Abstract
BackgroundTotal knee arthroplasty (TKA) is the major surgical treatment for end-stage osteoarthritis (OA). Despite its effectiveness, there are about 20% of patients who are dissatisfied with the outcome. Predicting the surgical outcome preoperatively could be beneficial in order to guide clinical decisions.MethodsOne-hundred and ten knees of 110 consecutive patients who underwent TKAs for varus knees resulting from OA were included in this study. Preoperative varus deformities were evaluated by femorotibial angle (FTA), medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA), and classified as a severe varus (SV) or a mild varus (MV) group. The osteophyte score (OS), which we developed originally, was also calculated based on the size of the osteophytes and classified as groups with more or less osteophytes. We compared preoperative and 1-year postoperative range of motion, the Knee Society Score, and Japanese Knee injury Osteoarthritis Outcome Score (KOOS) between SV and MV groups (varus defined by FTA, MPTA, or LDFA), in each group with more or less osteophytes.ResultsWhen varus deformities were defined by FTA, regardless of OS, postoperative KOOS subscales and/or the improvement rates were significantly higher in the SV group than in the MV group. When varus defined by MPTA, regardless of OS, there were no significant differences in postoperative KOOS subscales between groups. However, when varus defined by LDFA, scores for pain, activities of daily living (ADL), and quality of life (QOL) on postoperative KOOS and/or the improvement rates were significantly higher in the SV group than in the MV group only in patients with less osteophytes. No significant differences were found between groups in patients with more osteophytes.ConclusionsWe classified OA types by radiographic measurements of femur and tibia in combination with OS. Postoperative patient-reported outcomes were better in patients with SV knees but were poor in patients with knees with MV deformity and less osteophytes.
Highlights
Total knee arthroplasty (TKA) is the major surgical treatment for end-stage osteoarthritis (OA)
Patients A total of 110 consecutive patients (19 males and 91 females) who underwent primary total knee arthroplasties (TKAs) (110 knees) for varus knees resulting from osteoarthritis (OA) at our institution between January 2015 and December 2016 were included in this study
When varus deformities were defined by femorotibial angle (FTA), patients with FTA≧185 o and FTA < 185 o were classified as a severe varus (SV) or a mild varus (MV) group, respectively since the average of FTA for all patients was 185.1 ± 5.1 degrees (Table 1)
Summary
Total knee arthroplasty (TKA) is the major surgical treatment for end-stage osteoarthritis (OA). There are about 20% of patients who are dissatisfied with the outcome. Predicting the surgical outcome preoperatively could be beneficial in order to guide clinical decisions. Total knee arthroplasty (TKA) is the major surgical treatment for end-stage osteoarthritis. The procedure relieves patients of pain and improves their quality of life. Despite good clinical evaluation by physicians, it has been reported that approximately 20% of patients are dissatisfied with the outcome [1]. There is sometimes a dissociation between physician-based and patient-based outcomes in TKAs. There is great merit in being able to preoperatively identify patients who would have satisfactory or unsatisfactory results. Predicting the surgical outcomes preoperatively could be beneficial to guide clinical decisions
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