Postoperative Tibiofemoral Angle Research Articles

Use of semi-constrained total knee arthroplasty in gonarthrosis with collateral ligament insufficiency: Clinical and functional outcomes

IntroductionAchieving stability in total knee arthroplasty (TKA) is crucial for long-term implant survival. In cases of severe deformity or ligament laxity, constrained implants may be required. Traditionally, increasing constraint involved intramedullary stems. However, there are intermediary alternatives, including employing a constrained polyethylene insert without stems, thereby avoiding complications related to them. The study aims to evaluate our experience with a non-modular constrained (NMC) implant in primary TKA. Material and methodsWe conducted a retrospective review of the clinical and radiographic outcomes of 108 non-stemmed primary TKAs performed at our institution between 2013 and 2021 in patients with at least 10° deformity or 10mm ligament laxity. Data included demographics, preoperative and postoperative deformities, clinical outcomes and revision rates. ResultsA total of 103 patients (108 knees) with a mean age of 74 were followed up for a minimum of 2 years. The mean postoperative range of motion was 105°/0°. The median Oxford Knee Score, Knee Society Score and Knee Society Function Score were 43.5, 92 and 90, respectively. 17 knees had varus deformity (mean tibiofemoral angle of 2.7°), and 87 knees had excessive valgus deformity (mean tibiofemoral angle of 15.1°). The remaining 4 knees had a neutral alignment. The mean postoperative tibiofemoral angle was 6.8°. The overall revision rate was 6.5% (7 patients): 3 deep periprosthetic infections, 2 patellar dislocations, 1 stiffness and 1 aseptic loosening. ConclusionOur experience demonstrates favorable mid-term outcomes with the NMC implant, providing a safe alternative to stemmed implants in primary TKA, particularly in cases of severe deformity or ligament laxity.

Effects of proximal fibular partial excision on medial compartment knee osteoarthritis.

This study aimed to investigate the clinical and radiological progression of the patients who underwent proximal fibular partial excision (PFPE) for medial compartment knee osteoarthritis. Patients with medial compartment knee osteoarthritis who did not benefit from conservative treatment and accepted the PFPE surgery were involved in this study. Patients with traumatic arthritis, inflammatory arthritis, previous lower extremity fractures, valgus malalignment of the knee, and infection at the planned surgical site, however, were kept apart. Patients were assessed both clinically by Visual Analog Scale (VAS) and American Knee Society Score (AKSS), radiologically by Kellgren Lawrence classification, tibiofemoral angle, and joint-line convergence angle (JLCA). The patients were systematically assessed especially in the sixth month and first, second, and third years of the post-operative period. A total of 35 patients (mean age: 56.5, min: 45, max: 79) were involved in this study. The mean follow-up period was 22.4months (min: 6, max: 36). It has been observed that: Statistically significant decrease in VAS and increase in AKSS after PFPE (p < 0.001) No statistically significant improvement in preoperative and postoperative tibiofemoral angle and JLCA measurements CONCLUSIONS: The PFPE is a safe and effective surgical treatment for pain relief and functional improvement in medial compartment knee osteoarthritis. More studies are needed on its mechanism of action, long-term effects, and comparison with other treatment options.

Functional Outcome of Proximal Fibular Osteotomy in Medial Compartment Osteoarthritis of The Knee Joint

