SURGICAL TECHNIQUE AND CLINICAL RESULTS OF TOTAL KNEE ARTHROPLASTY IN TREATING ENDSTAGEGONARTHROSIS COMBINED WITH VALGUS KNEE DEFORMITY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xingshan , WENG Xisheng , LIN Jin , JIN Jin , QIAN Wenwei.

Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College &;
Chinese Academy of Medical Sciences, Beijing, 100730, P.R.China.;

Corresponding author：

Keywords：

Total knee arthroplasty ,Gonarthrosis ,Valgus knee deformity ,Medial parapatellar approach

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【Abstract】 Objective To investigate the surgical technique and the cl inical results of total knee arthroplasty (TKA)
in treating end-stage gonarthrosis combined with valgus knee deformity. Methods Between November 1998 and October
2010, 64 patients (72 knees) with end-stage gonarthrosis combined with valgus knee deformity underwent TKA by a medial
parapatellar approach. Of the 64 patients, 18 were male and 46 were female with an average age of 62.5 years (range, 23-82 years),
including 44 cases (49 knees) of osteoarthritis, 17 cases (20 knees) of rheumatoid arthritis, 2 cases (2 knees) of haemophilic
arthritis, and 1 case (1 knee) of post-traumatic arthritis. Bilateral knees were involved in 8 cases, and single knee in 56 cases. The
flexion and extension range of motion (ROM) of the knee joint was (82.2 ± 28.7)°; the femur-tibia angle (FTA) was (18.0 ± 5.8)°;
according to Knee Society Score (KSS) criterion, the preoperative cl inical score was 31.2 ± 10.1 and functional score was
37.3 ± 9.0. According to Krackow’s classification, there were 65 knees of type I and 7 knees of type II. By medial parapatellar
approach, conventional osteotomy and Ranawat soft tissue release were performed in all cases. Prosthesis of preserved posterior
cruciate l igament were used in 7 cases (7 knees), posterior stabil ize prosthesis in 54 cases (60 knees), constrained prosthesis
in 4 cases (5 knees). Results Incisions healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient with
haemophilic arthritis, severe valgus deformity (FTA was 41°), and flexion contracture (20°), which was cured after 1 year of
conservative treatment. Revison surgery was performed in 1 case of deep infection at 2 years after surgery. All the patients were
followed up 4.9 years on average (range, 1-13 years). At last follow-up, the FTA was (7.0 ± 2.5)°, showing significant difference
when compared with preoperative value (t=15.502, P=0.000). The KSS cl inical score was 83.0 ± 6.6 and functional score was
85.1 ± 10.5, the flexion and extension ROM of the knee joint was (106.1 ± 17.0)°, all showing significant differences when
compared with preoperative values (P lt; 0.05). Five patients had 12-15° valgus knee deformity, but the function of the affect
knees were good. Conclusion TKA is an effective way for the patients with end-stage gonarthrosis combined with valgus
knee deformity by medial parapatellar approach combined with conventional osteotomy and Ranawat soft tissue release. The
correction of deformity and improvement of joint function can be achieved significantly. The cl inical result is satisfactory.

Citation： WANG Xingshan,WENG Xisheng,LIN Jin,JIN Jin,QIAN Wenwei.. SURGICAL TECHNIQUE AND CLINICAL RESULTS OF TOTAL KNEE ARTHROPLASTY IN TREATING ENDSTAGEGONARTHROSIS COMBINED WITH VALGUS KNEE DEFORMITY. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(5): 513-517. doi: Copy

1.	Koskinen E, Remes V, Paavolainen P, et al. Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9 years. Knee, 2011, 18(3): 145-150.
2.	Kamath AF, Israelite C, Horneff J, et al. Editorial: What is varus or valgus knee alignment?: a call for a uniform radiographic classification. Clin Orthop Relat Res, 2010, 468(6): 1702-1704.
3.	Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991, (273): 9-18.
4.	Aglietti P, Sensi L, Cuomo P, et al. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res, 2008, 466(11): 2751-2755.
5.	Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 271-284.
6.	畅怡, 周殿阁. 初次全膝关节置换术中韧带加强技术的应用. 中华医学杂志, 2009, 89(21): 1509-1511.
7.	Williot A, Rosset P, Favard L, et al. Total knee arthroplasty in valgus knee. Orthop Traumatol Surg Res, 2010, 96(4 Suppl): S37-S42.
8.	Krackow KA, Phillips MJ, Mihalko WM. Ligament advancement techniques in primary and revision total knee arthroplasty. Tech Knee Surg, 2003, 2(3): 138-143.
9.	Stern SH, Moeckel BH, Insall JN. Total knee arthroplasty in valgus knees. Clin Orthop Relat Res, 1991, (273): 5-8.
10.	Hirschmann MT, Hoffmann M, Krause R, et al. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty: does it matter? BMC Musculoskeletal Disorders, 2010, 11: 167.
11.	Mertl P, Jarde O, Blejwas D, et al. Lateral approach of the knee with tibial tubercle osteotomy for prosthetic surgery. Rev Chir Orthop Reparatrice Appar Mot, 1992, 78(4): 264-267.
12.	Wolff AM, Hungerford DS, Krackow KA, et al. Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg (Am), 1989, 71(6): 848-852.
13.	Miyasaka KC, Ranawat CS, Mullaji A. 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res, 1997, (345): 29-37.
14.	Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991, (271): 52-62.
15.	Boyer P, Boublil D, Magrino B, et al. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. Int Orthop, 2009, 33(6): 1577-1583.
16.	Girard J, Amzallag M, Pasquier G, et al. Total knee arthroplasty in valgus knees: predictive preoperative parameters influencing a constrained design selection. Orthop Traumatol Surg Res, 2009, 95(4): 260-266.
17.	Lachiewicz PF, Soileau ES. Results of a second-generation constrained condylar prosthesis in primary total knee arthroplasty. J Arthroplasty, 2011, 26(8): 1228-1231.
18.	刘军, 孙振辉, 张宇, 等. 改良Ranawat软组织松解平衡技术在外翻畸形全膝关节置换术中的应用. 中国修复重建外科杂志, 2009, 23(9): 1034-1037.
19.	Idusuyi OB, Morrey BF. Peroneal palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg (Am), 1996, 78(2): 177-184.
20.	Mihalko WM, Krackow KA. Anatomic and biomechanical aspects of pie crusting posterolateral structures for valgus deformity correction in total knee arhtroplasty: a cadaveric study. J Arthroplasty, 2000, 15(3): 347-353.
21.	Rose HA, Hood RW, Otis JC, et al. Peroneal-nerve palsy following total knee arthroplasty. A review of the hospital for special surgery experience. J Bone Joint Surg (Am), 1982, 64(3): 347-351.

