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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-05-2020 | KNEE

Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee

Authors: Han-Jun Lee, Jung-Won Lim, Dong-Hoon Lee, Dong-Hyun Kim, Yong-Beom Park

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2020

Abstract

Purpose

Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional varus distal femoral cutting yielded satisfactory clinical and radiological outcomes.

Methods

A total of 77 patients (91 knees) with varus knee (hip–knee–ankle axis ≥ 10°) and lateral femoral bowing > 5° underwent navigation-assisted primary TKA using individualized intentional varus distal femoral cutting. Knee Society scores, Western Ontario and McMaster Universities scores, and radiographs for limb alignment, implant alignment, and aseptic loosening were evaluated. Subgroup analyses were performed according to the limb alignment and coronal femoral component alignment (0° ± 3° vs. varus of > 3°).

Results

All clinical outcomes significantly improved at the final follow-up (p < 0.05 in all). The mechanical axis angle changed from 13.1° ± 2.7° to 2.8° ± 1.5°. The coronal femoral component angle at the final follow-up was 2.8° ± 1.3°. Radiolucent lines were observed in 6 cases (6.6%) and were less than 2 mm in all cases without progression. In subgroup analyses, no significant differences were observed in clinical outcomes (n.s. in all) and in the incidence of radiolucent lines (n.s. in limb alignment, n.s. in coronal femoral component alignment).

Conclusions

Individualized intentional varus distal femoral cutting yielded favorable clinical outcomes without complications at 5-year follow-up. Slight under-correction using intentional varus distal femoral cutting could be a viable option in patients with varus knee and lateral femoral bowing during navigation-assisted TKA.

Level of evidence

IV.

Argenson J-NA, Parratte S, Ashour A, Saintmard B, Aubaniac J-M (2012) The outcome of rotating-platform total knee arthroplasty with cement at a minimum of 10 years of follow-up. J Bone Joint Surg Am 94:638–644CrossRef

Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The Chitranjan Ranawat Award: is neutral mechanical alignment normal for all patients?: the concept of constitutional varus. Clin Orthop Relat Res 470:45–53CrossRef

Bonner TJ, Eardley WG, Patterson P, Gregg PJ (2011) The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 93:1217–1222CrossRef

Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63CrossRef

Cheng T, Zhao S, Peng X, Zhang X (2012) Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials? Knee Surg Sports Traumatol Arthrosc 20:1307–1322CrossRef

Choong PF, Dowsey MM, Stoney JD (2009) Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 24:560–569CrossRef

Cooke TD, Sled EA, Scudamore RA (2007) Frontal plane knee alignment: a call for standardized measurement. J Rheumatol 34:1796–1801PubMed

Crowninshield RD, Rosenberg AG, Sporer SM (2006) Changing demographics of patients with total joint replacement. Clin Orthop Relat Res 443:266–272CrossRef

Delport H, Labey L, Innocenti B, De Corte R, Vander Sloten J, Bellemans J (2015) Restoration of constitutional alignment in TKA leads to more physiological strains in the collateral ligaments. Knee Surg Sports Traumatol Arthrosc 23:2159–2169CrossRef

10.

11.

Herschmiller T, Grosso MJ, Cunn GJ, Murtaugh TS, Gardner TR, Geller JA (2018) Step-wise medial collateral ligament needle puncturing in extension leads to a safe and predictable reduction in medial compartment pressure during TKA. Knee Surg Sports Traumatol Arthrosc 26:1759–1766CrossRef

12.

Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty 27:1177–1182CrossRef

13.

Heyse TJ, Decking R, Davis J, Boettner F, Laskin RS (2009) Varus gonarthrosis predisposes to varus malalignment in TKA. HSS J 5:143–148CrossRef

14.

Howell SM, Papadopoulos S, Kuznik K, Ghaly LR, Hull ML (2015) Does varus alignment adversely affect implant survival and function 6 years after kinematically aligned total knee arthroplasty? Int Orthop 39:2117–2124CrossRef

15.

Hsu R, Himeno S, Coventry MB, Chao E (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res 255:215–227

16.