Background: Proximal Fibular Osteotomy (PFO) has been proposed as a new surgical option for pain relief in patients with medial compartment knee osteoarthritis. It is simple, safe and affordable. To assess functional outcome of proximal fibular osteotomy in medial compartment osteoarthritis of knee joint.&#x0D; Materials and methods: This prospective hospital based clinical trial was carried out in the Department of Orthopedic Surgery Chittagong Medical College Hospital (CMCH) Chattogram from July 2019 to June 2020. A total of 30 patients with knee osteoarthritis were enrolled through inclusion and exclusion criteria by purposive sampling. Proximal fibular osteotomy was done after taking written informed consent. Data was recorded in a predesigned case record form. All the patients were followed up to 6 months when final outcome was assessed by Oxford Knee Score. All the data were analyzed statistically by using Statistical Package for Social Sciences (SPSS-25). The result was expressed as frequency, percentage and mean ± SD. Level of significance was calculated at p&lt;0.05.&#x0D; Results: In this study, out of 30 cases, majority of the cases (57.7%) was in 55-64 years of age group. Mean ± SD pre-operative and post-operative VAS score were 7.13 ± 1.408 and 2.10 ± 0.803 respectively. According to Oxford Knee Score (OKS) pre-operative and postoperative mean ± SD were, 18.00 ± 2.117 and 36.53 ± 2.403. Mean ± SD pre-operative and post-operative Tibio Femoral Angle were 182.97 ± 1.810 and 178.63 ± 1.377 respectively. Mean ± SD pre-operative and post-operative Medial Joint Space (mm) were 1.223 ± 0.378 and 3.816 ± 0.982 respectively. Mean ± SD pre-operative and postoperative Lateral Joint Space (mm) were 6.640 ± 1.209 and 5.050 ± 0.897 respectively.&#x0D; Conclusion: After analyzing the results of present study, it can be concluded that proximal fibular osteotomy is a new, simple procedure in the management of medial compartment osteoarthritis of the knee which may delay the need for definitive knee procedures like unicompartmental knee arthroplasty or total knee replacement.&#x0D; JCMCTA 2021 ; 32 (2) : 137-141

STUDY TO EVALUATE THE ROLE OF HIGH TIBIAL OSTEOTOMY (HTO) FIXED WITH ANGLE STABLE PLATE IN TREATMENT OF OSTEOARTHRITIS OF KNEE AT NMCH, ROHTAS, BIHAR

Background: Osteoarthritis is more common in females. It is because osteoarthritis in post-menopausal women is associated with higher body weight, higher subcutaneous fat, calcium deficiency and weaker muscles linked to hormonal changes. The purpose of this study was to evaluate the role of high tibial osteotomy fixed with angle stable plate in treatment of osteoarthritis of knee. Material and Methods: In our study 10 cases were operated by modified coventry technique, 10 cases were operated by open wedge osteotomy with non locking plates and bone graft and 104 cases were operated by medial open wedge osteotomy and iliac graft secured by locking plate. In these cases full weight bearing was allowed at 8 week, 6 week and 3rd post operative day respectively. Radiographical analysis include post operatively change in tibio-femoral angle. Mean follow up of these cases was 2 year. Results: In our study thee knee pain and function score were significantly improved (p value &lt;0.001). The average pain score preoperatively was 1 8± 7(the maximum pain score for pain is 50) and post-operatively was 44±5. According to the grading used for functional assessment in knee scores there was definite improvement in the function of cases 122 (98.38%) at 2 yrs. The preoperatively mean functional knee score in of 110 cases (88.7%) cases was 28.86 (the maximum functional knee score is 100) and postoperatively was 70.45. There is correction in tibiofemoral angle (mean preoperative and postoperative tibiofemoral angle was 5.2±1.5 degrees varus and 5.8±1.3 degrees valgus respectively). Conclusion: There was definite improvement in the pain and function of the knee after the correction of the deformity (P value &lt;0.001). The results of high tibial osteotomy in 88.23 percentage knees were rated as excellent. 104 out of these 124 cases were fix by locking plates. 2 cases had poor results due to excessive over correction and associated comorbidities. There is a definite correlation between the postoperative valgus obtained and relief in the pain.

Lateral and patellofemoral compartment osteoarthritis progression after medial unicompartmental knee arthroplasty: A five- to 10-year follow-up study