1. Koskinen E, Remes V, Paavolainen P, et al. Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9 years. Knee, 2011, 18(3): 145-150.
2. Kamath AF, Israelite C, Horneff J, et al. Editorial: What is varus or valgus knee alignment?: a call for a uniform radiographic classification. Clin Orthop Relat Res, 2010, 468(6): 1702-1704.
3. Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991, (273): 9-18.
4. Aglietti P, Sensi L, Cuomo P, et al. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res, 2008, 466(11): 2751-2755.
5. Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 271-284.
6. 畅怡, 周殿阁. 初次全膝关节置换术中韧带加强技术的应用. 中华医学杂志, 2009, 89(21): 1509-1511.
7. Williot A, Rosset P, Favard L, et al. Total knee arthroplasty in valgus knee. Orthop Traumatol Surg Res, 2010, 96(4 Suppl): S37-S42.
8. Krackow KA, Phillips MJ, Mihalko WM. Ligament advancement techniques in primary and revision total knee arthroplasty. Tech Knee Surg, 2003, 2(3): 138-143.
9. Stern SH, Moeckel BH, Insall JN. Total knee arthroplasty in valgus knees. Clin Orthop Relat Res, 1991, (273): 5-8.
10. Hirschmann MT, Hoffmann M, Krause R, et al. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty: does it matter? BMC Musculoskeletal Disorders, 2010, 11: 167.
11. Mertl P, Jarde O, Blejwas D, et al. Lateral approach of the knee with tibial tubercle osteotomy for prosthetic surgery. Rev Chir Orthop Reparatrice Appar Mot, 1992, 78(4): 264-267.
12. Wolff AM, Hungerford DS, Krackow KA, et al. Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg (Am), 1989, 71(6): 848-852.
13. Miyasaka KC, Ranawat CS, Mullaji A. 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res, 1997, (345): 29-37.
14. Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991, (271): 52-62.
15. Boyer P, Boublil D, Magrino B, et al. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. Int Orthop, 2009, 33(6): 1577-1583.
16. Girard J, Amzallag M, Pasquier G, et al. Total knee arthroplasty in valgus knees: predictive preoperative parameters influencing a constrained design selection. Orthop Traumatol Surg Res, 2009, 95(4): 260-266.
17. Lachiewicz PF, Soileau ES. Results of a second-generation constrained condylar prosthesis in primary total knee arthroplasty. J Arthroplasty, 2011, 26(8): 1228-1231.
18. 刘军, 孙振辉, 张宇, 等. 改良Ranawat软组织松解平衡技术在外翻畸形全膝关节置换术中的应用. 中国修复重建外科杂志, 2009, 23(9): 1034-1037.
19. Idusuyi OB, Morrey BF. Peroneal palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg (Am), 1996, 78(2): 177-184.
20. Mihalko WM, Krackow KA. Anatomic and biomechanical aspects of pie crusting posterolateral structures for valgus deformity correction in total knee arhtroplasty: a cadaveric study. J Arthroplasty, 2000, 15(3): 347-353.
21. Rose HA, Hood RW, Otis JC, et al. Peroneal-nerve palsy following total knee arthroplasty. A review of the hospital for special surgery experience. J Bone Joint Surg (Am), 1982, 64(3): 347-351.

Chinese Journal of Reparative and Reconstructive Surgery

SURGICAL TECHNIQUE AND CLINICAL RESULTS OF TOTAL KNEE ARTHROPLASTY IN TREATING ENDSTAGEGONARTHROSIS COMBINED WITH VALGUS KNEE DEFORMITY

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