Deformity correction with total knee arthroplasty for severe knee osteoarthritis accompanying extra-articular femoral deformity: the results are promising
- 38 Downloads
This study aimed to evaluate patients with severe degenerative osteoarthritis of the knee and extra-articular femoral deformities treated with total knee arthroplasty (TKA) and acute deformity correction.
Ten patients with severe degenerative osteoarthritis of the knee and extra-articular femoral deformities were included, and the median age was 63 years (range 38–67). The etiology was post-traumatic malunion in four patients, rickets sequelae in four patients, and surgical sequelae due to multiple epiphyseal dysplasia in two patients. The severity of degenerative osteoarthritis and deformity analyses were assessed according to the Kellgren–Lawrence and Paley criteria, respectively. The median number of previous operations the patients had undergone was two (range 0–3), and the median Oxford Knee Society score was 9 (range 5–13) before treatment. All patients were treated with primary TKA and deformity correction in the same surgery. The TKA was completed first, followed by an osteotomy at the apex of the deformity. Finally, a retrograde intramedullary nail was inserted.
The median follow-up period was 44 (31–60) months. A stable and functional knee joint, a physiological mechanical axis, and solid osseous union were achieved in all patients. Late prosthetic failure was seen in one patient due to deep infection. The median Oxford Knee Society score was 42 (range 37–47) at the final follow-up.
Combining several procedures in single setting for the treatment of severe knee osteoarthritis accompanied by extra-articular deformity may eliminate the need for multiple surgeries. Furthermore, a proper physiological mechanical axis can be obtained without causing substantial bone loss.
Level of evidence
KeywordsExtra-articular deformity Knee arthroplasty Retrograde intramedullary nailing
We thank Peter Mittwede, MD, Ph.D., from Edanz Group (http://www.edanzediting.com/ac) for editing a draft of this manuscript.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
Institutional review board (IRB)/Ethics committee approval was obtained (ID number 15) on 9/20/2017 from the Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital (Istanbul, Turkey).
Patients were informed, and they consented to conduct the study.
- 1.Bargren JH, Blaha JD, Freeman MA (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183Google Scholar
- 5.Brinkman JM, Hurschler C, Agneskirchner J, Lobenhoffer P, Castelein RM, van Heerwaarden RJ (2014) Biomechanical testing of distal femur osteotomy plate fixation techniques: the role of simulated physiological loading. J Exp Orthop 1:1. https://doi.org/10.1186/s40634-014-0001-1 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Lombardi AV Jr, Berend KR, Ng VY (2011) Neutral mechanical alignment: a requirement for successful TKA: affirms. Orthopedics 34:e504-506Google Scholar
- 29.Ozcan C, Sokucu S, Beng K, Cetinkaya E, Demir B, Kabukcuoglu YS (2016) Prospective comparative study of two methods for fixation after distal femur corrective osteotomy for valgus deformity; retrograde intramedullary nailing versus less invasive stabilization system plating. Int Orthop 40:2121–2126CrossRefPubMedGoogle Scholar
- 30.Paley D (2002) Principles of deformity correction. Springer, Berlin, Heidelberg, pp 1–30, 61–71, 102–109. https://doi.org/10.1007/978-3-642-59373-4
- 40.Veltman ES, van Wensen RJ, Defoort KC, van Hellemondt GG, Wymenga AB (2017) Single-stage total knee arthroplasty and osteotomy as treatment of secondary osteoarthritis with severe coronal deviation of joint surface due to extra-articular deformity. Knee Surg Sports Traumatol Arthrosc 25:2835–2840CrossRefPubMedGoogle Scholar