Rajgopal Ashok, Dahiya Vivek, Vasdev Attique, Kochhar Hemanshu, Tyagi Vipin
Medanta Bone and Joint Institute, Medanta-The Medicity, Gurgaon, India.
J Orthop Surg (Hong Kong). 2011 Apr;19(1):60-3. doi: 10.1177/230949901101900114.
To report long-term results of total knee arthroplasty (TKA) for valgus knees.
34 women and 19 men aged 39 to 84 (mean, 74) years with valgus knees underwent primary TKA by a senior surgeon. Of the 78 knees, 43, 29, and 6 had type-I, type-II, and type-III valgus deformities, respectively. A preliminary lateral soft-tissue release was performed, and the tibia and femur were prepared. The tight lateral structures were released using the pie-crusting technique. In 92% of the knees, cruciate-retaining implants were used. In knees with severe deformity and medial collateral ligament insufficiency, the posterior cruciate ligament was sacrificed and constrained implants were used. The Hospital for Special Surgery (HSS) knee score was assessed, as were tibiofemoral alignment, range of motion, stability, and evidence of loosening or osteolysis.
Patients were followed up for 8 to 14 (mean, 10) years. All knees had a good patellar position and were clinically stable in both mediolateral and anteroposterior planes. No radiolucency was noted. The mean HSS knee score improved from 48 to 91 (p<0.001). The mean tibiofemoral alignment improved from valgus 20 to 5 degrees (p<0.001). The mean range of motion improved from 65 to 110 degrees (p<0.001). One patient developed a deep infection at year 4, and 2 had periprosthetic fractures at years 6 and 8.
Adequate lateral soft-tissue release is the key to successful TKAs in valgus knees. The choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release needed to obtain a stable, balanced flexion and extension gap, in order to achieve minimal constraint with maximum stability.
报告外翻膝全膝关节置换术（TKA）的长期疗效。
34名女性和19名男性，年龄39至84岁（平均74岁），患有外翻膝，由一名资深外科医生进行初次TKA。在这78个膝关节中，分别有43个、29个和6个为I型、II型和III型外翻畸形。进行了初步的外侧软组织松解，并对胫骨和股骨进行了准备。使用“饼皮”技术松解紧张的外侧结构。92%的膝关节使用了保留交叉韧带的假体。对于畸形严重且内侧副韧带不足的膝关节，牺牲后交叉韧带并使用限制性假体。评估了特种外科医院（HSS）膝关节评分、胫股对线、活动范围、稳定性以及假体松动或骨溶解的证据。
患者随访8至14年（平均10年）。所有膝关节髌骨位置良好，在内外侧和前后平面临床上均稳定。未发现透光线。HSS膝关节评分平均从48分提高到91分（p<0.001）。胫股对线平均从外翻20度改善到5度（p<0.001）。平均活动范围从65度提高到110度（p<0.001）。1例患者在第4年发生深部感染，2例分别在第6年和第8年发生假体周围骨折。
充分的外侧软组织松解是外翻膝TKA成功的关键。假体的选择取决于外翻畸形的严重程度以及获得稳定、平衡的屈伸间隙所需的软组织松解程度，以实现最小限度的限制和最大程度的稳定性。
