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Krzysztof K, Trams E, Pomianowski S, Kaminski R. Osteotomies and Total Knee Arthroplasty: Systematic Review and Meta-Analysis. Life (Basel) 2022; 12:1120. [PMID: 35892922 PMCID: PMC9394298 DOI: 10.3390/life12081120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
Total knee replacement (TKA) is a frequent modality performed in patients with osteoarthritis. Specific circumstances can make it much more difficult to execute successfully, and additional procedures such as osteotomy may be required. The aim of this study was to perform a meta-analysis and systematic review of osteotomies combined with TKA. METHODS In June 2022, a search PubMed, Embase, Cochrane, and Clinicaltrials was undertaken, adhering to PRISMA guidelines. The search included the terms "osteotomy" and "total knee arthroplasty". RESULTS Two subgroups (tibial tubercle osteotomy and medial femoral condyle osteotomy) were included in the meta-analysis. Further subgroups were described as a narrative review. The primary outcome showed no significant difference in favor to TTO. Secondary outcomes showed improved results in all presented subgroups compared to preoperative status. CONCLUSION This study showed a significant deficit of randomized control trials treated with osteotomies, in addition to TKA, and a lack of evidence-based surgical guidelines for the treatment of patients with OA in special conditions: posttraumatic deformities, stiff knee, severe varus, and valgus axis or patella disorders.
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Affiliation(s)
| | | | | | - Rafal Kaminski
- Department of Orthopaedics and Trauma Surgery, Centre of Postgraduate Medical Education, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland; (K.K.); (E.T.); (S.P.)
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Li F, Wang C, Zhao MW, Geng X, Li JY, Zhou G, Sun D, Tian H. Modified Medial Collateral Ligament Indentation Technique in Total Knee Arthroplasty with Severe Type II Valgus Deformity. Orthop Surg 2022; 14:663-670. [PMID: 35174652 PMCID: PMC9002074 DOI: 10.1111/os.13230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To explore the feasibility and clinical efficacy of a modified medial collateral ligament indentation technique in total knee arthroplasty (TKA) with severe type II valgus deformity. Methods Consecutive patients with Krackow type II valgus deformity >20° who underwent a primary unilateral TKA between May 2008 and June 2017 were studied retrospectively. A medial collateral ligament indentation technique was performed in 20 patients (MCLI group), and 23 patients received the routine lateral structures release technique (LSR group). Radiological parameters, such as the valgus angle (VA), and functional outcomes including the use of constraint implants, Knee Society Score (KSS), Knee Society Function score (KSF), and thickness of the polyethylene insert were compared between the two groups. Results A total of 43 consecutive patients had a minimum 2‐year follow‐up. The preoperative VA was comparable between the MCLI (23.5° ± 5.8°) and LSR groups (21.3° ± 3.2°, P = 0.134), as was the postoperative VA (1.1° ± 2.1° and 2.5° ± 3.0°, respectively, P = 0.084). The mean KSS and KSF scores in the MCLI group were 30.2 ± 4.8 and 38.8 ± 4.8, respectively, before surgery, and they increased to 91.3 ± 2.6 and 86.5 ± 2.4 at the last follow‐up. The scores in the LSR group were 31.5 ± 7.5 and 36.5 ± 7.8 before surgery and 92.4 ± 3.5 and 88.5 ± 3.6 at the last follow‐up. While no statistically significant differences in pre‐ or postoperative functional scores were found between the two groups, the MCLI group had thinner polyethylene inserts (9.5 ± 1.1 mm vs 12.9 ± 1.5 mm) and less use of constrained condylar inserts (15% vs 69.6%). During follow‐up, the MCLI group had fewer complications. Conclusion A modified MCLI technique can achieve good outcomes in TKA with type II valgus deformity of >20°. It can maintain a normal joint line level, reduce the use of constrained condylar knee prostheses, and is a reliable choice for severe genu valgum.