BackgroundThe purpose of the study was to evaluate lateral and patellofemoral osteoarthritis (OA) progression after medial unicompartmental knee arthroplasty (UKA) and identify factors affecting the progression that were not identified previously. MethodsWe evaluated 146 patients who underwent medial UKA between 2009 and 2014. Kellgren–Lawrence grading of lateral and patellofemoral OA was performed on preoperative and final follow-up knee radiographs. Radiographic and clinical characteristics, SF-36, and Oxford knee scores were compared between the OA progressed and non-progressed groups. Risk factors for lateral and patellofemoral OA progression were evaluated. ResultsThe lateral OA progressed and non-progressed groups significantly differed in side, preoperative flexion contracture, preoperative joint line convergence angle, postoperative tibiofemoral angle, insert size, revision status (P < 0.05), and the patellofemoral OA progressed and non-progressed groups significantly differed in age, pre- and postoperative flexion contracture, postoperative tibiofemoral angle and pre- and postoperative patellofemoral OA grade (P < 0.05). At the final follow-up, Visual Analogue Scale, Oxford Knee Scores, and SF-36 sub-scores were significantly better in the lateral OA non-progressed group (P < 0.001).Dominant leg (odds ratio (OR): 2.759), insert size (>4, OR: 2.219), revision status (+, OR: 6.692), and postoperative tibiofemoral angle (>5.5°, OR: 1.177) were independent risk factors for lateral OA progression, whereas age (>60 years, OR: 3.222), preoperative patellofemoral OA grade (>1, OR: 2.085), and postoperative flexion contracture (>10°, OR: 1.919) were those for patellofemoral OA progression. ConclusionsMild radiographic progression of 1 KL grade is frequently seen five to 10 years after medial UKA. Postoperative outcomes are significantly affected by lateral compartment OA progression but not by patellofemoral OA progression.

Factors related to stress fracture after unicompartmental knee arthroplasty

Background/objectiveUnicompartmental knee arthroplasty (UKA) is a low-invasive knee surgery that enables early recovery. Stress fracture of the medial tibial plateau (MTP) is a complication of UKA that prolongs treatment once it has occurred. We investigated factors affecting its occurrence. MethodsThe study subjects were 167 patients who underwent fixed-bearing UKA between 2009 and 2016 (45 men and 122 women of mean age 77 years, including 134 with osteoarthritis of the knee and 33 with spontaneous osteonecrosis). We measured bone mineral density, installation angle of the tibial component, and leg alignment in those patients who developed stress fracture within 3 months after UKA. ResultsStress fracture did not occur in 155 patients (N group, 45 men and 110 women) and did occur in 12 (SF group, 12 women). The bone mineral density (BMD) of the proximal femur was significantly lower in the SF group, indicating that bone fragility may have contributed to stress fractures at this site. There was no significant difference in the preoperative tibio-femoral angle (TFA), however, postoperative TFA was larger and the magnitude of the change in the valgus direction (ΔTFA) was smaller in the SF group. DiscussionIn usual UKA for medial compartment, the leg is more extroverted postoperatively than preoperatively, and leaving the knee in the genu varus position, which places a greater load on the tibial component, may raise the risk of stress fracture. Although there was no difference between the two groups in the varus angle of the tibial component, in a scatter plot of postoperative TFA and the installation angle of the tibial component members of the SF group were concentrated in the region of high TFA and low varus angle. Varus of the leg and a low varus angle of the tibial component may thus be factors in the occurrence of stress fracture. ConclusionOur results suggested that low BMD in the affected femur, large postoperative TFA, and a combination of large postoperative TFA and small varus angle of the tibial component may contribute to stress fracture of the MTP following UKA.

Medial Tibial Reduction Osteotomy is Associated with Excellent Outcomes and Improved Coronal Alignment

Background: The medial tibial reduction osteotomy (MTRO) was introduced to achieve coronal ligamentous balance in total knee arthroplasty (TKA) patients with substantial preoperative varus deformity. Limited data exists on the outcomes of patients requiring an MTRO. This study compares outcomes of a matched cohort of patients that either required or did not require an MTRO during TKA.Methods: A retrospective review was performed on 67 patients that underwent an MTRO during primary TKA to achieve coronal balance. This patient population was matched 1:1 to another cohort of TKA patients by age, gender, and BMI that did not require an MTRO. A clinical and radiographic evaluation was utilized to compare the two cohorts.Results: Preoperatively, the tibiofemoral angle was 3.42° valgus versus 6.12° varus in the control and MTRO cohorts respectively (p=0.01). Mean postoperative tibiofemoral angles were 3.40° versus 2.43° valgus respectively. Postoperative Knee Society Scores were superior in the MTRO cohort (183.84 versus 174.58; p=0.04). Intraoperatively, no superficial MCL releases were required to achieve coronal balance in either cohort. Complications were similar and limited in both groups. Medial tibial bone resorption was observed in 64% of MTRO subjects averaging 2.02mm versus only 0.3mm in the control cohort ( p=0.01).Conclusion: Patients requiring an MTRO achieved similar alignment and superior knee scores compared to a control cohort with less varus deformity. This procedure eliminated the need for release of the superficial MCL. Resorption of medial tibial bone was commonly observed, possibly secondary to saw-induced thermal necrosis associated with performing an MTRO.