Innocenti B, Bellemans J, Catani F (2016) Deviations from optimal alignment in TKA: is there a biomechanical difference between femoral or tibial component alignment? J Arthroplasty 31:295–301CrossRef

17.

Kim J-M, Hong S-H, Lee B-S, Kim D-E, Kim K-A, Bin S-I (2015) Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc 23:1936–1942CrossRef

18.

Ko Y-B, Jang E-C, Park S-M, Kim SH, Kwak Y-H, Lee H-J (2015) No difference in clinical and radiologic outcomes after total knee arthroplasty with a new ultra-congruent mobile bearing system and rotating platform mobile bearing systems after minimum 5-year follow-up. J Arthroplasty 30:379–383CrossRef

19.

Kwak DS, In Y, Kim TK, Cho HS, Koh IJ (2016) The pie-crusting technique using a blade knife for medial collateral ligament release is unreliable in varus total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:188–194CrossRef

20.

Lampart M, Behrend H, Moser LB, Hirschmann MT (2018) Due to great variability fixed HKS angle for alignment of the distal cut leads to a significant error in coronal TKA orientation. Knee Surg Sports Traumatol Arthrosc 27:1434–1441CrossRef

21.

Lasam MPG, Lee KJ, Chang CB, Kang YG, Kim TK (2013) Femoral lateral bowing and varus condylar orientation are prevalent and affect axial alignment of TKA in Koreans. Clin Orthop Relat Res 471:1472–1483CrossRef

22.

Lee C-Y, Lin S-J, Kuo L-T, Peng K-T, Huang K-C, Huang T-W, Lee MS, Hsu RW-W, Shen W-J (2014) The benefits of computer-assisted total knee arthroplasty on coronal alignment with marked femoral bowing in Asian patients. J Orthop Surg Res 9:122CrossRef

23.

Lee YS, Howell SM, Won YY, Lee OS, Lee SH, Vahedi H, Teo SH (2017) Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25:3467–3479CrossRef

24.

Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R (2009) Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty 24:570–578CrossRef

25.

Maderbacher G, Baier C, Benditz A, Wagner F, Greimel F, Grifka J, Keshmiri A (2017) Presence of rotational errors in long leg radiographs after total knee arthroplasty and impact on measured lower limb and component alignment. Int Orthop 41:1553–1560CrossRef

26.

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

27.

Matziolis G, Adam J, Perka C (2010) Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement. Arch Orthop Trauma Surg 130:1487–1491CrossRef

28.

Mugnai R, Zambianchi F, Digennaro V, Marcovigi A, Tarallo L, Del Giovane C, Catani F (2016) Clinical outcome is not affected by total knee arthroplasty alignment. Knee Surg Sports Traumatol Arthrosc 24:3339–3345CrossRef

29.

Mullaji AB, Marawar SV, Mittal V (2009) A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees. J Arthroplasty 24:861–867CrossRef

30.

Nagamine R, Miura H, Bravo CV, Urabe K, Matsuda S, Miyanishi K, Hirata G, Iwamoto Y (2000) Anatomic variations should be considered in total knee arthroplasty. J Orthop Sci 5:232–237CrossRef

31.

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 Am 92:2143–2149CrossRef

32.

Parsch D, Kruger M, Moser MT, Geiger F (2009) Follow-up of 11–16 years after modular fixed-bearing TKA. Int Orthop 33:431–435CrossRef

33.

Slevin O, Hirschmann A, Schiapparelli FF, Amsler F, Huegli RW, Hirschmann MT (2018) Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc 26:1602–1609CrossRef

34.

Tang W, Zhu Y, Chiu K (2000) Axial alignment of the lower extremity in Chinese adults. J Bone Joint Surg Am 82:1603–1608CrossRef

35.

Vanlommel L, Vanlommel J, Claes S, Bellemans J (2013) Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 21:2325–2330CrossRef

36.

Yau W, Chiu K, Tang W, Ng T (2007) Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg 15:32–36CrossRef

Title: Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee
Authors: Han-Jun Lee
Jung-Won Lim
Dong-Hoon Lee
Dong-Hyun Kim
Yong-Beom Park
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-019-05577-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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