scholarly journals Compensatory Function of the Subtalar Joint for Lower Extremity Malalignment

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Kensei Yoshimoto ◽  
Masahiko Noguchi ◽  
Akifumi Yamada ◽  
Yuki Nasu
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Subtalar Joint ◽  
Valgus Knee ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Knee Deformity ◽  
Total Knee ◽  
Valgus Alignment

It is important to evaluate the subtalar joint and hip-knee-ankle alignment to understand lower extremity alignment. In this review, we focused on the compensatory changes in the subtalar joint alignment for the deformity of the knee and ankle joint, reviewing previous research. The subtalar joint alignment was compensatory valgus in patients with varus knee and ankle deformity, whereas it was uncertain whether the subtalar joint alignment was compensatory varus in patients with valgus knee and ankle deformity. The subtalar joint valgus alignment improved after total knee arthroplasty or high tibial osteotomy for varus knee deformity, even if the deformity was severe. In contrast, whether the subtalar joint alignment changed after the surgery for ankle or valgus knee deformity has not been considered. Further research on the compensatory function of the subtalar joint is needed.

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.

scholarly journals Lateral or medial approach for valgus knee in total knee arthroplasty - which one is better? A systematic review

2019 ◽  
Vol 47 (11) ◽  
pp. 5400-5413 ◽  
Author(s):  
Bin Wang ◽  
Dan Xing ◽  
Jiao Jiao Li ◽  
Yuanyuan Zhu ◽  
Shengjie Dong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Evaluation Method ◽  
Primary Total Knee Arthroplasty ◽  
Lateral Approach ◽  
Tibial Tubercle ◽  
Valgus Knee ◽  
Medial Approach ◽  
Knee Deformity ◽  
Total Knee

Objective To identify whether the medial or lateral approach is superior for patients with valgus knees undergoing primary total knee arthroplasty (TKA). Methods Studies evaluating the 2 approaches were sourced from the PUBMED, EMBASE, Web of Science, and OVID databases. The quality of included studies was assessed using a modified quality evaluation method, and differences between approaches were systematically reviewed. Results Seventeen observational studies were included. The studies were published between 1991 and 2016, and included 5 retrospective studies and 12 prospective studies. Sixteen evaluation methods for the study outcomes were identified. Twelve and eight complication types were identified by studies reporting the lateral and medial approaches for valgus knee, respectively. Several studies showed that pain scores and knee function were superior using a lateral approach. Conclusion The lateral approach (combined with a tibial tubercle osteotomy or proximal quadriceps snip) was more useful and safer than the medial approach in the treatment of severe uncorrectable valgus knee deformity in patients undergoing TKA. Most of the available evidence supports the use of a lateral approach provided that the surgeon is familiar with the pathological anatomy of the valgus knee.

scholarly journals Medio-Lateral and Flexion-Extension Gap Imbalances in Mechanically Aligned Total Knee Arthroplasty Using Measured Resection Technique in Korean Patients: 3D Simulation

2021 ◽  
Vol 10 (4) ◽  
pp. 845
Author(s):  
Byung Woo Cho ◽  
Ji Hoon Nam ◽  
Yong Gon Koh ◽  
Kwan Kyu Park ◽  
Kyoung Tak Kang
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Valgus Knee ◽  
Varus Knee ◽  
Asian Patients ◽  
Measured Resection ◽  
Flexion Extension ◽  
Total Knee ◽  
Extension Gap ◽  
Flexion And Extension

Background: It is well known that the measured resection (MR) technique in mechanically aligned (MA) total knee arthroplasty (TKA) generates significant gap imbalances, but little is known about whether this applies to the knees of Asian patients. The aim of this study was to evaluate the medio-lateral and flexion-extension gap imbalances and to find the most optimal posterior femoral condyle resection method for operating on the knees of Asian patients. Methods: In total, 738 magnetic resonance imaging (MRI) scans of consecutive patients who underwent TKA were obtained. Four posterior femoral condylar resection methods were used: alignment by the surgical transepicondylar axis (TEA), Whiteside’s line (WSL), 3° external rotation to the posterior condylar axis (PCA), and flexion-extension axis (FEA). Results: For the medial compartments, there were significant differences between the flexion and extension gaps in the varus knee group in all four methods, but there were no differences between the flexion and extension gaps in the valgus knee group. For the lateral compartment, all the methods showed significant differences except for WSL of the valgus knee group and FEA of the varus knee group. Conclusions: In Asian patients, the use of the MA MR technique inevitably leads to medio-lateral or flexion-extension imbalances. Therefore, surgeons should consider which methods can minimize imbalances and choose the best method within the technically possible range.

scholarly journals Using Tibia Proximal Cut Autograft in Advanced Varus Knee Deformity in Total Knee Arthroplasty; Outcomes Compared to the Control Group