Pedobarographic Analysis in Total Knee Arthroplasty.

Pedobarographic gait analysis is a useful tool for the determination of loading distributions and alterations on the lower extremity and their reflection on the foot sole after many orthopaedic surgical applications. To date, there have been no studies evaluating the relationship between component alignment and changes of pedobarographic gait analysis in total knee arthroplasty (TKA). We aimed to investigate the effects of TKA and prosthetic alignment on the distribution of pedobarographic parameters. Quantitative gait patterns of 47 patients were prospectively evaluated by using pedobarography 1 week before surgery and at the seventh month, on average, postoperatively. Component positions were assessed, and all applications were divided into three groups according to tibial component position as varus, neutral, and valgus. Pedobarographic results were compared between pre- and postoperative values for all applications and compared among the groups. Mean postoperative tibiofemoral angle was 5.4 degrees in valgus, and preoperative knee scores were markedly improved postoperatively. The range of tibial component alignment changed between 1 and 4 degrees in the varus and valgus groups. Plantar loading parameters (force and pressure) were significantly decreased in all operated knees, especially in forefoot and midfoot. In varus tibial components, plantar loading values decreased in midfoot and hindfoot. However, in the neutral and valgus groups, similar alterations of plantar loadings were obtained, which included decreasing in forefoot and midfoot with significant increase in hindfoot. Plantar loading distribution changed statistically significantly after TKA despite good clinical and radiographic results. Tibial component alignment was also responsible for plantar loading distribution. Tibial components in varus position create different foot loading characteristics compared with neutral and valgus aligned components. Pedobarographic evaluation in TKA allows clinicians to obtain a proper understanding of abnormal gait caused by component malposition.

Lateralization of Tibial Plateau Reference Point Improves Accuracy of Tibial Resection in Total Knee Arthroplasty in Patients with Proximal Tibia Vara.

BackgroundThe tibial cut referenced to the center of the intercondylar eminence often leads to varus malalignment in the presence of preexisting proximal tibia vara. The purpose of this study was to investigate the effect of lateralization of the lateral tibial plateau reference point (based on the amount of proximal tibia vara) on the postoperative coronal plane alignment.MethodsIn this prospective cohort study, 62 patients (95 knees) with osteoarthritis and proximal tibia vara underwent primary total knee arthroplasty using a lateral tibial plateau reference point for the extramedullary jig. The pre- and postoperative radiographs were obtained for measurement of mechanical axis deviation, degree of tibia vara, proximal lateral reference point of the tibial condyle, and coronal alignment of the femoral and tibial components. The distance between the tibial reference point and the center of the intercondylar eminence was measured intraoperatively.ResultsThe mean tibia vara was 7.1° (standard deviation [SD], 2.3°). The mean lateral displacement of the reference point was 7 mm (SD, 2.2 mm). Postoperative tibiofemoral angle was 6° to 10° of valgus in 94% of cases. There was a strong correlation between the magnitude of tibia vara and the amount of lateralization of the tibial reference point (R2 = 0.79, p < 0.001).ConclusionsIn total knee arthroplasty patients with proximal tibia vara, reasonable accuracy can be achieved with use of the extramedullary jig for tibial component alignment by lateralizing the proximal tibial reference point.

