Use of External Approach for Severe Genu Valgo Knee Arthroplasty

2021 ◽  
pp. 1-4
Author(s):  
Sebastián Rosero Cabrera ◽  
William Pinzón Gallardo ◽  
Helberth Augusto González Rico ◽  
Carlos Fernando Bastidas Gómez ◽  
Tulio Sotomayor Medina ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Lower Limbs ◽  
External Approach ◽  
Treatment Results ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Physiological Processes ◽  
Total Knee ◽  
Genu Varus

The deformities of the lower limbs (genu valgus and genu varus) are alterations frequently developed properly by physiological processes which usually disappear at 2 years (genu varus) and at 7-8 years (genu valgus), being considered in adults normal a 4º-6º genu valgus, however the appearance of the latter is also related to various metabolic pathologies, tumors, traumatic sequelae, infections, skeletal dysplastic and idiopathic genu valgus. In the bibliography, there is a greater consensus on the approach to varus deformity, not so in valgus deformities, where there is no bibliography with a level of evidence that defines established protocols to treat severe valgus deformities>20, currently good treatment results have been demonstrated by means of knee arthroplasty to correct genu valgus deformities, which showed good results in the alignment of the lower extremities through the balance of ligaments in patients with severe genu valgus with pain reduction. , improvements in knee function and with a low rate of complications, the use of these alternatives such as the external approach in total knee replacement in patients with severe genu valgus and medial collateral ligament insufficiency allows correcting large deformities using a technique simple and in most cases without the use of a prosthesis that generates a degree of constraint, progressively improving their living conditions.

scholarly journals Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

2021 ◽  
Author(s):  
Nicola Pizza ◽  
Stefano Di Paolo ◽  
Raffaele Zinno ◽  
Giulio Maria Marcheggiani Muccioli ◽  
Piero Agostinone ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Motor Task ◽  
Medial Compartment ◽  
Level Of Evidence ◽  
Contact Points ◽  
Sit To Stand ◽  
Medial Pivot ◽  
Total Knee

Abstract Purpose To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not. Methods 52 patients undergoing TKA surgery were prospectively evaluated at least a year of follow-up (13.5 ± 6.8 months) through clinical and functional Knee Society Score (KSS), and kinematically through dynamic radiostereometric analysis (RSA) during a sit-to-stand motor task. Patients received posterior-stabilized TKA design. Based on the result of the KSS, patients were divided into two groups: “KSS > 70 group”, patients with a good-to-excellent score (93.1 ± 6.8 points, n = 44); “KSS < 70 group”, patients with a fair-to-poor score (53.3 ± 18.3 points, n = 8). The anteroposterior (AP) low point (lowest femorotibial contact points) translation of medial and lateral femoral compartments was compared through Student’s t test (p < 0.05). Results Low point AP translation of the medial compartment was significantly lower (p < 0.05) than the lateral one in both the KSS > 70 (6.1 mm ± 4.4 mm vs 10.7 mm ± 4.6 mm) and the KSS < 70 groups (2.7 mm ± 3.5 mm vs 11.0 mm ± 5.6 mm). Furthermore, the AP translation of the lateral femoral compartment was not significantly different (p > 0.05) between the two groups, while the AP translation of the medial femoral compartment was significantly higher for the KSS > 70 group (p = 0.0442). Conclusion In the group of patients with a postoperative KSS < 70, the medial compartment translation was almost one-fourth of the lateral one. Surgeons should be aware that an over-constrained kinematic of the medial compartment might lead to lower clinical outcomes. Level of evidence II.

scholarly journals Medial abrasion syndrome: a neglected cause of persistent pain after knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shaw-Ruey Lyu ◽  
Chia-Chen Hsu ◽  
Jung-Pin Hung
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Varus Deformity ◽  
Outcome Study ◽  
Primary Arthroplasty ◽  
Post Operative Pain ◽  
Plateau Fracture ◽  
Advanced Stages ◽  
Total Knee ◽  
Medial Release

Abstract Introduction Persistent post-operative pain (PPOP) has detracted from some otherwise successful knee arthroplasties. This study investigated medial abrasion syndrome (MAS) as a cause of PPOP after knee arthroplasty. The surgical techniques and outcomes of incorporating this concept into the management of both primary arthroplasty cases and patients suffering from unknown causes of PPOP after arthroplasties were presented. Materials and methods In a 1-year period, the author performed unicompartmental or total knee arthroplasty (the UKA or TKA group) that also eliminated medial abrasion phenomenon (MAP) on 196 knees of 150 patients at advanced stages of knee osteoarthritis (OA). During the same year, 16 knees of 16 patients with unknown causes of PPOP after knee arthroplasties were referred to the author for the arthroscopic medial release procedure (the AMR group) after being diagnosed as MAS. Subjective satisfaction, Knee Society Score (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS) evaluations were used for outcome study. Results All 166 patients were followed for more than 3 years (mean 3.7 years, 3.1–4.2) for the outcome study. All knees receiving arthroplasty showed medial plicae with MAP at the time of surgery. Only 2 of them suffered from PPOP: one was a neglected tibial plateau fracture with residual varus deformity after UKA, and the other was a late infection after TKA and received revision. The satisfactory rate was 98.8% in the UKA group, 99.1% in the TKA group, and 100% in the AMR group. The Knee Society Scores and all subscales of KOOS were statistically improved in all groups. Conclusions MAS is a cause of pain in patients who have received knee arthroplasties, and MAP should be eliminated to ensure a successful knee arthroplasty. PPOP after knee arthroplasty can be caused by MAS, which can be managed by AMR.

scholarly journals Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110020
Author(s):  
Seikai Toyooka ◽  
Hironari Masuda ◽  
Nobuhiro Nishihara ◽  
Takashi Kobayashi ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Varus Deformity ◽  
Varus Knee ◽  
Before And After ◽  
Knee Deformity ◽  
Varus Stress ◽  
Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

Total Knee Arthroplasty for Profound Varus Deformity

2005 ◽  
Vol 20 (5) ◽  
pp. 550-561 ◽  
Author(s):  
Arun B. Mullaji ◽  
Vinod Padmanabhan ◽  
Gaurav Jindal
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Total Knee
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