Objective To explore the technique of the soft tissue balancing inthe total knee arthroplasty (TKA) for the patients with the knees of varus deformity and flexion contracture. Methods From January 2001 to December 2005, 86 patients (19 males, 67 females; age, 57-78 years;average, 66 years) with the knees of varus deformity and flexion contracture underwent primary TKA and the balancing of the soft tissues. All the patients had suffered from osteoarthritis. The unibilateral affection was found in 68 patients and the bilateral affection in 18. The varus deformity angle was averaged 12.3° (range, 6-34°). The soft tissue varus accounted for 56.7% and the bony varus accounted for 43.3%. The flexion contracture lt; 10° was found in 21 knees, 10-19° in 45 knees, 20-29° in 22 knees, and gt;30° in 16 knees, with an average angle of 18.9°. Results The flexion contractures were improved. Before operation the average angle ofthe flexion contracture was 18.9° but after operation only 4 patients had a residual flexion contracture of 5° and the remaining patients had a complete correction. The follow-up for 37 months (range, 6-72 months) in all the patients revealed that only 6 patients had a residual flexion contracture of 5-10° and the others had a full extension. Before operation the average varus angle was 12.3°(range, 6-34°) and the average tibiofemoral angle was 174.7° (range, 70.3-175.6°), but after operation the residual varus angle gt; 3° was only found in 2 patients. The complications occurring during operation and after operation were found in 6 patients, injuries to the attachment of the medial collateral ligaments in 2, patellar clunk syndromes in 2, cerebral embolism in 1, and lacunar infarction in 1, with no nerve disorders left after the medical treatment. No skin necrosis, the cut edge infection or deep infection occurred. Conclusion The balancing of the soft tissues is a major management for correction of the varus deformity and the flexion contracture. The proper balancing of the softtissues can achieve an obvious recovery of the function and correction of the varus deformity after TKA.
Objective To explore the treatment of the malunited fracture of the tibial plateau. Methods From June 2000 to June 2005, reconstruction was performed on 29 patients (18 males, 11 females; age, 1943 years, average, 31.6 years) with the malunited fracture of the tibial plateau. The injury duration ranged from 2.5 months to 2 years, averaged 9.7 months. After the injury, the plasterexternal fixation was performed on 8 patients and operation was performed on the other 21 patients. The operation was involved in the use of screws in 11 patients, anatomic plates, Golf plates and allotype plates in 8 patients, external fixation braces in 2 patients. A complicating injury to the anterior cruciate ligament (ACL) was found in 4 patients, an injury to the posterior cruciate ligament(PCL) in 2 patients, an injury to both ACL and PCL in 1 patient, and an injury to the meniscus in 6 patients. Reestablishment was performed on 19 patients, high tibial osteotomy on 7 patients, and osteotomy of the half tibial metaphysis on3 patients. Results Base on the followup for 8 months to 3 years(average, 13.6 months), the comprehensively scoring assessment showed that an excellent result was achieved in 8 patients, good in 15, fair in 4, and poor in 1, with an excellent and good rate of 82.1%, according to the Hohl knee joint function assessment on the pain, active movement, motion range, stability, and selfassessment. ConclusionFor the reconstruction of the malunited fracture of the tibial plateau, the satisfactory therapeutic effectiveness can only be achieved if the proper indications are identified and the suitable operative methods are adopted. The total knee replacement is only applicable to the elderly patient, and for the young patient, the reconstruction should be performed.