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Affiliation(s)
- Feng Li
- Peking University Third Hospital, Department of Orthopaedics / Engineering Research Center of Bone and Joint Precision Medicine, Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Cheng Wang
- Peking University Third Hospital, Department of Orthopaedics / Engineering Research Center of Bone and Joint Precision Medicine, Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Min-Wei Zhao
- Peking University Third Hospital, Department of Orthopaedics / Engineering Research Center of Bone and Joint Precision Medicine, Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xiao Geng
- Peking University Third Hospital, Department of Orthopaedics / Engineering Research Center of Bone and Joint Precision Medicine, Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Jun-Yang Li
- Centre for Robotics and Automation, Shenzhen Research Institute of City University of Hong Kong, Shenzhen, China
| | - Ge Zhou
- Peking University Third Hospital, Department of Orthopaedics / Engineering Research Center of Bone and Joint Precision Medicine, Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Dong Sun
- Centre for Robotics and Automation, Shenzhen Research Institute of City University of Hong Kong, Shenzhen, China
| | - Hua Tian
- Peking University Third Hospital, Department of Orthopaedics / Engineering Research Center of Bone and Joint Precision Medicine, Beijing Key Laboratory of Spinal Disease Research, Beijing, China
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Daxhelet J, Aït-Si-Selmi T, Müller JH, Saffarini M, Ratano S, Bondoux L, Mihov K, Bonnin MP. Custom TKA enables adequate realignment with minimal ligament release and grants satisfactory outcomes in knees that had prior osteotomies or extra-articular fracture sequelae. Knee Surg Sports Traumatol Arthrosc 2021; 31:1212-1219. [PMID: 34041553 DOI: 10.1007/s00167-021-06619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the early clinical and radiographic outcomes of custom total knee arthroplasty (TKA) in knees that had prior osteotomies and/or extra-articular fracture sequelae. METHODS The authors retrospectively analysed a consecutive series of 444 knees that received custom TKA between 2016 and 2019 and identified 41 knees that had prior extra-articular events (osteotomies or fracture sequelae). Patients responded to pre- and post-operative (> 12 months) questionnaires, including Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Net improvements were calculated by subtracting pre- from post-operative scores. In addition to a preoperative CT scan, pre- and post-operative long-leg weight-bearing radiographs were obtained, on which the hip-knee-ankle (HKA) angle, femoral mechanical angle (FMA, between femoral mechanical axis and joint line) and tibial mechanical angle (TMA, between tibial mechanical axis and joint line) angles were measured, and alignment was planned within a 'target zone' of FMA and TMA within 85°-95° and HKA angle within 175°-183°. Agreements between preoperative, planned and post-operative angles were calculated using intra-class correlation coefficients (ICC). RESULTS From the initial 41 knees, 3 had incomplete post-operative data and 1 was revised for painful stiffness due to uncorrected rotational malunion, leaving 37 knees for analysis. Twenty had prior osteotomies (tibia, n = 18, femur, n = 2), 8 had isolated fractures (tibial, n = 3; femoral, n = 5), and 9 had both osteotomies and fractures. Postoperative coronal alignments were 90.4° ± 2.4° for FMA, 89.3° ± 2.6° for TMA and 179.9° ± 3.0° for HKA angle. Agreements between planned and achieved alignments were fair to excellent, and 29 (78%) knees were within the 'target zone'. At a mean follow-up of 15 ± 5 months, all clinical scores had improved significantly (p < 0.001). CONCLUSIONS Custom TKA granted satisfactory clinical outcomes and a low complication rate in knees that had prior osteotomies and/or extra-articular fracture sequelae. Using custom implants and strategies for coronal alignment, 29 (78%) of the 37 knees were successfully aligned within the 'target zone', and 35 (95%) of the 41 knees did not require ligament release. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jeremy Daxhelet
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Salvatore Ratano
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Louka Bondoux
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Kalin Mihov
- University Hospital "Saint Marina", Varna, Bulgaria
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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Alesi D, Meena A, Fratini S, Rinaldi VG, Cammisa E, Lullini G, Vaccari V, Zaffagnini S, Marcheggiani Muccioli GM. Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021? Musculoskelet Surg 2021; 106:1-8. [PMID: 33587251 PMCID: PMC8881420 DOI: 10.1007/s12306-021-00695-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/02/2021] [Indexed: 10/31/2022]
Abstract
Total knee arthroplasty in valgus knee deformities continues to be a challenge for a surgeon. Approximately 10% of patients who undergo total knee arthroplasty have a valgus deformity. While performing total knee arthroplasty in a severe valgus knee, one should aware with the technical aspects of surgical exposure, bone cuts of the distal femur and proximal tibia, medial and lateral ligament balancing, flexion and extension gap balancing, creating an appropriate tibiofemoral joint line, balancing the patellofemoral joint, preserving peroneal nerve function, and selection of the implant regarding constraint. Restoration of neutral mechanical axis and correct ligament balance are important factors for stability and longevity of the prosthesis and for good functional outcome. Thus, our review aims to provide step by step comprehensive knowledge about different surgical techniques for the correction of severe valgus deformity in total knee arthroplasty.