Opening-Wedge High Tibial Osteotomy: Review of 100 Consecutive Cases

We report intermediate-term outcomes of a large consecutive series of medial opening-wedge tibial osteotomies. One hundred consecutive patients who underwent medial high tibial osteotomy from 2004-2013 were retrospectively reviewed. Charts were reviewed for patient age and gender, knee pain and range of motion, smoking status, and body mass index. Operative reports were reviewed for bone graft type, degree of correction, and osteotomy fixation method. Radiographs were evaluated for lateral cortical or intra-articular fracture, osteotomy healing, and preoperative and postoperative tibiofemoral angles. Eighty-nine osteotomies (89%) in 83 patients were included in the study. Most procedures were performed for medial knee arthritis. The mean age at surgery was 48.1 years, and the mean follow-up period was 4.0 years. The mean tibiofemoral alignment was 3.2° of varus preoperatively and 6.4° of valgus postoperatively. Plate and screw fixation was used in all cases. Bone grafting methods included autograft, allograft, iliac crest aspirate, platelet-rich plasma, and demineralized bone matrix. Of the osteotomies, 83 (93%) healed uneventfully. Five nonunions and 1 delayed union occurred. Allograft combined with demineralized bone matrix and/or platelet-rich plasma was associated with nonunion (P= .02). Lateral cortical fracture was associated with repeat surgery for nonunion or alignment loss (P= .02). Pain was minimal or mild in 65% of patients, moderate in 16%, and severe in 19%. Osteotomy fixation with a small 4-screw plate was associated with increased postoperative pain (P= .01). Seven patients underwent arthroplasty an average of 5 years after osteotomy. The need for arthroplasty was associated with longer follow-up (P= .02) and use of a smaller plate (P= .04). Uncomplicated osteotomy union occurred in 93% of medial opening-wedge high tibial osteotomies. Allograft mixed with demineralized bone matrix and/or platelet-rich plasma was associated with nonunion. At intermediate follow-up, 65% of patients had minimal or mild pain. Seven patients had undergone arthroplasty. Fixation with a smaller plate was associated with increased postoperative pain and the need for subsequent arthroplasty. Level IV, therapeutic case series.

Distal femoral osteotomy in genovalgum: internal fixation with blade plate versus casting.

To compare the results of two different ways of distal femoral osteotomy stabilization in patients suffering from genuvalgum: internal fixation with plate, and casting. In a non-randomized prospective study, after distal femoral osteotomy with the zigzag method, patients were divided into two groups: long leg casting, and internal fixation with blade plate. For all patients, questionnaires were filled to obtain data. Information such as range of motion, tibiofemoral anatomical angle and complications were recorded. 38 knees with valgus deformity underwent distal femoral supracondylar osteotomy. (8 with plaster cast and 30 with internal fixation using a blade plate). Preoperative range of motion was 129±6° and six months later it was 120±14°. The preoperative tibiofemoral angle was 32±6°; postoperative tibiofemoral angles were 3±3°, 6±2°, and 7±3° just after operation, six months, and two years later, respectively. Although this angle was greater among the group stabilized with a cast, this difference was not statistically significant. In postoperative complications, over-correction was found in five, recorvatom deformity in one, knee stiffness in three and superficial wound infection was recorded in three knees. There is no prominent difference in final range of motion and alignment whether fixation is done with casting or internal fixation. However, the complication rate seems higher in the casting method.

The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty

To evaluate and quantify the effect of the tibial slope on the postoperative maximal knee flexion and stability in the posterior-stabilized total knee arthroplasty (TKA). Fifty-six patients (65 knees) who had undergone TKA with the posterior-stabilized prostheses were divided into the following 3 groups according to the measured tibial slopes: Group 1: ≤4°, Group 2: 4°-7° and Group 3: >7°. The preoperative range of the motion, the change in the posterior condylar offset, the elevation of the joint line, the postoperative tibiofemoral angle and the preoperative and postoperative Hospital for Special Surgery (HSS) scores were recorded. The tibial anteroposterior translation was measured using the Kneelax 3 Arthrometer at both the 30° and the 90° flexion angles. The mean values of the postoperative maximal knee flexion were 101° (SD 5), 106° (SD 5) and 113° (SD 9) in Groups 1, 2 and 3, respectively. A significant difference was found in the postoperative maximal flexion between the 3 groups (P < 0.001). However, no significant differences were found between the 3 groups in the postoperative HSS scores, the changes in the posterior condylar offset, the elevation of the joint line or the tibial anteroposterior translation at either the 30° or the 90° flexion angles. A 1° increase in the tibial slope resulted in a 1.8° flexion increment (r = 1.8, R (2) = 0.463, P < 0.001). An increase in the posterior tibial slope can significantly increase the postoperative maximal knee flexion. The tibial slope with an appropriate flexion and extension gap balance during the operation does not affect the joint stability.

