EFFECTIVENESS OF SLIDING OSTEOTOMY FOR CORRECTING SEVERE VALGUS DEFORMITY IN TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHONGHang , HUANGQiang ,  YANGJing , PEIFuxing , SHENBin , ZHOUZongke , KANGPengde

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

YANGJing, Email: cd-yangjing@163.com

Keywords：

Total knee arthroplasty; Valgus knee deformity; Sliding osteotomy; Soft tissue balance

DOI：

10.7507/1002-1892.20160029

Video：

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Objective To explore the surgical technique and effectiveness of sliding osteotomy of medial femur condyle in handling soft tissue balance of severe valgus deformity in total knee arthroplasty (TKA). Methods Between June 2008 and February 2014, 18 cases (19 knees) of severe valgus knees undergoing sliding osteotomy of medial femur condyle in primary TKA were included. Of the 18 patients, 6 were male and 12 were female with an average age of 52.3 years (range, 29-72 years), including 3 cases (3 knees) of osteoarthritis, 11 cases (12 knees) of rheumatoid arthritis, 3 cases (3 knees) of post-traumatic arthritis, and 1 case (1 knee) of deformities in skeletal dysplasia. Before surgery, the tibial-femur angle (TFA) was (33.0±2.9)°; the Hospital for Special Surgery (HSS) score was 41.6±7.7; the Knee Society Score (KSS) lateral stability score was 6.0±5.4. All cases were rated as type II according to Krackow classification of valgus knee. During primary TKA, sliding osteotomy of medial femur condyle was performed via a medial parapatellar approach. Results Incision healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient, which was cured after 6 months of conservative treatment. Eighteen cases were followed up 19 months to 7 years, with an average of 5.7 years. All patients had no complications of deep vein thrombosis, deep infection, and prosthesis loosening. X-ray films showed that bone healing was achieved in all cases at 6 months. At last follow-up, the TFA was (4.8±1.8)°, showing significant difference when compared with preoperative value (t=62.61, P=0.00). The HSS score was 87.2±10.5 and the KSS lateral stability score was 12.4±3.1, all showing significant differences when compared with preoperative scores (t= —33.35, P=0.00; t= —6.83, P=0.00). Conclusion Sliding osteotomy of medial femur condyle is effective for correcting severe valgus knee deformity during TKA. Satisfactory joint function and stability may be achieved.

Citation： ZHONGHang, HUANGQiang, YANGJing, PEIFuxing, SHENBin, ZHOUZongke, KANGPengde. EFFECTIVENESS OF SLIDING OSTEOTOMY FOR CORRECTING SEVERE VALGUS DEFORMITY IN TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 143-147. doi: 10.7507/1002-1892.20160029 Copy

1.	Falez F. Knee arthroplasty today. Int Orthop, 2014, 38(2):221-225.
2.	Nikolopoulos D, Michos I, Safos G, et al. Current surgical strategies for total arthroplasty in valgus knee. World J Orthop, 2015, 6(6):469-482.
3.	Rossi R, Rosso F, Cottino U, et al. Total knee arthroplasty in the valgus knee. Int Orthop, 2014, 38(2):273-283.
4.	Favorito PJ, Mihalko WM, Krackow KA. Total knee arthroplasty in the valgus knee. J Am Acad Orthop Surg, 2002, 10(1):16-24.
5.	Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991, (273):9-18.
6.	Engh GA. The difficult knee:severe varus and valgus. Clin Orthop Relat Res, 2003, (416):58-63.
7.	Brilhault J, Lautman S, Favard L, et al. Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. J Bone Joint Surg (Br), 2002, 84(8):1131-1137.
8.	Mullaji AB, Shetty GM. Surgical technique:Computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA. Clin Orthop Relat Res, 2013, 471(5):1484-1491.
9.	Whiteside LA. Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res, 1999, (367):130-140.
10.	Engh GA, Ammeen D. Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity. Clin Orthop Relat Res, 1999, (367):141-148.
11.	Healy WL, Iorio R, Lemos DW. Medial reconstruction during total knee arthroplasty for severe valgus deformity. Clin Orthop Relat Res, 1998, (356):161-169.
12.	Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1 (Pt 2):271-284.
13.	Hirschmann MT, Hoffmann M, Krause R, et al. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty:does it matter? BMC Musculoskelet Disord, 2010, 11:167.
14.	Rawal J, Devany AJ, Jeffery JA. Arthroplasty in the valgus knee:Comparison and discussion of lateral vs medial parapatellar approaches and implant selection. Open Orthop J, 2015, 9:94-97.
15.	Sekiya H, Takatoku K, Takada H, et al. Lateral approach is advantageous in total knee arthroplasty for valgus deformed knee. Eur J Orthop Surg Traumatol, 2014, 24(1):111-115.
16.	Miyasaka KC, Ranawat CS, Mullaji A. 10-to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res, 1997, (345):29-37.
17.	Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991, (271):52-62.
18.	Boyer P, Boublil D, Magrino B, et al. Total knee replacement in the fixed valgus deformity using a lateral approach:role of the automatic iliotibial band release for a successful balancing. Int Orthop, 2009, 33(6):1577-1583.
19.	Ritter MA, Lutgring JD, Davis KE, et al. The role of flexion contracture on outcomes in primary total knee arthroplasty. J Arthroplasty, 2007, 22(8):1092-1096.
20.	Mihalko WM, Whiteside LA. Bone resection and ligament treatment for flexion contracture in knee arthroplasty. Clin Orthop Relat Res, 2003, (406):141-147.
21.	Mullaji AB, Shetty GM. Lateral epicondylar osteotomy using computer navigation in total knee arthroplasty for rigid valgus deformities. J Arthroplasty, 2010, 25(1):166-169.

