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Under-corrected knees do not fail more than aligned knees at 8 years in fixed severe valgus total knee replacement

  • Bertrand Boyer
  • Régis Pailhé
  • Nassima Ramdane
  • David Eichler
  • Franck Remy
  • Matthieu Ehlinger
  • Gilles Pasquier
Knee

Abstract

Purposes

A fixed severe valgus knee is a surgical challenge. A safe post-operative Hip-Knee-Ankle angle (HKA) range of 180° ± 4 was recommended, but recent studies mentioned equal results from outliers of this range. Nevertheless, no distinction was made between varus and valgus knees, as well as over-corrected or under-corrected knees. Did post-operative nonaligned total knee replacements (TKR) from fixed severe valgus knees behave differently from the properly aligned population? Did over-corrected knees behave differently from under-corrected knees?

Methods

Through a multi-center retrospective cohort study, we provided 557 knees of at least 10° of minimal pre-operative valgus; in this population 75 presented a post-operative Hip-Knee-Ankle angle (HKA) outside of the 180° ± 4 range; 23 of them had at least 5° of varus; 52 of them had at least 5° of valgus. Median pre-operative HKA of the entire cohort was 194° (range 190–198). Median follow-up was 8 years (range 5–11); Knee Society Score (KSS) results, HKA, Femoral and Tibial Mechanical Angles (FMA, TMA) and complication rates were obtained. The outlier group (HKA ≤ 175 or ≥ 185) was compared to the control group (HKA 180 ± 4); over-corrected (HKA ≤ 175) and under-corrected (HKA ≥ 185) sub-groups were individually tested against the control group.

Results

The outlier group had a lower Final Knee Score than the aligned group (p = 0.023). In the over-corrected sub-group, median post-operative FMA was 88° (SD 4°) and median TMA was 87° (SD 4°). The complication rate was higher (p = 0.019). Knee (p = 0.018), Function (p = 0.034) and Final Knee Scores (p = 0.03) were statistically lower than in the control group. In the under-corrected sub-group, mean post-operative FMA was 93° (SD 2°) and mean TMA was 91° (SD 2°). The complication rate was lower (p = 0.019) and there was no difference with the control group concerning KSS.

Conclusions

In case of pre-operative fixed severe valgus knee, one should avoid over-correcting HKA angle and especially the TMA. Over-correction of a severe preoperative valgus in a post-operative varus was prejudicial for TKA survival. Keeping a severe valgus knee in low valgus to avoid using a more constrained implant and/or ligament releases will not decrease the 5–10 year implant survival and functional scores.

Level of evidence

Level IV—Case series.

Keywords

Valgus deformity Knee arthritis Total knee arthroplasty Residual deformity 

Notes

Funding

No funding was necessary for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

French Orthopedic Society SOFCOT does not require an ethical approval statement for inhouse studies.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Service de chirurgie orthopédiqueCentre Hospitalier Universitaire de Saint EtienneSaint-ÉtienneFrance
  2. 2.Faculté de MédecineJ. Lisfranc Mines de Saint Etienne, INSERM U1059Saint-ÉtienneFrance
  3. 3.Orthopédie et traumatologie du sportcentre hospitalier universitaire Grenoble AlpesGrenoble cedexFrance
  4. 4.Service de Biostatistiques du CHRU de LilleLilleFrance
  5. 5.Université de Lille, Hauts de FranceLilleFrance
  6. 6.Service de chirurgie orthopédique et traumatologiquecentre hospitalier universitaire de StrasbourgStrasbourgFrance
  7. 7.Clinique de Saint OmerBlendecquesFrance
  8. 8.Service d’Orthopédiecentre hospitalier universitaire de LilleLilleFrance

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