scholarly journals Radiological and Functional Outcome of Medial Tibial Reduction Osteotomy for Severe Varus Deformity in patients undergoing Total Knee Arthroplasty- A Prospective Cohort Study

2021 ◽  
Author(s):  
Amal Mathew ◽  
AS Arun Kumar ◽  
Murukan Babu ◽  
TC Ranjith ◽  
Susan John
Keyword(s):  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Deformity Correction ◽  
Varus Deformity ◽  
P Value ◽  
Knee Score ◽  
Function Score ◽  
Total Knee

Introduction: The deformity and imbalance in an osteoarthritic knee undergoing Total Knee Arthroplasty (TKA) are the result of a combination of bony and soft tissue changes locally. Proper and ideal balancing of ligaments is considered essential to the success of a TKA. There are numerous techniques to achieve soft tissue balance in varus knee. More recently, Medial Tibial Reduction Osteotomy (MTRO) has been described as an adjuvant to soft tissue release. Limited data exists on the outcomes of patients requiring a MTRO. There are not many Indian studies available regarding the radiographic and clinical outcomes of medial reduction osteotomy in severe varus deformity in TKA. Aim: To find out the radiological and functional outcome of MTRO for severe varus deformity in patients undergoing TKA. Materials and Methods: This study was Prospective Cohort study conducted at the Department of Orthopaedics, Rajagiri Hospital, Chunangamveli, Aluva, Kerala from December 2018 to November 2019. Twenty patients 15 females and 5 males (30 knees), in the age group 55-80 years with osteoarthritis of knee with severe varus deformity, were enrolled in the study. Preoperative and postoperative standing leg Antero-posterior radiographs were taken for all patients and hip- knee- ankle angle was measured and amount of deformity correction was calculated. Postoperatively, radiographs were taken on the 5th day and 3rd month. Knee society scores were also recorded preoperatively and on the 5th postoperative day, postoperative visits on 6 weeks, 3 months and clinical outcome was assessed. The statistical analysis was performed by SPSS version 25 using Analysis of Variance(ANOVA) and Wilcoxon Signed Rank test. Results: The median knee score improved from 47±9 to 93±3 postoperatively. Similarly, median function score improved from 50±5 to 80±0. The improvement in function score and knee score were statistically significant (p-value 0.001). The correction of varus between preoperative, postoperative (p-value 0.001) day 5 & 3 months postoperatively was statistically significant. No patient required a release of the superficial Medial Collateral Ligament (MCL). The MTRO was associated with statistically significantly improved Knee Society scores and varus deformity correction. Conclusion: In patients with fixed varus deformity of the knee, the MTRO is found to be safe and adequate to achieve coronal alignment.

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.

Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

2021 ◽  
Author(s):  
Mohammadreza Minator Sajjadi ◽  
Mohammad Ali Okhovatpour ◽  
Yaser Safaei ◽  
Behrooz Faramarzi ◽  
Reza Zandi
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Soft Tissue Release ◽  
Varus Knee ◽  
Significant Difference ◽  
Leg Alignment ◽  
Total Knee ◽  
Group 2

AbstractThe aim of this study was to assess the predictive value of the femoral intermechanical-anatomical angle (IMA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), femorotibial or varus angle (VA), and joint line convergence angle (CA) in predicting the stage of the medial collateral ligament (MCL) during total knee arthroplasty (TKA) of varus knee. We evaluated 229 patients with osteoarthritic varus knee who underwent primary TKA, prospectively. They were categorized in three groups based on the extent of medial soft tissue release that performed during TKA Group 1, osteophytes removal and release of the deep MCL and posteromedial capsule (stage 1); Group 2, the release of the semimembranosus (stage 2); and Group 3, release of the superficial MCL (stage 3) and/or the pes anserinus (stage 4). We evaluated the preoperative standing coronal hip-knee-ankle alignment view to assessing the possible correlations between the knee angles and extent of soft tissue release. A significant difference was observed between the three groups in terms of preoperative VA, CA, and MPTA by using the Kruskal–Wallis test. The extent of medial release increased with increasing VA and CA as well as decreasing MPTA in preoperative long-leg standing radiographs. Finally, a patient with a preoperative VA larger than 19, CA larger than 6, or MPTA smaller than 81 would need a stage 3 or 4 of MCL release. The overall results showed that the VA and MPTA could be useful in predicting the extent of medial soft tissue release during TKA of varus knee.

scholarly journals The role of knee arthroscopy in managing common soft tissue complications after total knee arthroplasty: a retrospective case series study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yunfei Hou ◽  
Jiaxiang Gao ◽  
Jian Chen ◽  
Jianhao Lin ◽  
Lei Ni ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Recurrence Rate ◽  
Revision Rate ◽  
Knee Score ◽  
Function Score ◽  
Prosthesis Revision ◽  
Total Knee ◽  
Symptom Recurrence

