Total knee arthroplasty for osteoarthritis secondary to extra-articular malunions

Autor: C. Chol, G. Deschamps, Philippe Massin, Yves Catonné, C. Bussière, F. Khiami
Rok vydání: 2010
Předmět:
Male
Extra-articular malunion
medicine.medical_treatment
Osteotomy
Prosthesis
0302 clinical medicine
Orthopedics and Sports Medicine
030212 general & internal medicine
Malunion
Traumatic knee arthritis
Arthroplasty
Replacement
Knee
Aged
80 and over
030222 orthopedics
biology
Bone Malalignment
Middle Aged
Osteoarthritis
Knee
musculoskeletal system
Prosthesis Failure
Female
medicine.symptom
Bone Plates
Femoral Fractures
musculoskeletal diseases
Adult
Torsion Abnormality
medicine.medical_specialty
Total knee prosthesis
Prosthesis-Related Infections
Nonunion
Knee Injuries
03 medical and health sciences
medicine
Deformity
Humans
Fractures
Malunited
Aged
Retrospective Studies
Varus deformity
business.industry
biology.organism_classification
medicine.disease
Arthroplasty
Surgery
Tibial Fractures
Valgus
business
Follow-Up Studies
Zdroj: Orthopaedics & Traumatology: Surgery & Research. 96:849-855
ISSN: 1877-0568
DOI: 10.1016/j.otsr.2010.06.010
Popis: Summary Introduction Post-traumatic total knee arthroplasty for extra-articular malunion requires correction of the deformity, either through asymmetrical bone resection (possibly inducing ligaments imbalance) or osteotomy at the time of arthroplasty. We report the results of a continuous multicenter, retrospective series of 78 patients (18 implants with osteotomy) with a mean 4 years of follow-up. The hypothesis is that the selected procedure requires to be based on the deformity's location and severity. Patients With a mean age of 63 years (younger in the osteotomy group), 38 patients had femoral malunion, 36 had tibial malunion, and four had a combined malunion. There were 70 frontal deformities (48 varus and 22 valgus) and 10 rotational deformities, often diaphyseal, four of which more than 20°. Twelve patients had a history of infection; eight had frontal laxity greater than 10°, and 15 a limited range of motion in flexion. In 70 cases, semi- or nonconstrained implants were used, and in eight cases more constrained implants, including four hinge prostheses. Results We observed two deep infections, one case of avulsion of the extensor mechanism, and two cases of aseptic loosening with femoral malunion and varus deformity. Two osteotomies resulted in nonunion, one with internal fixation devices mobilization requiring revision using extension rods. The function and pain scores were significantly improved. The mobility improvements were moderate but did not compromise the surgical procedure main objective. The preoperative hip-knee angle was corrected with both techniques. Only the function score gain was greater for the isolated arthroplasty procedures. Discussion and conclusion The indications for arthroplasty alone were extended to 20° varus and 15° valgus, with no major residual laxity. Beyond 10°, hinge prosthesis should be available. Associated osteotomy can correct rotational deformities that cannot be compensated with bone cuts. In deformities that are close to the joint, osteotomy facilitates implantation of moderately constrained prosthesis. This indication is based on CAT scan rotational deformities measurements because rotational deformities require an osteotomy, and/or the presence of extraligamentous deformity that cannot be reduced with collateral ligaments surgical release. Level of evidence Level 4. Non-controlled retrospective study.
Databáze: OpenAIRE
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