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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Funding

No funding was necessary for this study.

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Authors and Affiliations

  1. Service de chirurgie orthopédique, Centre Hospitalier Universitaire de Saint Etienne, 25 bld Pasteur, 42055, Saint-Étienne, France

    Bertrand Boyer

  2. Faculté de Médecine, J. Lisfranc Mines de Saint Etienne, INSERM U1059, Saint-Étienne, France

    Bertrand Boyer

  3. Orthopédie et traumatologie du sport, centre hospitalier universitaire Grenoble Alpes, Hôpital Sud, BP 217X, 38043, Grenoble cedex, France

    Régis Pailhé

  4. Service de Biostatistiques du CHRU de Lille, rue Emile Laine, 59037, Lille, France

    Nassima Ramdane

  5. Université de Lille, Hauts de France, Lille, France

    Nassima Ramdane & Gilles Pasquier

  6. Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Strasbourg, 1 avenue Molière, 67098, Strasbourg, France

    David Eichler & Matthieu Ehlinger

  7. Clinique de Saint Omer, 71 rue Ambroise Paré, 62575, Blendecques, France

    Franck Remy

  8. Service d’Orthopédie, centre hospitalier universitaire de Lille, rue Emile Laine, 59037, Lille, France

    Gilles Pasquier

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  1. Bertrand Boyer
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Correspondence to Bertrand Boyer.

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The authors declare that they have no conflict of interest.

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

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Boyer, B., Pailhé, R., Ramdane, N. et al. Under-corrected knees do not fail more than aligned knees at 8 years in fixed severe valgus total knee replacement. Knee Surg Sports Traumatol Arthrosc 26, 3386–3394 (2018). https://doi.org/10.1007/s00167-018-4906-6

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  • DOI: https://doi.org/10.1007/s00167-018-4906-6

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