RESIDUAL DEFORMITY AFTER BILATERAL KNEE ARTHROPLASTY: IMPACT ON SHORT TERM OUTCOMES

Cover Page


Cite item

Abstract

Purpose — to evaluate the impact of frontal positioning of prosthesis components after bilateral Tka on short term functional outcomes. 

Material and Methods. The authors performed a retrospective analysis of teleroentgenograms of 466 patients after bilateral Tka with initial varus deformity. Functional and roentgenological outcomes were evaluated at average in 16,4±2,9 months postoperatively. Mean preoperative varus deformity was 10° (from 5 to 25°), initial angle between the anatomical and mechanical femoral axis (FVa) was 6,7±2° (from 3 to 12°). The neutral axis of both lower limbs (Hka = 180±0,5°) was obtained in 99 (21,2%) out of 466 patients. Residual deformity in one of the limbs above 3° with the neutral alignment of the contralateral limb was observed in 44 (9,4%) patients, bilateral residual deformity – in 32 (6,9%) patients. Other 291 patients demonstrated the deviation from mechanical axis in the range from 1 to 3° (±0,5°). all patients were divided into three groups: first group consisted of 10 patients with neutral axis of one limb and varus deformity of the other limb above 3°; second group — 10 patients with bilateral residual varus deformity above 3°; third group — 12 patients with neutral axis of both limbs (Hka = 180°). The angle of residual deformity averaged 3,7° (from 3,2 to 5,1°).

Results. No statistically significant differences between the groups were observed for dynamometric parameters and SF-36 scores, as well as for functional kSS scores (p>0,05). However, the authors reported in patients of the first group a stance phase on the side of residual varus deformity longer at 15% (p<0,05) and transfer phase shorter at 17% (p<0,05) as compared to contralateral limb (with neutral alignment, Hka = 180°), which is indicative of load asymmetry and can have a negative impact at a later stage.

Conclusion. Symmetrical residual varus deformity of lower limbs in the rage of 3,2–5,1° has no negative impact of short term clinical and functional outcomes of Tka. Muscular function and gait properties in patients with neutral axis of the lower limbs and in patients with symmetrical residual varus deformity after Tka were similar 16,4±2,9 months postoperatively.

About the authors

M. P. Zinoviev

Ural Clinical Medical and Rehabilitation Center.

Author for correspondence.
Email: max_travma@mail.ru

Maxim P. Zinoviev — orthopedic surgeon, Orthopedic  department N 1.
 
55, Ural’skiy pr., 622049, Nizhny Tagil. Russian Federation

R. V. Paskov

Ural Clinical Medical and Rehabilitation Center.

Email: fake@neicon.ru

Roman V. Paskov — dr. Sci. (Med.), head doctor.

55, Ural’skiy pr., 622049, Nizhny Tagil.

Russian Federation

S. K. Sergeev

Tyumen State Medical University.

Email: fake@neicon.ru

Konstantin S. Sergeev — dr. Sci. (Med.), professor.

54, ul. Odesskaya, 625023, Tyumen.

Russian Federation

D. V. Rimashevsky

Peoples’ Friendship University of Russia.

Email: fake@neicon.ru

Denis V. Rimashevsky — cand. Sci. (Med.), associate professor.

6, Miklukho-Maklaya, Moscow, 117198.

