótica consigue una alineación funcional, que es un ángulo cadera-rodilla-tobillo de 0°. Sin embargo, no es posible ofrecer cirugía asistida por robot a todos nuestros pacientes, por lo que debemos incluir la radiografía AP de soporte de peso de cadera a tobillo de cuerpo entero en la planificación preoperatoria para obtener una alineación de "zona segura", que es un ángulo postquirúrgico cadera-rodilla-tobillo de 0 ± 3°. ¿Cómo podemos conseguir una artroplastia total de rodilla con alineación de "zona segura" en pacientes con deformidad extraarticular?
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Procedimentos Cirúrgicos Robóticos , Humanos , Osteoartrite do Joelho/cirurgia , Articulação do Joelho/cirurgia , Estudos Retrospectivos , Fêmur/cirurgiaRESUMO
Abstract: The need for total knee arthroplasty is increasing considerably and one of the goals is to achieve post-surgical coronal alignment. Robotic surgical assistance achieves a functional alignment, which is a hip-knee-ankle angle of 0o. However, it is not possible to provide robotic assisted surgery to all our patients so we must include the full-length hip-to-ankle AP weight-bearing radiograph in preoperative planning to obtain a «safe zone¼ alignment, which is a post-surgical hip-knee-ankle Angle of 0 ± 3o. How can we achieve a «safe zone¼ alignment total knee arthroplasty in patients with extra-articular deformity?
Resumen: La necesidad de artroplastia total de rodilla está aumentando considerablemente y uno de los objetivos es lograr la alineación coronal postquirúrgica. La asistencia quirúrgica robótica consigue una alineación funcional, que es un ángulo cadera-rodilla-tobillo de 0o. Sin embargo, no es posible ofrecer cirugía asistida por robot a todos nuestros pacientes, por lo que debemos incluir la radiografía AP de soporte de peso de cadera a tobillo de cuerpo entero en la planificación preoperatoria para obtener una alineación de «zona segura¼, que es un ángulo postquirúrgico cadera-rodilla-tobillo de 0 ± 3o. ¿Cómo podemos conseguir una artroplastia total de rodilla con alineación de «zona segura¼ en pacientes con deformidad extraarticular?
RESUMO
Introducción El reemplazo total de rodilla (RTR) en pacientes con deformidades extraarticulares es un desafío. Se han descrito diferentes intervenciones como la corrección con cortes intraarticulares y la realización de osteotomías concomitantes. El objetivo del estudio es evaluar los desenlaces funcionales asociados a las diferentes técnicas de RTR en pacientes con deformidades extra-articulares. Materiales y Métodos Revisión sistemática de la literatura. Se incluyeron estudios que evaluaran desenlaces funcionales del RTR primario en pacientes adultos con osteoartritis y deformidades extra-articulares. Se describen el tipo de deformidad e intervención, escalas de funcionalidad y rango de movilidad. Resultados Se incluyeron 29 estudios para un total de 401 rodillas. La deformidad del eje mecánico más frecuente fue varo, con un promedio menor a 20° en la mayoría de estudios. El "Knee score" (KS) promedio postoperatorio en el grupo de RTR con cortes intra-articulares y guías convencionales osciló entre 85 y 96,5; con cortes guiados por navegación entre 82 y 95; y en el grupo con osteotomía concomitante entre 60,7 y 97. El "Function Score" (FS) postoperatorio promedio estuvo entre 69,5 y 91,4, 80 y 95,4, y 72,3 y 90 respectivamente. Se reportaron más complicaciones en el grupo de RTR más osteotomía concomitante. Discusión El RTR con cortes intra-articulares y balance de tejidos blandos, con guías convencionales o por navegación, es una opción viable especialmente en casos de deformidades extra-articulares leves. En casos con deformidades mayores se puede considerar la realización concomitante de osteotomía correctora.
Background Total knee replacement (TKR) in patients with extra-articular deformities is a challenging procedure for the surgeon. Different types of surgical techniques have been described, such as correction with intra-articular cuts, and concomitant osteotomies. The objective of this study is to evaluate the functional outcomes associated with the different TKR techniques in patients with extra-articular deformities. Methods A systematic review of the literature was performed. Studies evaluating functional outcomes of primary TKR in adult patients with osteoarthritis and extra-articular deformities were included. The type of deformity and intervention, functional scales records, and range of motion were evaluated. Results A total of 29 studies were included with a total of 401 knees. The most frequent mechanical axis deformity was varus, with a mean range below 20° in most studies. The mean after surgery knee score (KS) in the TKR group with intra-articular cuts and conventional guides ranged between 85 and 96.5. Those with cuts guided by navigation had a score between 82 and 95, and between 60.7 and 97 in the group with concomitant osteotomy. The mean post-operative Function Score (FS) was between 69.5 and 91.4, 80 and 95.4, and 72.3 and 90, respectively. More complications were reported in the TKR plus concomitant osteotomy group. Discussion TKR with intra-articular cuts and soft tissue balance, with conventional guides or by navigation, is a viable option and should be preferred in cases of mild extra-articular deformities. In cases with major deformities, a concomitant corrective osteotomy should be considered.
Assuntos
Humanos , Artroplastia do Joelho , Osteoartrite , Osteotomia , Anormalidades CongênitasRESUMO
PURPOSE: To assess functional outcomes in patients undergoing total knee arthroplasty (TKA) without previous corrective osteotomy for treatment of knee osteoarthritis associated with extra-articular deformity. METHODS: From January to December 2016, patients with knee osteoarthritis with extra-articular deformities who presented for preoperative assessment before TKA were evaluated prospectively. Physical and radiological characteristics were documented pre- and postoperatively. RESULTS: TKA was performed in 33 knees; 25 were considered for analysis. The mean age was 65.2 years (range, 48-79 years). Sixteen deformities were secondary to fractures and nine to failed osteotomies. The mean Knee Society Score (KSS) improved from 27.1 pre-operatively to 68.7 post-operatively (p = 0.000). Pre-operative mechanical axis ranged from 32° varus (negative) to 26° valgus. After correction, 20 knees were within 3° (varus or valgus) of mechanical alignment. CONCLUSION: In patients with extra-articular deformities, TKA with asymmetric intra-articular resection and ligament balancing can relieve pain and realign the mechanical axis of the lower limb.