Influence du varus préopératoire sur l’alignement postopératoire et les résultats fonctionnels à long terme dans les arthroplasties totales de genou - 19/09/19
Impact of preoperative varus deformity on postoperative mechanical alignment and long-term results of “mechanical” aligned total knee arthroplasty
, Jae-Young Kim b, Bum-Sik Lee b, Jong-Min Kim bAbstract |
Purpose |
Preoperative varus deformity may affect postoperative mechanical alignment and outcomes of total knee arthroplasty (TKA). In this study, we aimed to determine whether (1) greater degrees of preoperative varus deformity increase the incidence of varus-aligned TKAs and (2) residual varus alignment improves the long-term survival rate in TKAs with preoperative varus deformity.
Methods |
We retrospectively reviewed 905 primary TKAs for varus-type osteoarthritis from November 1998 to June 2009. The mean follow-up was 8.23 years (±3.47 years). We measured pre- and postoperative mechanical hip-knee-ankle axis angle (HKA) on full-length standing radiographs to assess the severity of preoperative varus deformities, defined as mild (0°<HKA≤5°), moderate (5°<HKA≤10°), severe (10°<HKA≤15°), and very severe (HKA>15°). Postoperative alignment was divided to four groups: valgus (HKA<−3°), neutral (−3°≤HKA≤3°), mild varus (3°<HKA≤6°), and severe varus (HKA>6°). We performed survival analysis in all cases for mechanical failure.
Results |
Varus-aligned TKAs increased proportionally to increasing preoperative varus deformity (p<0.001). The survival rate showed no significant difference according to the preoperative varus deformity (p=0.147). However, the survival time for postoperative neutral alignment (16.13±0.10 years, 95 % CI 15.94–16.33 years) was longer than the survival time for mild varus (15.32±0.35 years, 95 % CI 14.64–16.00 years) and severe varus (13.38±0.53 years, 95 % CI 12.35–14.42 years) alignment (p<0.001).
Conclusion |
Postoperative varus malalignment appears to increase proportionally to the severity of preoperative varus deformity. Also, postoperative neutral alignment results in longer TKA survival time than residual varus alignment.
Level of evidence |
III, Retrospective comparative cohort study.
Le texte complet de cet article est disponible en PDF.Keywords : Total knee arthroplasty, Varus deformity, Survivorship
| ☆ | Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. |
Vol 105 - N° 6
P. 692 - octobre 2019 Retour au numéro
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