INFLUENCES OF PREOPERATIVE SEVERE LOWER LIMB DEFORMITY ON PROSTHESIS INSTALLATION AND ALIGNMENT RESTORATION IN TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUBaoxi , FANGShuying , FUMing , ZHANGZhiqi ,  WUPeihui , HUANGZhiyu , SUNHong

Derpartment of Joint Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510080, P.R.China;

Corresponding author：

WUPeihui, Email: wupeihui@hotmail.com

Keywords：

Total knee arthroplasty; Lower limb alignment; Prosthesis

DOI：

10.7507/1002-1892.20160072

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effect of preoperative valgus or varus deformity on the prosthesis installation and alignment restoration in total knee arthroplasty (TKA). Methods Between January 2012 and December 2013, 198 patients (245 knees) with osteoarthritis underwent primary TKA, and the clinical data were retrospectively analyzed. There were 23 males and 175 females, with the average age of 67 years (range, 43-90 years). Single knee and double knees were involved in 151 and 47 cases respectively. The disease duration was from 1 month to 30 years (mean, 8.99 years). The anteroposterior X-ray films of whole lower limbs were taken, and the femorotibial angle (FT) was measured before operation and at 1 week after operation; the mechanical femoral angle (MF) and the anatomical tibial angle (AT) at 1 week after operation were measured. The correlation analysis was made for pre-and post-operative FT, MF, and AT. According to the valgus or varus deformity before operation, all patients were divided into 5 groups:≥20° varus (group A), 10-20° varus (group B), ≤10° varus (group C), < 10° valgus (group D), and≥10° valgus (group E), and the above indicators were compared between groups. And the rate of the good limb alignment was recorded after operation. Results The pre-and post-operative FT were (171.53±9.12) and (177.38±3.57)° respectively, and postoperative MF and AT were (89.00±2.68) and (88.62±2.16)° respectively. Preoperative FT was associated with postoperative FT and MF (r=0.375, P=0.000; r=0.386, P=0.000), but it was not correlated with AT (r=0.024, P=0.710). Postoperative FT was associated with MF and AT (r=0.707, P=0.000; r=0.582, P=0.000). Postoperative FT was significantly increased when compared with preoperative FT in each group (P < 0.05). There were significant differences in preoperative FT between groups (P < 0.05). There were significant differences in postoperative FT when compared group A with groups B, C, D, and E (P < 0.05), and when compared groups B and C with groups D and E (P < 0.05), but there was no significant difference between groups B and C, and between groups D and E (P>0.05). The rate of good alignment was 70.2% (172/245); it was 27.8% (5/18), 66.0% (62/94), 74.4% (67/90), 88.9% (32/36), and 85.7% (6/7) in groups A, B, C, D, and E respectively, showing significant differences between groups (P < 0.05). There was no significant difference in postoperative AT between groups (P>0.05). Except for between group D and group E (P>0.05), significant difference in MF was shown between the other groups (P < 0.05). Conclusion The more severe deformity of lower limb before TKA, the higher risk of deviation for prosthesis installation and poor alignment in TKA.

Citation： YUBaoxi, FANGShuying, FUMing, ZHANGZhiqi, WUPeihui, HUANGZhiyu, SUNHong. INFLUENCES OF PREOPERATIVE SEVERE LOWER LIMB DEFORMITY ON PROSTHESIS INSTALLATION AND ALIGNMENT RESTORATION IN TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(3): 368-372. doi: 10.7507/1002-1892.20160072 Copy

1.	Gordon JE, Chen RC, Dobbs MB, et al. Interobserver and intraobserver reliability in the evaluation of mechanical axis deviation. J Pediatric Orthop, 2009, 29(3): 281-284.
2.	Andriacchi TP. Dynamics of knee malalignment. Orthop Clin North Am, 1994, 25(3): 395-403.
3.	Longstaff LM, Sloan K, Stamp N, et al. Good alignment after total knee arthroplasty leads to daster rehabilitation and better function. J Arthroplasty, 2009, 24(4): 570-578.
4.	Bae DK, Song SJ, Heo DB, et al. Does the severity of preoperative varus deformity influence postoperative alignment in both conventional and computer-assisted total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2248-2254.
5.	Ritter MA, Davis KE, Meding JB, et al. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg (Am), 2011, 93(17): 1588-1596.
6.	Deakin AH, Basanagoudar PL, Nunag P, et al. Natural distribution of the femoral mechanical-anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty. Knee, 2012, 19(2): 120-123.
7.	Deakin AH, Sarungi M. A comparison of variable angle versus fixed angle distal femoral resection in primary total knee arthroplasty. J Arthroplasty, 2014, 29(6): 1133-1137.
8.	Shi X, Li H, Zhou Z, et al. Individual valgus correction angle improves accuracy of postoperative limb alignment restoration after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2015.[Epub ahead of print].
9.	柴旭峰, 卫小春.下肢力线的X线测量及影响因素.中国矫形外科杂志, 2007, 15(12): 915-917.
10.	Nam D, Maher PA, Robles A, et al. Variability in the relationship between the distal femoral mechanical and anatomical axes in patients undergoing primary total knee arthroplasty. J Arthroplasty, 2013, 28(5): 798-801.
11.	Yau WP, Chiu KY, Tang WM, et al. Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong), 2007, 15(1): 32-36.
12.	Innocenti B, Bellemans J, Catani F. Deviations from optimal alignment in TKA: Is there a biomechanical difference between femoral or tibial component alignment? J Arthroplasty, 2015. [Epub ahead of print].
13.	Bae DK, Song SJ, Yoon KH, et al. The position of the tibial component affecting the postoperative mechanical axis in total knee arthroplasty. J Arthroplasty, 2010, 25(7): 1131-1136.
14.	Lin SJ, Lee CY, Huang KC, et al. Improved femoral component rotation in advanced genu valgum deformity using computer-assisted measured resection total knee arthroplasty. J Orthop Surg Res, 2015, 10: 135.
15.	Heyse TJ, Tibesku CO. Improved tibial component rotation in TKA using patient-specific instrumentation. Arch Orthop Trauma Surg, 2015, 135(5): 697-701.
16.	Heyse TJ, Tibesku CO. Improved femoral component rotation in TKA using patient-specific instrumentation. Knee, 2014, 21(1): 268-271.

1. Gordon JE, Chen RC, Dobbs MB, et al. Interobserver and intraobserver reliability in the evaluation of mechanical axis deviation. J Pediatric Orthop, 2009, 29(3): 281-284.
2. Andriacchi TP. Dynamics of knee malalignment. Orthop Clin North Am, 1994, 25(3): 395-403.
3. Longstaff LM, Sloan K, Stamp N, et al. Good alignment after total knee arthroplasty leads to daster rehabilitation and better function. J Arthroplasty, 2009, 24(4): 570-578.
4. Bae DK, Song SJ, Heo DB, et al. Does the severity of preoperative varus deformity influence postoperative alignment in both conventional and computer-assisted total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2248-2254.
5. Ritter MA, Davis KE, Meding JB, et al. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg (Am), 2011, 93(17): 1588-1596.
6. Deakin AH, Basanagoudar PL, Nunag P, et al. Natural distribution of the femoral mechanical-anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty. Knee, 2012, 19(2): 120-123.
7. Deakin AH, Sarungi M. A comparison of variable angle versus fixed angle distal femoral resection in primary total knee arthroplasty. J Arthroplasty, 2014, 29(6): 1133-1137.
8. Shi X, Li H, Zhou Z, et al. Individual valgus correction angle improves accuracy of postoperative limb alignment restoration after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2015.[Epub ahead of print].
9. 柴旭峰, 卫小春.下肢力线的X线测量及影响因素.中国矫形外科杂志, 2007, 15(12): 915-917.
10. Nam D, Maher PA, Robles A, et al. Variability in the relationship between the distal femoral mechanical and anatomical axes in patients undergoing primary total knee arthroplasty. J Arthroplasty, 2013, 28(5): 798-801.
11. Yau WP, Chiu KY, Tang WM, et al. Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong), 2007, 15(1): 32-36.
12. Innocenti B, Bellemans J, Catani F. Deviations from optimal alignment in TKA: Is there a biomechanical difference between femoral or tibial component alignment? J Arthroplasty, 2015. [Epub ahead of print].
13. Bae DK, Song SJ, Yoon KH, et al. The position of the tibial component affecting the postoperative mechanical axis in total knee arthroplasty. J Arthroplasty, 2010, 25(7): 1131-1136.
14. Lin SJ, Lee CY, Huang KC, et al. Improved femoral component rotation in advanced genu valgum deformity using computer-assisted measured resection total knee arthroplasty. J Orthop Surg Res, 2015, 10: 135.
15. Heyse TJ, Tibesku CO. Improved tibial component rotation in TKA using patient-specific instrumentation. Arch Orthop Trauma Surg, 2015, 135(5): 697-701.
16. Heyse TJ, Tibesku CO. Improved femoral component rotation in TKA using patient-specific instrumentation. Knee, 2014, 21(1): 268-271.

Chinese Journal of Reparative and Reconstructive Surgery

INFLUENCES OF PREOPERATIVE SEVERE LOWER LIMB DEFORMITY ON PROSTHESIS INSTALLATION AND ALIGNMENT RESTORATION IN TOTAL KNEE ARTHROPLASTY

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content