Ismailidis Petros, Kernen Rolf, Mueller Sebastian Andreas
Department of Orthopedic Surgery, University Hospital of Basel, Spitalstrasse 21, 4056 Basel, Switzerland.
Clinic for Orthopedics "Claraortho", Claragraben 82, 4058 Basel, Switzerland.
Case Rep Orthop. 2017;2017:9301017. doi: 10.1155/2017/9301017. Epub 2017 Mar 12.
Grade III valgus deformity (tibiofemoral alignment > 20°) is present in only 0.5% of patients receiving total knee arthroplasty. Furthermore, cases with a valgus deformity exceeding 40° are even rarer. Since they mostly affect elderly, polymorbid patients, successful outcome means a great challenge. We report on a case of a 90-year-old patient with a valgus deformity of 47°. The patient was preoperatively restricted to a wheel chair, unable to walk, and only able to stand for a few seconds. The maximal knee flexion was 100°, and there was an extension deficit of 15°. The WOMAC score was 91; the EQ-5D-5L Index was 0.048. She was treated with a constrained hinged prosthesis. Postoperatively, the axis was 6° valgus. After 3 months of rehabilitation, she was independent using a wheeled walker. The maximal flexion of the knee was 110° and there was no extension deficit. The WOMAC score was 45; the EQ-5D-5L Index was 0.813. This case demonstrates the possibility of a satisfactory result and an improvement in quality of life and mobility with a plausible timetable and with reasonable use of resources even in advanced age and severe valgus deformity.
接受全膝关节置换术的患者中，仅有0.5%存在III级外翻畸形（胫股关节对线>20°）。此外，外翻畸形超过40°的病例更为罕见。由于这些病例大多影响老年多病患者，取得成功的治疗结果意味着巨大挑战。我们报告一例90岁外翻畸形47°的患者。该患者术前只能坐轮椅，无法行走，仅能站立几秒钟。膝关节最大屈曲度为100°，伸直受限15°。WOMAC评分为91；EQ-5D-5L指数为0.048。她接受了限制性铰链式假体治疗。术后，关节轴外翻6°。经过3个月的康复治疗，她使用轮式助行器能够独立活动。膝关节最大屈曲度为110°，无伸直受限。WOMAC评分为45；EQ-5D-5L指数为0.813。该病例表明，即使在高龄和严重外翻畸形的情况下，通过合理的时间安排和资源利用，仍有可能获得满意的治疗结果，并改善生活质量和活动能力。