2018 ◽  
Vol 12 (1) ◽  
pp. 405-410
Author(s):  
Aydin Arslan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Womac Score ◽  
Control Group ◽  
Varus Knee ◽  
Knee Deformity ◽  
Total Knee ◽  
Reconstruction Group

Background:The purpose of this study was to compare the outcomes of Total Knee Arthroplasty (TKA) performed for advanced varus knee deformity, which is performed by using tibia proximal cut bone for the reconstruction of the tibia proximal medial bone defects, with a control group consisting of TKAs which did not need reconstruction.Methods:Patients in the present study underwent total knee arthroplasty between 2009 and 2015. 12 patients with advanced varus deformity who had undergone reconstruction with tibia proximal cut autograft and 15 patients who were randomly selected from patients who did not need reconstruction, were compared clinically and radiographically.Results:The mean follow-up period of the patients was found to be 73.1 ± 19.7 (36-108) months in the reconstruction group and 73.2 ± 12.3 (39-107) months in the control group. (p> 0.05) In both groups, significant improvement was observed postoperatively. In both groups, there was no evidence of loosening the required revision. WOMAC score was 32.4 ± 13.3 (8-64) in the reconstruction group and 28.9 ± 17.2 (6-70) in the control group at the last control visit. There was no difference between the groups when comparing the WOMAC scores at the last control visit. In the reconstruction group, the Hip-Knee-Ankle (HKA) angle was 26.1 ± 4.9 ° varus preoperatively and 1.3 ± 2.3 ° valgus postoperatively; and in the control group 10.1 ± 2.1 ° varus preoperatively and 2.7 ± 3.4 ° valgus postoperatively. (p> 0.05)Conclusion:In the present study, clinical and radiographic results of total knee arthroplasty patients, who suffered from advanced knee varus deformity and whose proximal tibia medial defects were reconstructed by using tibial proximal cut autograft, have been found to be successful when compared to the control group.

scholarly journals Application of 3D printed osteotomy guide plate-assisted total knee arthroplasty in treatment of valgus knee deformity

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Zhimin Shen ◽  
Hong Wang ◽  
Yiqiang Duan ◽  
Jian Wang ◽  
Fengyan Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Treatment Group ◽  
Knee Arthroplasty ◽  
Combined Treatment ◽  
Operation Time ◽  
Valgus Knee ◽  
Guide Plate ◽  
Knee Deformity ◽  
3D Printed ◽  
Total Knee

Abstract Introduction To analyze the application of 3D printed osteotomy guide plate-assisted total knee arthroplasty (TKA) for valgus knee deformity. Methods The clinical data of 20 patients with valgus knee deformity admitted to our hospital from April 2012 to April 2017 were collected and analyzed. According to the treatment method, these patients were divided into two groups: 3D printed osteotomy guide plate-assisted TKA (combined treatment group, n = 10) and TKA (treatment group, n = 10). The operation time, intraoperative bleeding volume, postoperative mean femorotibial angle (MFTA), and Knee Society Score (KSS) of the two groups were statistically analyzed. Results Compared with the treatment group, the operation time was significantly shorter (P < 0.05), the intraoperative blood loss and postoperative MFTA were significantly decreased (P < 0.05), and the clinical and functional scores were significantly increased (P < 0.05) in the combined treatment group. Conclusion 3D printed osteotomy guide plate-assisted TKA for valgus knee deformity is more effective than TKA alone.

Less valgus alignment in total knee arthroplasty for the varus knee

2018 ◽  
Vol 29 (1) ◽  
pp. 36-41
Author(s):  
Daniel S. Mangiapani ◽  
Jordan F. Schaeffer ◽  
Alexandria R. Myers ◽  
Aaron A. Hofmann
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Varus Knee ◽  
Total Knee ◽  
Valgus Alignment

scholarly journals Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021?

2021 ◽  
Author(s):  
D. Alesi ◽  
A. Meena ◽  
S. Fratini ◽  
V. G. Rinaldi ◽  
E. Cammisa ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Valgus Deformity ◽  
Lateral Ligament ◽  
Valgus Knee ◽  
Ligament Balance ◽  
Comprehensive Knowledge ◽  
Knee Deformity ◽  
Total Knee

AbstractTotal knee arthroplasty in valgus knee deformities continues to be a challenge for a surgeon. Approximately 10% of patients who undergo total knee arthroplasty have a valgus deformity. While performing total knee arthroplasty in a severe valgus knee, one should aware with the technical aspects of surgical exposure, bone cuts of the distal femur and proximal tibia, medial and lateral ligament balancing, flexion and extension gap balancing, creating an appropriate tibiofemoral joint line, balancing the patellofemoral joint, preserving peroneal nerve function, and selection of the implant regarding constraint. Restoration of neutral mechanical axis and correct ligament balance are important factors for stability and longevity of the prosthesis and for good functional outcome. Thus, our review aims to provide step by step comprehensive knowledge about different surgical techniques for the correction of severe valgus deformity in total knee arthroplasty.

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