Abstract Background To investigate the feasibility, safety and therapeutic efficacy of arthroscopy in managing the 3 most common soft tissue complications, peripatellar impingement (PI), arthrofibrosis (AF) and generalized synovitis (GS), after total knee arthroplasty (TKA). Methods A retrospective review of patients undertaking arthroscopy for PI, AF and GS was conducted. Outcome measures included complications, postoperative range of motion (ROM), Knee Society Score (KSS) and rates of symptom recurrence, prosthesis revision. Intraoperative findings and surgical procedures were also recorded. Paired t test, Fisher’s exact test, Kruskal-Wallis test and post hoc analysis with Bonferroni correction were used for statistical evaluation. Results A total of 74 patients, including 35 patients with peripatellar impingement, 25 patients with arthrofibrosis and 14 patients with generalized synovitis, with a mean age of 66.1 ± 7.9 years, were analysed. The mean follow-up (FU) duration was 81.3 ± 40.6 months. All patients underwent arthroscopic surgery safely without intraoperative complications. However, there were 4 postoperative complications, including 1 acute myocardial infarction and 3 periprosthetic joint infections. Overall, patients acquired improvements in ROM from 81.7 ± 23.1° to 96.8 ± 20.5° (p < 0.05), in KSS knee score from 64.2 ± 9.6 to 78.7 ± 12.1 (p < 0.05) and in KSS function score from 61.1 ± 7.4 to 77.3 ± 12.2 (p < 0.05) postoperatively. Patients in all 3 groups had improvements in ROM (p < 0.05), KSS knee score (p < 0.05) and KSS function score (p < 0.05). The overall recurrence rate was 22.9% (95% confidence interval (CI) 15.1–34.9%), and the overall revision rate was 14.9% (95% CI 8.6–25.6%). There were significant differences in both the symptom recurrence and prosthesis revision rates among the groups (p < 0.05). The PI group had a significantly lower symptom recurrence rate (11.4%, 95% CI 4.5–28.7%) and revision rate (8.6%, 95% CI 2.9–25.3%) (p < 0.017), while the GS group had a significantly higher recurrence rate (42.9%, 95% CI 23.4–78.5%) and revision rate (35.7%, 95% CI 17.6–72.1%) (p < 0.017). Conclusions In the setting of symptomatic TKA, although carrying certain risks for PJI and other complications, arthroscopic intervention could be feasible and provide clinical improvement in most cases at an average of 81.3 months follow-up. Patients with PI had the best outcomes, while patients with GS had the worst outcomes. Level of evidence Level IV

Can isolated removal of osteophytes achieve correction of varus deformity and gap-balance in computer-assisted total knee arthroplasty?

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 49-58
Author(s):  
Arun Mullaji
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Knee Flexion ◽  
Deformity Correction ◽  
Computer Assisted ◽  
Cruciate Ligaments ◽  
Collateral Ligament ◽  
Total Knee

Aims The aims of this study were to determine the effect of osteophyte excision on deformity correction and soft tissue gap balance in varus knees undergoing computer-assisted total knee arthroplasty (TKA). Methods A total of 492 consecutive, cemented, cruciate-substituting TKAs performed for varus osteoarthritis were studied. After exposure and excision of both cruciates and menisci, it was noted from operative records the corrective interventions performed in each case. Knees in which no releases after the initial exposure, those which had only osteophyte excision, and those in which further interventions were performed were identified. From recorded navigation data, coronal and sagittal limb alignment, knee flexion range, and medial and lateral gap distances in maximum knee extension and 90° knee flexion with maximal varus and valgus stresses, were established, initially after exposure and excision of both cruciate ligaments, and then also at trialling. Knees were defined as ‘aligned’ if the hip-knee-ankle axis was between 177° and 180°, (0° to 3° varus) and ‘balanced’ if medial and lateral gaps in extension and at 90° flexion were within 2 mm of each other. Results Of 50 knees (10%) with no soft tissue releases (other than cruciate ligaments), 90% were aligned, 81% were balanced, and 73% were aligned and balanced. In 288 knees (59%) only osteophyte excision was performed by subperiosteally releasing the deep medial collateral ligament. Of these, 98% were aligned, 80% were balanced, and 79% were aligned and balanced. In 154 knees (31%), additional procedures were performed (reduction osteotomy, posterior capsular release, and semimembranosus release). Of these, 89% were aligned, 68% were balanced, and 66% were aligned and balanced. The superficial medial collateral ligament was not released in any case. Conclusion Two-thirds of all knees could be aligned and balanced with release of the cruciate ligaments alone and excision of osteophytes. Excision of osteophytes can be a useful step towards achieving deformity correction and gap balance without having to resort to soft tissue release in varus knees while maintaining classical coronal and sagittal alignment of components. Cite this article: Bone Joint J 2020;102-B(6 Supple A):49–58.

Is the Pie-Crusting Technique Safe for MCL Release in Varus Deformity Correction in Total Knee Arthroplasty?