The Influence of Postoperative Tibiofemoral Alignment on the Clinical Results of Unicompartmental Knee Arthroplasty

PurposeTo evaluate the influence of postoperative tibiofemoral alignment on the clinical results and failure in patients who underwent unicompartmental knee athroplasty (UKA).Materials and MethodsWe reviewed 246 cases of medial UKA which were followed up for at least 5 years after the operation. The clinical results were compared between 5 groups classified according to the tibiofemoral angle that was measured at 3 months after surgery. We analyzed the relationship between the tibiofemoral alignment and the failure after UKA.ResultsThe preoperative tibiofemoral angle was changed from 0.4° of varus to 5.4° of valgus after surgery and the average correction angle was 5.8°. During the follow-up, which averaged 7 years and 5 months, the knee score and function score were improved significantly in all groups regardless of the tibiofemoral angle (p<0.01). There were no significant difference between the groups in the clinical results (p>0.05). However, there were significant differences in the cumulative survival rate of implants between the groups and the highest rate was found in the group with a tibiofemoral angle of 4° to 6° of valgus (p<0.01).ConclusionsThe tibiofemoral angle after UKA had no significant influence on the midterm clinical scores, but there was a significant relationship between the postoperative tibiofemoral angle and failure rate of implant.

No impact of severe varus deformity on clinical outcome after posterior stabilized total knee arthroplasty

Severe varus deformity may lead to premature failure of total knee arthroplasties (TKAs) because of technical difficulties associated with satisfactory alignment and good ligament balance. The aim of the study was to assess whether preoperative varus severity would affect the longevity, clinical outcomes, and complication rates of TKAs. From a prospectively collected database, we assessed outcomes in 168 knees that underwent primary TKAs using a single posterior stabilized design. These included 86 knees with mild preoperative deformity (varus mechanical tibiofemoral angle≤5°) and 82 knees with severe preoperative deformity (varus angle≥15°). Survivorship was analyzed by a life-table method. Clinical outcomes were also compared, including Knee Society knee and functional scores and complication rates. The postoperative tibiofemoral angle of the mild varus group was 7.1°±2.5°, whereas that of the severe varus group was 6.4°±2.5° (n.s.). There were no significant differences in terms of perioperative complications. Both groups showed the same cumulative survival rate, with absence of mechanical failure, of 98% at 7 years without difference (n.s.). There were no significant between-group differences of clinical parameters throughout the each follow-up period. The knees with preoperative severe varus deformity were achieved the results comparable to those in knees with mild varus deformity, as determined by survival rate and clinical results. These data suggest that preoperative severe varus deformities can be successfully managed and do not have any detrimental effect on the longevity and clinical outcomes after a modern posterior stabilized TKA.

Opening-Wedge High Tibial Osteotomy with a Locked Low-Profile Plate

High tibial osteotomy has been recognized as a beneficial treatment for osteoarthritis of the medial compartment of the knee. The purpose of this prospective study was to assess the short-term results of opening-wedge high tibial osteotomies with locked plate fixation. From September 2002 to November 2005, fifty-one consecutive medial opening-wedge high tibial osteotomies were performed. The mean age of the patients at the time of the index operation was forty-nine years. The preoperative and postoperative factors analyzed included the grade of arthritis of the tibiofemoral compartment (the Ahlbäck radiographic grade), the anatomic tibiofemoral angle, patellar height, the Hospital for Special Surgery rating system score, and the Lysholm and Gillquist knee score. Postoperatively, one superficial wound infection occurred. Fifty of the fifty-one osteotomies healed after an average period of 12.9 weeks (range, eight to sixteen weeks) without bone grafts. A nonunion developed in a sixty-two-year-old patient who was a cigarette smoker. The average postoperative tibiofemoral angle was 9° of valgus. Forty-nine patients were followed for a mean of fifty-two months. The average score on the Hospital for Special Surgery rating system was 86 points at the time of the most recent follow-up. The rating was excellent in twenty-eight patients (57%), good in twelve (24%), fair in four (8%), and poor in five (10%). The average score on the Lysholm and Gillquist knee-scoring scale was 83 points. According to these scores, the outcome was excellent in nine patients (18%), good in thirty-one (63%), fair in three (6%), and poor in six (12%). Four knees failed after an average of thirty-six months. Our results suggest that an opening-wedge high tibial osteotomy with locked plate fixation allows a correct valgus angle to be achieved with good short-term results.