1. Falez F. Knee arthroplasty today. Int Orthop, 2014, 38(2):221-225.
2. Nikolopoulos D, Michos I, Safos G, et al. Current surgical strategies for total arthroplasty in valgus knee. World J Orthop, 2015, 6(6):469-482.
3. Rossi R, Rosso F, Cottino U, et al. Total knee arthroplasty in the valgus knee. Int Orthop, 2014, 38(2):273-283.
4. Favorito PJ, Mihalko WM, Krackow KA. Total knee arthroplasty in the valgus knee. J Am Acad Orthop Surg, 2002, 10(1):16-24.
5. Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991, (273):9-18.
6. Engh GA. The difficult knee:severe varus and valgus. Clin Orthop Relat Res, 2003, (416):58-63.
7. Brilhault J, Lautman S, Favard L, et al. Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. J Bone Joint Surg (Br), 2002, 84(8):1131-1137.
8. Mullaji AB, Shetty GM. Surgical technique:Computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA. Clin Orthop Relat Res, 2013, 471(5):1484-1491.
9. Whiteside LA. Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res, 1999, (367):130-140.
10. Engh GA, Ammeen D. Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity. Clin Orthop Relat Res, 1999, (367):141-148.
11. Healy WL, Iorio R, Lemos DW. Medial reconstruction during total knee arthroplasty for severe valgus deformity. Clin Orthop Relat Res, 1998, (356):161-169.
12. Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1 (Pt 2):271-284.
13. Hirschmann MT, Hoffmann M, Krause R, et al. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty:does it matter? BMC Musculoskelet Disord, 2010, 11:167.
14. Rawal J, Devany AJ, Jeffery JA. Arthroplasty in the valgus knee:Comparison and discussion of lateral vs medial parapatellar approaches and implant selection. Open Orthop J, 2015, 9:94-97.
15. Sekiya H, Takatoku K, Takada H, et al. Lateral approach is advantageous in total knee arthroplasty for valgus deformed knee. Eur J Orthop Surg Traumatol, 2014, 24(1):111-115.
16. Miyasaka KC, Ranawat CS, Mullaji A. 10-to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res, 1997, (345):29-37.
17. Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res, 1991, (271):52-62.
18. Boyer P, Boublil D, Magrino B, et al. Total knee replacement in the fixed valgus deformity using a lateral approach:role of the automatic iliotibial band release for a successful balancing. Int Orthop, 2009, 33(6):1577-1583.
19. Ritter MA, Lutgring JD, Davis KE, et al. The role of flexion contracture on outcomes in primary total knee arthroplasty. J Arthroplasty, 2007, 22(8):1092-1096.
20. Mihalko WM, Whiteside LA. Bone resection and ligament treatment for flexion contracture in knee arthroplasty. Clin Orthop Relat Res, 2003, (406):141-147.
21. Mullaji AB, Shetty GM. Lateral epicondylar osteotomy using computer navigation in total knee arthroplasty for rigid valgus deformities. J Arthroplasty, 2010, 25(1):166-169.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF SLIDING OSTEOTOMY FOR CORRECTING SEVERE VALGUS DEFORMITY IN TOTAL KNEE ARTHROPLASTY

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