Mid-term Outcomes of Primary Constrained Condylar Knee Arthroplasty for Severe Knee Deformity

This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy（TKA） with use of Nex Gen#174; Legacy#174; Constrained Condylar Knee（CCK） prosthesis for severe knee deformity. Clinical data of 46 patients（48 knees in total, aged 61 years on average） with severe knee deformity who underwent TKA with Nex Gen#174; Legacy#174; CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months（range 40–90 months）. The New Knee Society scoring（NKSS） system and the Hospital for Special Surgery（HSS） score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale（VAS） was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion（ROM） from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus（≥7°） in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior（A/P） view of X-ray films showed 4 radiolucent lines（RLL） in 48 tibial components. It was concluded that TKA with CCK is effective for the treatment of the severe unstable knee that cannot be balanced by soft tissue.

Coronal plane deformity around the knee in the skeletally immature population:A review of principles of evaluation and treatment

Coronal plane deformity around the knee,also known as genu varum or genu valgum,is a common finding in clinical practice for pediatricians and orthopedists.These deformities can be physiological or pathological.If untreated,pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis.The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.

Effect of osteoarthritic knee flexion deformity correction by total knee arthroplasty on sagittal spinopelvic alignment in Indian population

BACKGROUND Sagittal alignment of the spine,pelvis,and lower extremities is essential for maintaining a stable and efficient posture and ambulation.Imbalance in any element can result in compensatory changes in the other elements.Knee flexion is a compensatory mechanism for spinopelvic sagittal alignment and is markedly affected in severe knee osteoarthritis(OA).The correction of knee flexion deformity(KFD)by total knee arthroplasty(TKA)can lead to complementary changes in the sagittal spinopelvic parameters(SSPs).AIM To determine the SSP changes in patients with knee OA,with or without KFD undergoing TKA.METHODS The study was conducted in 32 patients who underwent TKA.A neutral standing whole-spine lateral radiograph was performed before surgery and 3 mo after surgery in these patients.Subjects were divided into two groups(Group 1 obtained>10°corrections in KFD;group B obtained<10°correction).The pelvic tilt(PT),pelvic incidence(PI),sacral slope(SS),lumbar lordosis(LL),and sagittal vertical axis(SVA)were measured.RESULTS The median of change in PT,PI,SS,LL,and SVA was 0.20 mm,1.00 mm,2.20 mm,−0.40 mm,and 6.8 mm,respectively.The difference in the change in SSPs between the two groups was statistically non-significant.CONCLUSION SSPs,such as PI,PT,SS,LL,and SVA,do not change significantly following TKA in end-stage knee OA despite a significant correction(>10°)in KFD.

The impact of individualized care after artificial knee replacement surgery for patients with valgus deformity of the knee

Objective:To evaluate the perioperative nursing of total knee arthroplasty for patients with valgus deformity of the knee.Methods:Seventy-six patients who underwent surgical treatment were enrolled in the study from March 2014 to March 2018.The patients in the control group were treated with routine nursing.The experimental group was treated not only with routine nursing but also with health education,psychological care,family social support,and other nursing intervention.Hospital for special surgery and Pittsburgh sleep quality index were used to evaluate the effect of nursing intervention on patients after operation.Results:All the index scores of the experimental group were lower than those of the control group(P<0.05),indicating that the function of the diseased limb and the patient's sleep status improved significantly after the intervention.Conclusions:Individualized nursing can improve the recovery of limb function and improve the patients'quality of life.It is very effective for nurses to implement individualized nursing measures for patients after surgery.

TOTAL KNEE ARTHROPLASTY WITH POSTERIOR CRUCIATE LIGAMENT RETENTION IN PATIENTS WITH SEVERE VARUS DEFORMITY

Objective; TO observe the clinical outcome of total knee arthroplasty (TKA ) with posterior cruciate ligament (PCL ) retention in patients with severe varus deformity. Methods We reviewed the clinical treatment results of primary TKA in patients with severe varus deformity (≥20°) between January 1990 and July 1995. All patients, suffered from ostecoarthritis, were performed on a single surgeon using a minimally constrained "Hybrid" Miller-Galante knees (MG-I). Cliniccal evaluation were assessed by using the Knee Society clinical rating system. The Student’s t test was used to analyse the data. Results At a mean follow-up of 6 years (4-9years), 56 knees in 38 patients were available for review. 5 patients (7 knees) lost follow-up and 3 patients (4 knees) died. The average knee score improved from 33 points before operation to 91 points in the latest follow-up with excellent results in 84% of all patients. The Knee Society functional score improved from 39 to 76 points. The improvements were statistically significant (P < 0. 01 ). A functionally acceptable range of motion (ROM) of more than 90° were achieved in 86% of all patients. Most of cases (50/56 ) had postoperative alignment inside the normal range of 5° to 7° valgus. The other 6 cases had postoperative residual deformity of 5°-10°varus. Total revision rate was 21 % (12 /56 ), the average revision time was 5. 5 years after surgery. Other complications included patellar subluxation in 1 case, anterior pain of knee in 4 cases, and superficial cellulitis in 1 case. No early or late infection, aseptic loosening or anterioposterior instability occurred in this series. Conclusion Severs varus deformity can he successfully corrected at the time of primary TKA by using PCL-retention prosthesis. There were more problems from postoperative medial-lateral instability of knee which contributed significantly to early failure after an average of 6. 0 years.

Alignment of the hindfoot following total knee arthroplasty: A systematic review

BACKGROUND There appears to be a close relationship between deformities at the knee joint and at the hindfoot in patients with knee osteoarthritis(OA).Despite this intrinsic link,there is a dearth of studies investigating alterations in hindfoot alignment following total knee arthroplasty(TKA)in patients with knee OA.AIM To evaluate changes in alignment of the hindfoot following TKA,foot and ankle clinical outcomes in terms of subjective clinical scoring tools following surgical intervention,and to analyse the level of evidence(LOE)and quality of evidence(QOE)of the included studies.METHODS MEDLINE,EMBASE and Cochrane Library databases were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Studies reporting changes in the postoperative alignment of the hindfoot following TKA were included.The level and QOE were recorded and assessed.RESULTS Eleven studies with a total of 1142 patients(1358 knees)met the inclusion/exclusion criteria.Six studies were of LOE II and 5 studies were of LOE III.Patients with preoperative varus knee deformity and valgus hindfoot deformity demonstrated improvement in hindfoot alignment post TKA.Patients with preoperative varus knee deformity and varus hindfoot deformity demonstrated no improvement in hindfoot alignment following TKA.Twelve different radiographic parameters were used to measure the alignment of the hindfoot across the included studies,with the tibio-calcaneal angle most frequently utilised(27.3%).CONCLUSION This systematic review demonstrated that the hindfoot may display compensatory changes in alignment following TKA in patients with knee OA.However,the marked heterogeneity between the included studies and poor QOE limits any meaningful cross sectional comparisons between studies.Further,well designed studies are necessary to determine the changes and outcomes of hindfoot alignment following TKA.

Clinical outcomes of primary rotating-hinge knee arthroplasty for knees with severe deformity

Rotating-hinge total knee prostheses are often used for the treatment of global instability or severe bone loss around the knee,which is often accompanied by severe deformity.1 Competent and functional collateral ligaments are a prerequisite for performance of conventional total knee arthroplasty （TKA）.In cases of primary surgery for knees with severe deformities or in revision surgery for knees with substantial bone loss,standard condylar implants do not allow for proper stabilization of the joint.Under these circumstances,condylar TKA designs will fail within a short period of time,or other complications such as anterior knee pain will occur soon after surgery.2