Opening-Wedge High Tibial Osteotomy with a Locked Low-Profile Plate

High tibial osteotomy has been recognized as a beneficial treatment for osteoarthritis of the medial compartment of the knee. The purpose of this prospective study was to assess the short-term results of opening-wedge high tibial osteotomies with locked plate fixation. From September 2002 to November 2005, fifty-one consecutive medial opening-wedge high tibial osteotomies were performed. The mean age of the patients at the time of the index operation was forty-nine years. The preoperative and postoperative factors analyzed included the grade of arthritis of the tibiofemoral compartment (the Ahlbäck radiographic grade), the anatomic tibiofemoral angle, patellar height, the Hospital for Special Surgery rating system score, and the Lysholm and Gillquist knee score. Postoperatively, one superficial wound infection occurred. Fifty of the fifty-one osteotomies healed after an average period of 12.9 weeks (range, eight to sixteen weeks) without bone grafts. A nonunion developed in a sixty-two-year-old patient who was a cigarette smoker. The average postoperative tibiofemoral angle was 9 degrees of valgus. Forty-nine patients were followed for a mean of fifty-two months. The average score on the Hospital for Special Surgery rating system was 86 points at the time of the most recent follow-up. The rating was excellent in twenty-eight patients (57%), good in twelve (24%), fair in four (8%), and poor in five (10%). The average score on the Lysholm and Gillquist knee-scoring scale was 83 points. According to these scores, the outcome was excellent in nine patients (18%), good in thirty-one (63%), fair in three (6%), and poor in six (12%). Four knees failed after an average of thirty-six months. Our results suggest that an opening-wedge high tibial osteotomy with locked plate fixation allows a correct valgus angle to be achieved with good short-term results.

Coronal Alignment in Total Knee Arthroplasty: Just How Important is it?

A recent study has challenged the premise that well-aligned total knee arthroplasties (TKAs) have better survival than outliers. This study examines the importance of overall coronal alignment as a predictor for revision. Patients with primary TKAs were stratified into neutral, varus, and valgus alignment groups based on the postoperative tibiofemoral angle. In 6070 knees (3992 patients), there were 51 failures (0.84%): 21 (0.5%) in the neutral group, 18 (1.8%) in the varus group, and 12 (1.5%) in the valgus group. The best survival was for overall alignment between 2.4° and 7.2° of valgus. Varus knees failed primarily by medial tibia collapse, whereas valgus knees failed from ligament instability. Outliers in overall alignment have a higher rate of revision than well-aligned knees. The goal of TKA should be to restore alignment within 2.4° to 7.2° of valgus.

Varus distal femoral osteotomy in young adults with valgus knee

BackgroundMusculoskeletal disorders specially knee osteoarthritis are the most common causes of morbidity in old patients. Disturbance of the mechanical axis of the lower extremity is one of the most important causes in progression of knee osteoarthritis. The purpose of the present study was to analyze the surgical results of distal femoral varus osteotomy in patients with genu valgum.MethodsIn this study, after recording history and physical examination, appropriate radiographs were taken. We did varus distal femoral osteotomy by standard medial subvastus approach and 90-angle blade plate fixation then followed the patients clinically and radiographically.ResultsThis study was done on 23 knees (16 patients) age 23.3 years (range, 17 to 41 years). The mean duration of following up was 16.3 months (range, 8 to 25 months). Based on paired T test, there were statistically significant difference between pre- and postoperative tibiofemoral and congruence angles (p < 0.001, t = 21.3 and p < 0.001, t = 10.1 respectively). Pearson correlation between the amount of tibiofemoral and congruence angle correction was also statistically significant (p = 0.02 and r = 0.46).ConclusionDistal femoral varus osteotomy with blade plate fixation can be a reliable procedure for the treatment of valgus knee deformity. In this procedure, with more tibiofemoral angle correction, more congruence angle correction can be achieved. Therefore, along with genu valgum correction, the patella should be stabilized simultaneously.