2013 ◽  
Vol 28 (8) ◽  
pp. 1306-1309 ◽  
Author(s):  
R. Michael Meneghini ◽  
Andrew T. Daluga ◽  
Lindsey A. Sturgis ◽  
Jay R. Lieberman
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Total Knee

An Algorithmic, Pie-Crusting Medial Soft Tissue Release Reduces the Need for Constrained Inserts Patients With Severe Varus Deformity Undergoing Total Knee Arthroplasty

2016 ◽  
Vol 31 (7) ◽  
pp. 1465-1469 ◽  
Author(s):  
Kaveh Goudarz Mehdikhani ◽  
Beatriz Morales Moreno ◽  
Jeremy J. Reid ◽  
Ana de Paz Nieves ◽  
Yuo-Yu Lee ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Soft Tissue Release ◽  
Total Knee

scholarly journals A Prospective Cohort Study of Outcome In Total Knee Arthroplasty With Or Without Drainage At Dr. Hasan Sadikin General Hospital From January 2017 To January 2018

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0010
Author(s):  
R.M.S.N Magetsari ◽  
D Mulyadi ◽  
F.A Tandjung
Keyword(s):  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Knee Arthroplasty ◽  
Prospective Cohort ◽  
Womac Score ◽  
P Value ◽  
Postoperative Drainage ◽  
Total Knee ◽  
Drainage Group

The use of postoperative drainage after total knee arthroplasty (TKA) in osteoarthritis patients was believed effective in decreasing hematoma, swelling, infection, and postoperative pain. However, the drainage can also cause infection due to retrograde migration of bacteria and impair early postoperative rehabilitation. The aim of the study was to compare pain intensity (VAS), hemoglobin level (Hb), range of motion (ROM), clinical results (KSS and WOMAC) in TKA patients with and without postoperative drainage. This study was a prospective cohort study with samples of 98 patients at Dr. Hasan Sadikin Hospital from January 2017-January 2018. Simple random sampling with closed envelopes was used to determine TKA patients who undergone postoperative drainage and without drainage. The drainage group (K1) was 46 knees, the without drainage group (K2) was 52 knees. Both groups were compared based on VAS, Hb, ROM, KSS and WOMAC score on preoperative, 1st, 3rd, 5th day, 1st, 6th month, and 1 year postoperative. VAS score on K1 group showed better results (3rd day VAS K2 1.77; K1 1.32; p-value 0.070; 5th day K2 1.46; K1 1.22; p-value 0.090; p-value < 0.1). Based on postoperative Hb, K2 group was better (K2: 11.74;K1: 10.835; p-value 0.06). ROM on K2 is better than K1 (1st day ROM K2 52.50; K1 42.85; p-value 0.64;3rd day K2 53.70; K1 47.24; p-value 0.832; 5th day K2 54, 60; K1 45.85; p-value 0.73). Based on the KSS and WOMAC score there were no significant differences between K2 and K1. Our study concluded that there are several advantages for not using drainage after TKA in terms Hb, ROM on 1st, 3rd, and 5th day postoperative and early mobilization with weight bearing using walker at 3rd day postoperative. There is no rationale for the use of drain after primary TKA.

scholarly journals Assessing the Role of Minimal Medial Tissue Release during Navigation-Assisted Varus Total Knee Arthroplasty Based on the Degree of Preoperative Varus Deformity

2021 ◽  
Author(s):  
Seikai Toyooka ◽  
Hironari Masuda ◽  
Nobuhiro Nishihara ◽  
Wataru Miyamoto ◽  
Takashi Kobayashi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Soft Tissue Release ◽  
Neutral Position ◽  
Valgus Stress ◽  
Total Knee ◽  
Neutral Alignment ◽  
Medial Release

AbstractWe assessed the impact of a minimal medial soft-tissue release with complete peripheral osteophyte removal on the ability to attain manual preresection deformity correction during navigation-assisted total knee arthroplasty (TKA) for varus osteoarthritis. We included 131 TKAs for 109 patients with medial compartment predominant osteoarthritis. The steps for achieving minimal medial soft-tissue release were performed as follows: (1) elevation of a periosteal sleeve to 5-mm distal to the joint line and (2) complete removal of peripheral osteophytes. The evaluation criteria of this study were as follows: (1) age, (2) height, (3) weight, (4) body mass index (BMI), (5) sex, (6) the preoperative femorotibial mechanical angle in the neutral position before medial release and (7) the mechanical angle in maximum manual valgus stress after the two-step medial-release procedure (measured on the navigation screens). Multiple regression analysis of the criteria was performed to determine the degree of varus deformity that allowed neutral alignment but required extensive medial release. The femorotibial mechanical angle in the neutral position before medial release and sex correlated with the mechanical angle in maximum manual valgus stress on the navigation screen after medial release (r = 0.72, p < 0.001). Based on the regression formula, the maximum degree of preoperative varus deformity that allowed neutral alignment by the minimum medial-release procedure was 5.3 degrees for males and 9.1 degrees for females. The magnitude of deformity which has an impact on the ability to correct varus deformity (by minimal soft-tissue release and complete osteophyte removal) was clarified. If the preoperative degree of varus deformity was within 5.3 degrees for males and 9.1 degrees for females, an extensive medial release was not required to obtain neutral alignment.

Sign in / Sign up

Export Citation Format

Share Document