Modular Rotating-hinge Prosthesis in Severe Haemophilic Valgus Knee Osteoarthritis. Case Presentation

Background: The constrained knee prosthesis has the basic indication in revision arthroplasty, but the latest literature reveals that it takes place also in primary total knee arthroplasty in cases of knee osteoarthritis associated with major deformities. Material and methods: Present study is based on the surgical treatment, using the constrained knee prosthesis in the primary total knee arthroplasty, during 2019-2021, of 28 patients with knee osteoarthritis associated with severe deformities in varus or valgus, in the Big Joint Replacement Department, Clinical Hospital of Traumatology and Orthopedics, Chisinau. Results: In this study, the following criteria were evaluated: the type of deformity – valgus (10 cases) and varus (18 cases); the degree of deformation – for varus knees was on average 300 , and for valgus knee – 250 ; bone attrition – 11 cases with bone defects where it was necessary to use augmentations; affected side – in 19 cases the right knee was affected and 9 cases the left one; the women/men ratio was 4/1; the mean age of the patients was 67.5 years; average duration of the intervention – 140 minutes; in 5 cases a lateral para-patellar approach was performed, of which 2 cases with tibial tuberosity osteotomy; complications – 1 case with intra-operative periprosthetic fracture and 2 cases with superficial infections of the operated joints. Conclusions: Osteoarthritis of the knee progresses rapidly, leading to severe deformities, significant bone defects and joint instability, which are indications to use the constrained prosthesis in the primary total knee arthroplasty, long-term follow-up is necessary to obtain the last conclusion, but from this study the constrained knee prosthesis like primary implant for special indication had promising results.

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Radiological Parameters of the Femur in Lithuanian Patients with Knee Osteoarthritis and its Significance for Accuracy of the Total Knee Arthroplasty

Sveikatos mokslai ◽

10.5200/sm-hs.2015.029 ◽

2015 ◽

Vol 25 (2) ◽

pp. 41-45

Author(s):

Justinas Stučinskas ◽

Mindaugas Bakevičius ◽

Aleksej Lebedev ◽

Otto Robertsson ◽

Alfredas Smailys ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Valgus Knee ◽

Radiological Assessment ◽

Affecting Factors ◽

Radiological Parameters ◽

Valgus Angle ◽

Total Knee ◽

Femoral Bowing

Malalignment of the components affects long term total knee arthroplasty (TKA) survival. One of the options for achieving better TKA alignment may be a detailed preoperative radiological assessment. The aim of the study – to investigate the femoral valgus angle variations and affecting factors in patients with knee osteoarthritis (OA). Material and methods: We prospectively investigated severe OA patients, admitted for elective TKA. The standardized radiological assessment was performed – long standing hip-knee- ankle radiographs and the measurements were taken. We evaluated the relationship between the patients’, radiological parameters and femoral valgus angle. Results: 110 patients were included in the study and the mean measured femoral valgus angle was 6,7±1,3° and ranged from 4° to 10°. It was not significantly different between genders or varus/ valgus knee deformation. There was a significant relation between femoral valgus angle and neck-shaft, femoral bowing angles. Femoral valgus angle significantly increased with larger femoral bowing and smaller neck-shaft angles. Conclusions: Lithuanian patients with knee OA scheduled for TKA had a mean femoral valgus angle of 6,7±1,3° which ranged from 4° to 10°. Femoral neck-shaft and bowing angles significantly affects the femoral valgus angle.

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Orthoses versus gait retraining: Immediate response in improving physical performance measures in healthy and medial knee osteoarthritic adults

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411920924525 ◽

2020 ◽

Vol 234 (7) ◽

pp. 749-757

Author(s):

Saad Jawaid Khan ◽

Soobia Saad Khan ◽

Juliana Usman ◽

Abdul Halim Mokhtar ◽

Noor Azuan Abu Osman

Keyword(s):

Knee Osteoarthritis ◽

Physical Function ◽

Physical Performance ◽

Performance Measures ◽

Repeated Measures ◽

Valgus Knee ◽

Walk Test ◽

Gait Retraining ◽

Knee Brace ◽

Medial Knee

The conservative techniques of treating knee osteoarthritis (kOA) include wearing orthoses such as knee braces and laterally wedged insoles and applying gait modification techniques such as toe-in gait and toe-out gait. This study aimed at assessing the immediate effects of these techniques in improving physical function of healthy and kOA participants. Five Osteoarthritis Research Society International (OARSI) recommended performance-based tests were randomly applied to measure physical function: (1) 30-second chair stand test (30CST), (2) 40-m (4 × 10) fast-paced walk test (40FPW), (3) stair climb test (SCT), (4) timed up and go test (TUGT) and (5) 6-minute walk test (6MWT) during a single-visit on 20 healthy and 20 kOA patients (age: 59.5 ± 7.33 and 61.5 ± 8.63 years, BMI: 69.95 ± 9.86 and 70.45 ± 8.80 kg/m2). The interventions included natural gait, toe-out gait, toe-in gait, laterally wedged insoles and knee brace. Analysis was performed through repeated-measures ANOVA and independent sample t-test. 30CST and TUGT showed no significant differences for the five test conditions ( p > 0.05). Toe-out showed profound effects via pairwise comparison in impairing the physical function while knee brace improved it during 40FPW, SCT and 6MWT. In general, all the tested conservative techniques except laterally wedged insoles had immediate effects on physical performance measures in both healthy and medial knee osteoarthritis participants. The valgus knee brace improved the parameters the most, while toe-out gait impaired them the most. Future studies can develop strategies for improving gait retraining methods on the basis of issues identified by this study.

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Faculty Opinions recommendation of Effectiveness of medial-wedge insole treatment for valgus knee osteoarthritis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1109233.565240 ◽

2008 ◽

Author(s):

Leif Dahlberg

Keyword(s):

Knee Osteoarthritis ◽

Valgus Knee

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Constrained Rotating Hinge Prostheses in Severe Haemophilic Knee Osteoarthritis

Materiale Plastice ◽

10.37358/mp.18.4.5106 ◽

2018 ◽

Vol 55 (4) ◽

pp. 708-711

Author(s):

Vlad Veringa ◽

Wilhelm Friedl ◽

Norin Forna ◽

Andrei Ivan ◽

Nina Filip ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Life Quality ◽

Functional Results ◽

Knee Prostheses ◽

Haemophilic Arthropathy ◽

Severe Bone Loss ◽

Bone Damage ◽

Rotating Hinge ◽

Wound Healing Problems ◽

Total Knee

The purpose of this experimental study is to present the design and biomechanical characteristics of cemented total knee prostheses type rotating-hinge RT-PLUS® (Smith and Nephew), as well as to evaluate their use in severe haemophilic knee arthropathy with major bone damage, ligamentous lesions, axial deviations and muscle retractions. We retrospectively evaluated 5 patients with severe haemophilic arthropathy with an average age of 48.5years. The functional results are good, with a significant improvement of range of motion (ROM) and pain relief resulting in a much better life quality. We did not have any stem loosening or any other complications except 2 wound healing problems which were treated successfully. The authors recommend this type of arthroplasty in severe haemophilic knee arthropathy or in any primary knee osteoarthritis with severe bone loss or any kind of ligamentous lesions.

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