Russian Federation

References

  1. Abdel M.P., Oussedik S., Parrate S., Lustig S., Hadda F.S. Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone Joint J. 2014;96-B(7):857-862. doi: 10.1302/0301-620x.96B7.33946.
  2. Bellemans J., Colyn W., Vandenneucker H., Victor J. The chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res. 2012:470(1):45-53. doi: 10.1007/s11999-011-1936-5.
  3. Berend M.E., Ritter M.A., Meding J.B., Faris P.M., Keating E.M., Redelman R. et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res. 2004;(428):26-34.
  4. Collier M.B., Engh G.A. Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am. 2007; 89(6):1306-1314.
  5. Jeffery R.S., Morris R.W., Denham R.A. coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73:709-14.
  6. Fang D.M., Ritter M.A., Davis K.E. coronal alignment in total knee arthroplasty: just how important is it. J Arthroplasty. 2009;24(6):39-43. doi: 10.1016/j.arth.2009.04.034.
  7. Liu H.X., Shang P., Ying X.Z., Zhang Y. Shorter survival rate in varus-aligned knees afer total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016;24(8):26632671. doi: 10.1007/s00167-015-3781-7.
  8. Manzotti A., Pullen C., Confalonieri N. computerassisted alignment system for tibial component placement in total knee replacement: a radiological study. Chir Organi Mov. 2008;91(1):7-11. doi: 10.1007/s12306-007-0002-7.
  9. Matziolis G., Lucke M., Perka C. computer tomographically determined design parameters for optimized fit of an acetabular reconstrucnion cage. Acta Chir Orthop Traumatol Cech. 2007;74(1):14-18.
  10. Meneghini R.M., Grant T.W., Ishmael M.K., Ziembadavis M. Leaving Residual Varus alignment after Total knee arthroplasty does Not Improve patient Outcomes. J Arthroplasty. 2017;32(9S):171-176. doi: 10.1016/j.arth.2017.02.064.
  11. Teeter M.G., Naudie D.D., Mccalden R.W., Yuan X., Holdsworth D.W., Macdonald S.J., Lanting B.A. Varus tibial alignment is associated with greater tibial baseplate migration at 10 years following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017 Nov 16. doi: 10.1007/s00167-017-4765-6.
  12. Зиновьев М.П., Паськов Р.В., Римашевский Д.В. Влияние остаточной варусной деформации на клинико-функциональные, рентгенологические и динамометрические результаты тотального эндопротезирования коленного сустава. Травматология и ортопедия России. 2017;(1):108-116. doi: 10.21823/2311-2905-2017-23-1-208-116.
  13. Bellemans J. Neutral mechanical alignment: a requirement for successful Tka: opposes. Orthopedics. 2011;34(9):e507-509. doi: 10.3928/01477447-20110714-41.
  14. Hatayama K., Terauchi M., Saito K., Higuchi H. Does residual varus alignment cause increasing varus laxity at a minimum of five years after total knee arthroplasty? J. Arthroplasty. 2017;32(6):1808-1813. doi: 10.1016/j.arth.2017.01.006.
  15. Song M.H., Yoo S.H., Kang S.W., Kim Y.J., Park G.T., Pyeun Y.S. Coronal alignment of the lower limb and the Incidence of constitutional Varus knee in korean Females. Knee Surg Relat Res. 2015;27(1):49-55. dOI: 10/5792/ksrr.2015.27.1.49.
  16. Luyckx T., Vanhoorebeeck F., Bellenans J. Should we aim at undercorrection when doing a total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc. 2015;23(6):17061712. doi: 10.1007/s00167-014-3185-0.
  17. Yoon J.R., Han S.B., Jee M.K., Shin Y.S. comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty: a meta-analysis. Medicine (Baltimore). 2017;96(39):e8157. doi: 10.1097/Md.0000000000008157.
  18. Berger R.A., Rubash H.E., Seel M.J., Thompson W.H., Crossett L.S. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res. 1993;(286):40-47.
  19. Hirschmann M.T., Konala P., Amsler F., Iranpour F., Friederich N.F., Cobb J.P. The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2d-cT slices and 3d-cT reconstruction. J Bone Joint Surg Br. 2011;93(5):629-633. doi: 10.1302/0301-620x.93B5.25893.
  20. Durandet A., Ricci P.-L., Saveh A.H., Vanat Q., Wang B., Esat I., Chizari M. Radiographic analysis of lower limb axial alignments. proceedings of the World congress on engineering. 2013;2. available at: http://www.iaeng.org/ publication/Wce2013/.
  21. Дедов И. И., Мельниченко Г.А., Романцова Т.И. Стратегия управления ожирением: итоги всероссийской наблюдательной программы «прима вера». ожирение и метаболизм. 2016;13(1): 36-44. doi: 10.14341/OMeT2016136-44.
  22. Верткин А.Л., Наумов А.В., Шакирова С.Р., Зайченко Д.М. Остеопороз в практике врача. Современная ревматология. 2011;(2):64-71. doi: 10.14412/1996-7012-2011-672.
  23. Charlson M.E., Pompei P., Ales K.L., Mckenzie C.R. A New method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373-383.
  24. Henckel J., Richards R., Lozhkin K., Harris S., Rodriguez Y Baena F.M., Barret A.R., Cobb J.P. Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol. J Bone Jt Surg Br. 2006;88(11):1513-1518. doi: 10.1302/0301-620x.88B11.17986.
  25. Цапина Т.Н., Слизкова К.Ш, Эрдес Ш.Ф. качество жизни больных остеоартрозом. Научно-практическая ревматология. 2004;(2):4.
  26. Insall J.N., Dorr L.D., Scott R.D., Scott W.N. Rationale of the knee Society clinical rating system. Clin Orthop Relat Res. 1989;(248):13-14.
  27. Lienhard K., Lauermann S.P., Schneider D., Itemglatthorn J.F., Casartelli N.C., Maffiuletti N.A. Validity and reliability of isometric, isokinetic, and isonetrial modalities for the assessment or quadriceps muscle strength in patients with total knee arthroplasty. J Electromyogr Kinesiol. 2013;23(6):2663-2671. dOI: 10/1016/j.jelekin.2013.09.004.
  28. Mullagi A.B., Shetty G.M., Kanna R., Vadapalli R.C. The influence of preoperative deformity on valgus correction angle: an analysys of 503 total knee arthroplasties. J Arthroplasty. 2013;28(1):20-27. doi: 10.1016/j.arth.2012.04.014.
  29. Howie D.F., Love G.J., Deakin A.H., Kinninmoth A.W. Intra-operative deviation in limb alignment occurring at implantation in total knee arthroplasty. Knee. 2015:22(1):47-50. dOI: 10/1016/j.knee.2014.11.005.
  30. Matziolis G., Adam J., Perka C. Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement. Arch Orthop Trauma Surg. 2010;130(12):1487-1491. dOI: 10/1007/s00402-010-1064-9.
  31. Allen M.M., Pagnano M.W. Neutral mechanical alignment is it necessary? Bone Joint J. 2016:98-B (1 Suppl.a):81-83. doi: 10.1302/0301-620x.98B1.36403.
  32. Magnussen R.A., Weppe F., Demey G., Servien E., Lustig S. Residual varus alignment does not compromise results of Tkas in patients with preoperative varus. Clin Orthop Relat Res. 2011;469(12):3343-3350. doi: 10.1007/s11999-01101988-6.
  33. Stucinskas J., Robertsson O., Sirka A., Lebedev A., Wingstrand H., Tarasevicius S. Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength 91 patients assesed after 1 year. Acta Orthop. 2015;86(6):728-733. doi: 10.3109/17453674.2015.1059689.
  34. Green G.V., Berend K.R., Berend M.E., Glisson R.R., Vail T.P. The effects of varus tibial alignment on proximal tibial surface strain in total knee arthroplasty: the posteromedial hot spot. J Arthroplasty. 2002;17(8): 1033-1039. doi: 10.1054/arth.2002.35796.

Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies