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Correction of fixed varus deformity with peripheral osteophytes removal during varus total knee arthroplasty - an assessment with computer navigation
Author(s):
Masuda H. (Japan)
,
Masuda H. (Japan)
Affiliations:
Toyooka S.
,
Toyooka S.
Affiliations:
Yonemoto T.
,
Yonemoto T.
Affiliations:
Nishihara N.
,
Nishihara N.
Affiliations:
Shimazaki N.
,
Shimazaki N.
Affiliations:
Kawano H.
,
Kawano H.
Affiliations:
Nakagawa T.
Nakagawa T.
Affiliations:
ESSKA Academy. Masuda H. 05/09/18; 209617; P10-1157 Topic: Joint Replacement
Hironari Masuda
Hironari Masuda
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Abstract
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Objectives: The aim of this study was to clarify which procedure could restore neutral mechanical alignment of fixed varus deformity of arthritic knees during navigation assisted TKA. The hypothesis was that varus alignment was corrected to near neutral mechanical axis before any bone cut after removal of peripheral osteophytes from distal femur and proximal tibia.

Methods: Data from 59 varus arthritic knee that had undergone TKA using a non-image-based navigation system were included in the study. The change of coronal mechanical axis, while applying manual valgus stress at extension and 90 degrees of knee flexion, was recorded and documented when performing the following procedures: (1) anterior cruciate ligament (ACL) sectioned, (2) minimum subperiosteal release of the deep medial collateral ligament (MCL) fibers from the proximal medial aspect of the tibia, (3) complete removal of peripheral osteophytes from medial and posteromedial aspect of the proximal tibia and the distal medial femoral condyle. Paired t-test was used to compare passive coronal mechanical alignments at each steps versus the baseline varus deformity.

Results: No differences were found in passive coronal mechanical alignment after the ACL sectioning and the deep MCL release in comparison with the baseline varus deformity. The fixed varus deformity at knee extension (mean 5.8 ± 3.6 degrees varus, range 0 ~ 20.5 degrees varus) was significantly corrected to near neural mechanical axis (mean 0.7 ± 2.2 degrees varus, range -4.5 ~ 6.5 degrees varus) after complete resection of the peripheral osteophytes (p<001). The fixed varus deformity at 90 degrees (mean 5.1 ± 4.0 degrees varus, range -2 ~ 13.5 degrees varus) was also significantly corrected to near neural mechanical axis (mean 1.3 ± 4.5 degrees varus, range -10.5 ~ 12.5 degrees varus) after complete resection of the peripheral osteophytes (p<001). The passive mechanical axis with valgus stress at knee extension was restored to less than 3 degrees varus in 88.4 % of cases after the osteophyte removal.

Conclusions: The findings of the present study have demonstrated that fixed varus deformity of arthritic knees could be corrected to near neutral mechanical alignment before any bone cut after complete resection of the peripheral osteophytes in many cases. These procedures facilitate to achieve of soft tissue balance in TKA and minimizes the risk of over-release of the medial collateral ligament.

Keywords:
TKA, fixed varus deformity, computer navigation
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