Same-stage total knee arthroplasty and osteotomy for osteoarthritis with extra-articular deformity. Part II: Femoral osteotomy, prospective study of 6 cases - 19/09/19
, Frédéric Khiami a, b, Elhadi Sariali a, b, Marc-Antoine Ettori a, b, Olivier Delattre d, Bruno Tillie e
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Abstract |
Background |
Same-stage (1S) total knee arthroplasty (TKA) and femoral osteotomy (FO) may deserve consideration in patients with both knee osteoarthritis and severe extra-articular knee deformity (EKD). The objective of this study was to assess clinical and radiological outcomes and morbidity (complications and revisions) in 6 patients managed with S1-TKA-FO.
Hypothesis |
1S-TKA-FO produces satisfactory outcomes and is not associated with higher morbidity rates compared to two-stage TKA-TO or TKA with intra-articular EKD correction, while also significantly shortening total treatment duration.
Material and methods |
A prospective study was performed in 6 patients managed with 1S-TKA-FO between 1999 and 2011; mean age was 64 years (range, 59–72 years) and mean body mass index was 29.5 (range, 26–35). The EKD was consistently greater than 10°. The cause was post-traumatic mal-union in 4 patients, constitutional EKD in 1 patient, and FO in 1 patient. In each patient, the clinical International Knee Society (IKS) score and the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA), were recorded prospectively before and after surgery.
Results |
A long uncemented extension stem was used in all 6 patients and a posterior-stabilised implant in 5 patients. No hinged implants were used. In 4 patients, internal fixation of the FO was performed. Mean follow-up was 10 years (range, 4–15 years). From baseline to last follow-up, the mean IKS score increased from 46 to 161 and mean flexion from 95° (range, 70–110°) to 107° (range, 90–120°). The HKA measured radiographically was between 178° and 182° in all 6 patients. The complications consisted of deep vein thrombosis in 1 patient and knee stiffness requiring manipulation under general anaesthesia in 1 patient. No patient experienced mal-union or required revision surgery.
Discussion |
Apart from a case-series study of 11 patients, very few data are available on 1S-TKA-FO. In our small population, no major complications were recorded. The encouraging long-term outcomes warrant a recommendation to perform 1S-TKA-FO in patients with knee osteoarthritis and an intra-femoral deformity greater than 10°.
Level of evidence |
IV, prospective observational cohort study.
El texto completo de este artículo está disponible en PDF.Keywords : Knee osteoarthritis, Extra-articular knee deformities, Same-stage total knee arthroplasty, Proximal femoral osteotomy
Esquema
Vol 105 - N° 6
P. 1055-1060 - octobre 2019 Regresar al número
Artículo precedente
- Same-stage total knee arthroplasty and osteotomy for osteoarthritis with extra-articular deformity. Part I: Tibial osteotomy, prospective study of 26 cases
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Bienvenido a EM-consulte, la referencia de los profesionales de la salud.