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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2018

28.03.2018 | Knee

Under-corrected knees do not fail more than aligned knees at 8 years in fixed severe valgus total knee replacement

verfasst von: Bertrand Boyer, Régis Pailhé, Nassima Ramdane, David Eichler, Franck Remy, Matthieu Ehlinger, Gilles Pasquier

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 11/2018

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Abstract

Purposes

A fixed severe valgus knee is a surgical challenge. A safe post-operative Hip-Knee-Ankle angle (HKA) range of 180° ± 4 was recommended, but recent studies mentioned equal results from outliers of this range. Nevertheless, no distinction was made between varus and valgus knees, as well as over-corrected or under-corrected knees. Did post-operative nonaligned total knee replacements (TKR) from fixed severe valgus knees behave differently from the properly aligned population? Did over-corrected knees behave differently from under-corrected knees?

Methods

Through a multi-center retrospective cohort study, we provided 557 knees of at least 10° of minimal pre-operative valgus; in this population 75 presented a post-operative Hip-Knee-Ankle angle (HKA) outside of the 180° ± 4 range; 23 of them had at least 5° of varus; 52 of them had at least 5° of valgus. Median pre-operative HKA of the entire cohort was 194° (range 190–198). Median follow-up was 8 years (range 5–11); Knee Society Score (KSS) results, HKA, Femoral and Tibial Mechanical Angles (FMA, TMA) and complication rates were obtained. The outlier group (HKA ≤ 175 or ≥ 185) was compared to the control group (HKA 180 ± 4); over-corrected (HKA ≤ 175) and under-corrected (HKA ≥ 185) sub-groups were individually tested against the control group.

Results

The outlier group had a lower Final Knee Score than the aligned group (p = 0.023). In the over-corrected sub-group, median post-operative FMA was 88° (SD 4°) and median TMA was 87° (SD 4°). The complication rate was higher (p = 0.019). Knee (p = 0.018), Function (p = 0.034) and Final Knee Scores (p = 0.03) were statistically lower than in the control group. In the under-corrected sub-group, mean post-operative FMA was 93° (SD 2°) and mean TMA was 91° (SD 2°). The complication rate was lower (p = 0.019) and there was no difference with the control group concerning KSS.

Conclusions

In case of pre-operative fixed severe valgus knee, one should avoid over-correcting HKA angle and especially the TMA. Over-correction of a severe preoperative valgus in a post-operative varus was prejudicial for TKA survival. Keeping a severe valgus knee in low valgus to avoid using a more constrained implant and/or ligament releases will not decrease the 5–10 year implant survival and functional scores.

Level of evidence

Level IV—Case series.
Literatur
1.
Zurück zum Zitat Brilhault J, Lautman S, Favard L, Burdin P (2002) Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. Bone Joint J 84:1131–1137CrossRef Brilhault J, Lautman S, Favard L, Burdin P (2002) Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. Bone Joint J 84:1131–1137CrossRef
2.
Zurück zum Zitat Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. Bone Joint J 54:61–76 Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. Bone Joint J 54:61–76
3.
Zurück zum Zitat Clarke HD, Fuchs R, Scuderi GR, Scott WN, Insall JN (2005) Clinical results in valgus total knee arthroplasty with the “Pie Crust” technique of lateral soft tissue releases. J Arthroplasty 20:1010–1014CrossRef Clarke HD, Fuchs R, Scuderi GR, Scott WN, Insall JN (2005) Clinical results in valgus total knee arthroplasty with the “Pie Crust” technique of lateral soft tissue releases. J Arthroplasty 20:1010–1014CrossRef
4.
Zurück zum Zitat Devane PA, Horne JG, Martin K, Coldham G, Krause B (1997) Three-dimensional polyethylene wear of a press-fit titanium prosthesis: factors influencing generation of polyethylene debris. J Arthroplasty 12:256–266CrossRef Devane PA, Horne JG, Martin K, Coldham G, Krause B (1997) Three-dimensional polyethylene wear of a press-fit titanium prosthesis: factors influencing generation of polyethylene debris. J Arthroplasty 12:256–266CrossRef
5.
Zurück zum Zitat D’Lima DD, Chen PC, Colwell CW (2001) Polyethylene contact stresses, articular congruity, and knee alignment. Clin Orthop Relat Res 392:232–238CrossRef D’Lima DD, Chen PC, Colwell CW (2001) Polyethylene contact stresses, articular congruity, and knee alignment. Clin Orthop Relat Res 392:232–238CrossRef
6.
Zurück zum Zitat Eckhoff DG, Bach JM, Spitzer VM, Reinig KD, Bagur MM, Baldini TH, Flannery NM (2005) Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality. J Bone Joint Surg 87:71–80PubMed Eckhoff DG, Bach JM, Spitzer VM, Reinig KD, Bagur MM, Baldini TH, Flannery NM (2005) Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality. J Bone Joint Surg 87:71–80PubMed
7.
Zurück zum Zitat Gallo J, Goodman SB, Konttinen YT, Wimmer MA, Holinka M (2013) Osteolysis around total knee arthroplasty: a review of pathogenetic mechanisms. Acta Biomater 9:8046–8058CrossRef Gallo J, Goodman SB, Konttinen YT, Wimmer MA, Holinka M (2013) Osteolysis around total knee arthroplasty: a review of pathogenetic mechanisms. Acta Biomater 9:8046–8058CrossRef
8.
Zurück zum Zitat Hadi M, Barlow T, Ahmed I, Dunbar M, McCulloch P, Griffin D (2016) Does malalignment affect patient reported outcomes following total knee arthroplasty: a systematic review of the literature. SpringerPlus 5:1201CrossRef Hadi M, Barlow T, Ahmed I, Dunbar M, McCulloch P, Griffin D (2016) Does malalignment affect patient reported outcomes following total knee arthroplasty: a systematic review of the literature. SpringerPlus 5:1201CrossRef
9.
Zurück zum Zitat Huang T-W, Chuang P-Y, Lee C-Y, Lin S-J, Huang K-C, Shen S-H, Tsai Y-H, Lee MS, Hsu RW-W (2016) Total knee arthroplasty in patients with Ranawat type-II valgus arthritic knee with a marked coronal femoral bowing deformity: comparison between computer-assisted surgery and intra-articular resection. J Orthop Surg 11:88CrossRef Huang T-W, Chuang P-Y, Lee C-Y, Lin S-J, Huang K-C, Shen S-H, Tsai Y-H, Lee MS, Hsu RW-W (2016) Total knee arthroplasty in patients with Ranawat type-II valgus arthritic knee with a marked coronal femoral bowing deformity: comparison between computer-assisted surgery and intra-articular resection. J Orthop Surg 11:88CrossRef
10.
Zurück zum Zitat Insall J, Ranawat CS, Scott WN, Walker P (1976) Total condylar knee replacment: preliminary report. Clin Orthop Relat Res 120:149–154 Insall J, Ranawat CS, Scott WN, Walker P (1976) Total condylar knee replacment: preliminary report. Clin Orthop Relat Res 120:149–154
11.
Zurück zum Zitat Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14 Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
12.
Zurück zum Zitat Keblish PA (1991) 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 271:52–62 Keblish PA (1991) 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 271:52–62
13.
Zurück zum Zitat Kim Y-H, Park J-W, Kim J-S, Park S-D (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38:379–385CrossRef Kim Y-H, Park J-W, Kim J-S, Park S-D (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38:379–385CrossRef
14.
Zurück zum Zitat Krackow KA, Jones MM, Teeny SM, Hungerford DS (1991) Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res 273:9–18 Krackow KA, Jones MM, Teeny SM, Hungerford DS (1991) Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res 273:9–18
15.
Zurück zum Zitat Lombardi AV, Berend KR, Ng VY (2011) Neutral mechanical alignment: a requirement for successful TKA: affirms. Orthopedics 34:504–506 Lombardi AV, Berend KR, Ng VY (2011) Neutral mechanical alignment: a requirement for successful TKA: affirms. Orthopedics 34:504–506
16.
Zurück zum Zitat Magnussen RA, Weppe F, Demey G, Servien E, Lustig S (2011) Residual varus alignment does not compromise results of TKAs in patients with preoperative varus. Clin Orthop Relat Res 469:3443–3450CrossRef Magnussen RA, Weppe F, Demey G, Servien E, Lustig S (2011) Residual varus alignment does not compromise results of TKAs in patients with preoperative varus. Clin Orthop Relat Res 469:3443–3450CrossRef
17.
Zurück zum Zitat Martin JR, Beahrs TR, Stuhlman CR, Trousdale RT (2016) Complex primary total knee arthroplasty: long-term outcomes. J Bone Joint Surg 98:1459–1470CrossRef Martin JR, Beahrs TR, Stuhlman CR, Trousdale RT (2016) Complex primary total knee arthroplasty: long-term outcomes. J Bone Joint Surg 98:1459–1470CrossRef
18.
Zurück zum Zitat Miyasaka KC, Ranawat CS, Mullaji A (1997) 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 345:29–37CrossRef Miyasaka KC, Ranawat CS, Mullaji A (1997) 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 345:29–37CrossRef
19.
Zurück zum Zitat Mont MA, Mahoney OM (2010) Commentary on an Article by Sebastien Parratte, MD., PhD et al.: “Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements”. J Bone Joint Surg 92-A:e16(1)–e16(2) Mont MA, Mahoney OM (2010) Commentary on an Article by Sebastien Parratte, MD., PhD et al.: “Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements”. J Bone Joint Surg 92-A:e16(1)–e16(2)
20.
Zurück zum Zitat Nikolopoulos D, Michos I, Safos G, Safos P (2015) Current surgical strategies for total arthroplasty in valgus knee. World J Orthop 6:469CrossRef Nikolopoulos D, Michos I, Safos G, Safos P (2015) Current surgical strategies for total arthroplasty in valgus knee. World J Orthop 6:469CrossRef
21.
Zurück zum Zitat Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg 92:2143–2149CrossRef Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg 92:2143–2149CrossRef
22.
Zurück zum Zitat Peters CL, Jimenez C, Erickson J, Anderson MB, Pelt CE (2013) Lessons learned from selective soft-tissue release for gap balancing in primary total knee arthroplasty: an analysis of 1216 consecutive total knee arthroplasties: AAOS exhibit selection. J Bone Joint Surg 95:e152-1CrossRef Peters CL, Jimenez C, Erickson J, Anderson MB, Pelt CE (2013) Lessons learned from selective soft-tissue release for gap balancing in primary total knee arthroplasty: an analysis of 1216 consecutive total knee arthroplasties: AAOS exhibit selection. J Bone Joint Surg 95:e152-1CrossRef
23.
Zurück zum Zitat Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg 87:271–284CrossRef Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg 87:271–284CrossRef
24.
Zurück zum Zitat Ritter MA, Davis KE, Davis P, Farris A, Malinzak RA, Berend ME, Meding JB (2013) Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Joint Surg 95:126–131CrossRef Ritter MA, Davis KE, Davis P, Farris A, Malinzak RA, Berend ME, Meding JB (2013) Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Joint Surg 95:126–131CrossRef
25.
Zurück zum Zitat Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg 93:1588–1596CrossRef Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg 93:1588–1596CrossRef
26.
Zurück zum Zitat Rodriguez JA, Bas MA, Orishimo KF, Robinson J, Nicholas SJ (2016) Differential effect of total knee arthroplasty on valgus and varus knee biomechanics during Gait. J Arthroplasty 31:248–253CrossRef Rodriguez JA, Bas MA, Orishimo KF, Robinson J, Nicholas SJ (2016) Differential effect of total knee arthroplasty on valgus and varus knee biomechanics during Gait. J Arthroplasty 31:248–253CrossRef
27.
Zurück zum Zitat Schmalzried TP, Szuszczewicz ES, Northfield MR, Akizuki KH, Frankel RE, Belcher G, Amstutz HC (1998) Quantitative assessment of walking activity after total hip or knee replacement. J Bone Joint Surg 80:54–59CrossRef Schmalzried TP, Szuszczewicz ES, Northfield MR, Akizuki KH, Frankel RE, Belcher G, Amstutz HC (1998) Quantitative assessment of walking activity after total hip or knee replacement. J Bone Joint Surg 80:54–59CrossRef
28.
Zurück zum Zitat Shan L, Shan B, Suzuki A, Nouh F, Saxena A (2015) Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg 97:156–168CrossRef Shan L, Shan B, Suzuki A, Nouh F, Saxena A (2015) Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg 97:156–168CrossRef
29.
Zurück zum Zitat Smith CR, Vignos MF, Lenhart RL, Kaiser J, Thelen DG (2016) The influence of component alignment and ligament properties on tibiofemoral contact forces in total knee replacement. J Biomech Eng 138:021017CrossRef Smith CR, Vignos MF, Lenhart RL, Kaiser J, Thelen DG (2016) The influence of component alignment and ligament properties on tibiofemoral contact forces in total knee replacement. J Biomech Eng 138:021017CrossRef
30.
Zurück zum Zitat Stucinskas J, Robertsson O, Sirka A, Lebedev A, Wingstrand H, Tarasevicius S (2015) Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength. Acta Orthop 86:728–733CrossRef Stucinskas J, Robertsson O, Sirka A, Lebedev A, Wingstrand H, Tarasevicius S (2015) Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength. Acta Orthop 86:728–733CrossRef
31.
Zurück zum Zitat Werner FW, Ayers DC, Maletsky LP, Rullkoetter PJ (2005) The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech 38:349–355CrossRef Werner FW, Ayers DC, Maletsky LP, Rullkoetter PJ (2005) The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech 38:349–355CrossRef
32.
Zurück zum Zitat Whiteside LA (1993) Correction of ligament and bone defects in total arthroplasty of the severely valgus knee. Clin Orthop Relat Res 288:234–245 Whiteside LA (1993) Correction of ligament and bone defects in total arthroplasty of the severely valgus knee. Clin Orthop Relat Res 288:234–245
Metadaten
Titel
Under-corrected knees do not fail more than aligned knees at 8 years in fixed severe valgus total knee replacement
verfasst von
Bertrand Boyer
Régis Pailhé
Nassima Ramdane
David Eichler
Franck Remy
Matthieu Ehlinger
Gilles Pasquier
Publikationsdatum
28.03.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 11/2018
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-4906-6

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