The effect of tibiofemoral angle changes on the results of the dome osteotomy

We investigated the effect of tibiofemoral angle changes on the results of dome osteotomy in patients with medial compartment osteoarthritis of the knee. The study included 23 knees of 22 patients (15 women, 7 men; mean age 60 years; range 37 to 73 years) who underwent high tibial dome osteotomy for medial compartment osteoarthritis. A simple modified Charnley external fixator was used for stabilization of the osteotomy. Based on the Ahlback classification, 15 knees had grade I, six knees had grade II, and two knees had grade III osteoarthritis. The patients were evaluated in three groups based on the postoperative tibiofemoral angles obtained; hence, a valgus angle of less than 8 degrees (4 knees), 8 degrees to 12 degrees (10 knees), and greater than 12 degrees (9 knees). Clinical evaluations were made using the American Knee Society scoring system. The mean follow-up period was 5.4 years (range 1 to 10 years). The mean tibiofemoral angle was 4.4+/-2.9 degrees of varus (range 0 degrees to 10 degrees ) preoperatively, and 11+/-3.8 degrees of valgus (range 5 degrees to 18 degrees ) postoperatively. The mean correction loss at final evaluations was 2.7 degrees . The mean preoperative and postoperative knee scores were 37.7+/-15.8 (range 19 to 77) and 80.2+/-9.2 (range 51 to 93), respectively (p<0.001). The mean functional score increased from 52.3+/-18.8 (range 10 to 80) to 75.6+/-18.5 (range 35 to 100) at final analysis (p<0.001). The knee and functional scores did not differ significantly between three groups of patients having a different range of postoperative tibiofemoral angle (p>0.05). Our results show that the alignment obtained after high tibial osteotomy does not influence knee and functional scores provided that it is within an acceptable range.

Minimally invasive total knee arthroplasty through a quadriceps sparing approach: a comparative study

To evaluate the short term clinical results of minimally invasive total knee arthroplasty (MIS-TKA) through a quadriceps sparing (QS) approach compared with a standard TKA using a medial parapatellar exposure. Between March 2005 and March 2006, 26 consecutive unilateral primary MIS-TKA through a QS approach were performed. It was compared that the short term clinical results of this group with an age-matched and sex-match cohort of total knee arthroplasty done with a standard medial parapatellar approach. Length of incision, tourniquet time, blood loss, flexion degree, visual analog scale (VAS) score, Knee Society score, tibiofemoral angle and the ability to do a straight leg raising maneuver were evaluated respectively. The mean follow-up time were 17 months (range 12-23 months). The average length of incision was (9.5+/-1.5) cm in the QS group and (14.0+/-2.3) cm in the standard group (P<0.05). Average tourniquet times were (83+/-16) minutes in the QS group and (55+/-11) minutes for the standard group (P<0.05). Postoperative tibiofemoral angles averaged (5.7+/-1.5) degrees valgus in the QS group knees and (6.0+/-1.4) degrees valgus in the standard group knees (P>0.05). The average VAS scores were significantly lower at the first, the third and the seventh postoperative days in the QS group compared with that of the standard group, and the difference was not significant after 6 weeks between two groups. Mean flexion at one week was greater for the QS group (107+/-12) degrees than that in the standard group (95+/-11) degrees. Improved ROM also was seen 6 and 12 weeks postoperatively in the QS group with significant difference. There were no differences in ROM between the two groups in 12 months. The ability to straight leg raised at one week postoperatively was better in the QS group (23/26, 88%) than that of the standard group (21/33, 64%). At the 6 weeks follow-up, the average knee score was (78+/-15) points in the QS group and (71+/-20) points for the standard group (P<0.05). Deep vein thrombosis were found in 1 case of the QS group and 3 cases for the standard group. One patient in the QS group developed superficial wound necrosis that healed uneventfully. There were no other complications such as deep infection, neurovascular injury and so on. The MIS-TKA through a QS approach is associated with a more rapid functional recovery and improves range of motion. But higher specifications and more restrictive indications are of importance with the QS technique.