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Affiliation(s)
- D Alesi
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - A Meena
- VMMC and Safdarjung Hospital, Central Institute of Orthopedics, New Delhi, 110029, India
| | - S Fratini
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - V G Rinaldi
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - E Cammisa
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - G Lullini
- UO Medicina Riabilitativa e Neuroriabilitazione, IRCCS Istituto delle Scienze Neurologiche, Via Altura 3, 40139, Bologna, Italy
| | - V Vaccari
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - S Zaffagnini
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - G M Marcheggiani Muccioli
- 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
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Variable Lower Limb Alignment of Clinical Measures With Digital Photographs and the Footscan Pressure System. J Sport Rehabil 2020; 30:437-444. [PMID: 33075751 DOI: 10.1123/jsr.2018-0283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study examines the effect of the lower limb misalignment and its possible compensatory effect on plantar pressure in a normal population. The aim of this paper is to present a structured method for the analysis of posture and its changes using a standardized digital photography technique and plantar pressure measuring device. DESIGN Cohort. SETTING Laboratory. PARTICIPANTS A total of 200 adult volunteers between 18 and 22 years of age who had no current symptoms of pain and foot or ankle pathology participated in the study. MAIN OUTCOME MEASURES The gold standard measure of lower limb alignment with weight-bearing status is the mechanical axis and their angles using Image J software. Structural and functional measurements of the same foot were taken using a plantar pressure measuring device. In this study, 5 alignment (thigh, knee, leg, ankle, and foot) characteristics were measured on the lower limb using the 2 techniques, and, additionally, the foot contact area, peak pressure, foot axis, rearfoot angle, and subtalar joint flexibility score were analyzed in 10 different regions of the foot. RESULTS This study has shown a reasonable correlation between digitalized measurements and plantar pressures values. Quadriceps angle affected midfoot impulse, foot axis angle, subtalar joint minimum angle, and rearfoot angle positively. Subtalar joint flexibility scores were analyzed in 10 different regions of the foot. There was a positive correlation between rearfoot angle and quadriceps angle (P = .009, r = .261). Results of both methods show that they endorse each other. CONCLUSIONS The posture of the standing feet may have influence on lower limb alignment. Currently, there are no studies carried out by using digital photogrammetry and foot scan. The authors claim that patient-friendly digital photogrammetry would have a positive contribution to the monitoring of patients, even including new ones in the treatment programs, reducing any possible loss in the personal and national economy.
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Xu J, Liu H, Luo F, Lin Y. Common peroneal nerve 'pre-release' in total knee arthroplasty for severe valgus deformities. Knee 2020; 27:980-986. [PMID: 32144006 DOI: 10.1016/j.knee.2020.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/01/2019] [Accepted: 02/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Common peroneal nerve (CPN) palsy is a devastating complication that follows total knee arthroplasty (TKA). However, there are only a few studies on concrete measures for protecting the CPN in patients. This study aimed to put forward the CPN 'pre-release' method to protect the nerve. METHODS A prospective study was conducted on 30 patients (34 knees) with severe valgus knees who underwent CPN pre-release. This was a two-incision approach, and required a separate dissection of about three centimeters from the TKA operation. Clinical measurements including pre- and postoperative motor and sensory nerve function of CPN, radiological evaluation, complications, and the revised data were analyzed and compared. RESULTS The average preoperative femorotibial angle was 31.3 ± 8.0°. All patients had completely normal motor (grade 5) and sensory nerve function of CPN postoperatively, and there was no transient or late-onset CPN palsy. Patients had a routine rehabilitation with full weight bearing after recovery from anesthesia, including the knees with unconstrained extension/flexion motion. During the last follow-up visit, the visual analog scale, Knee Society Score, Hospital for Special Surgery knee-rating scale, and range of motion were 2.06 ± 1.13, 92.18 ± 5.57, 90.18 ± 3.70, and 115.59 ± 7.76°, respectively. There were no revisions for instability and recurrent valgus deformities during follow-up. Also, the femorotibial angle, hip-knee-ankle angle, condylar-hip angle, and plateau-ankle angle were 4.9 ± 2.0°, 179.09 ± 3.21°, 89.97 ± 2.41°, and 90.53 ± 1.26°, respectively. CONCLUSIONS The CPN pre-release for severe valgus knees is an effective method for nerve protection, achieving an adequate and safe release of lateral soft tissue, and providing immediate and early functional rehabilitation with decreasing constrained implant.
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Affiliation(s)
- Jie Xu
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, Fujian Province, China.
| | - Hongwen Liu
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, Fujian Province, China; Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
| | - Fenqi Luo
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yuan Lin
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, Fujian Province, China
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Cheng X, Wang Z, Zhang Y, Wang M, Zhang X. Tightening medial collateral ligament during total knee arthroplasty for patients with fixed valgus deformity: A novel technique. J Orthop Surg (Hong Kong) 2020; 27:2309499019834695. [PMID: 30862275 DOI: 10.1177/2309499019834695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study aimed to explore a new surgical technique for gap balance by tightening the medial collateral ligament (MCL) in total knee arthroplasty (TKA) in patients with fixed valgus deformity. MATERIALS AND METHODS A prospective analysis was performed on 15 patients (16 knees) with a fixed valgus deformity that was corrected by tightening the MCL during TKA. A single surgeon performed all the 16 TKAs using nonconstrained posterior substituting implant, with two knees treated with long-stem tibial prosthesis. Clinical scores, knee stability, and radiographic evaluations were recorded preoperatively and postoperatively. RESULTS Complete weight-bearing could be carried out under the protection of the brace postoperatively. At the third month after surgery, X-rays showed the brace was not worn. The mean follow-up was 26.6 months (range 12-42 months). The average preoperative mechanical axis was 15.4 ± 2.3° (range 11-25°), and postoperatively it was 0.6 ± 0.1° (range 0-2°). No complication relative to the technique occurred. CONCLUSION This new surgical technique has demonstrated excellent early clinical results and can be a good supplement for fixed valgus knee arthroplasty. Level of Evidence: III.
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Affiliation(s)
- Xingwang Cheng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhibing Wang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuan Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Min Wang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xia Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
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