Tawari Gautam J K, Maheshwari Rajan, Madan Sanjeev S
Department of Orthopaedics, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, DN2 5LT, UK.
Strategies Trauma Limb Reconstr. 2018 Nov;13(3):179-184. doi: 10.1007/s11751-018-0310-5. Epub 2018 Mar 20.
A good long-term outcome following a total knee arthroplasty relies on restoration of the mechanical axis and effective soft tissue balancing of the prosthetic knee. Arthroplasty surgery in patients with secondary osteoarthritis of the knee with an extra-articular tibial deformity is a complex and challenging procedure. The correction of mal-alignment of the mechanical axis is associated with unpredictable result and with higher revision rates. Single-staged deformity correction and replacement surgery often result in the use of constraint implants. We describe our experience with staged correction of deformity using a Taylor Spatial Frame (TSF) followed by total knee arthroplasty in these patients and highlight the advantage of staged approach. The use of TSF fixator for deformity correction prior to a primary total knee arthroplasty has not been described in the literature. We describe three cases of secondary osteoarthritis of the knee associated with multiplanar tibial deformity treated effectively with a total knee arthroplasty following deformity correction and union using a TSF. All patients had an improved Knee Society score and Oxford Knee score postoperatively and were satisfied with their replacement outcome. Staged deformity correction followed by arthroplasty allows the use of standard primary arthroplasty implants with predicable results and flexible aftercare. This approach may also provide significant improvement of patient symptoms following correction of deformity resulting in deferment of the arthroplasty surgery.
全膝关节置换术后良好的长期疗效依赖于机械轴的恢复以及假体膝关节有效的软组织平衡。对于伴有关节外胫骨畸形的膝关节继发性骨关节炎患者，关节置换手术是一项复杂且具有挑战性的操作。机械轴排列不齐的矫正结果难以预测，且翻修率较高。单阶段畸形矫正和置换手术常常导致使用限制性植入物。我们描述了在这些患者中使用泰勒空间框架（TSF）进行分期畸形矫正，随后进行全膝关节置换的经验，并强调了分期方法的优势。在初次全膝关节置换术前使用TSF固定器进行畸形矫正的情况在文献中尚未见报道。我们描述了3例伴有多平面胫骨畸形的膝关节继发性骨关节炎患者，在使用TSF进行畸形矫正和愈合后，通过全膝关节置换得到有效治疗。所有患者术后膝关节协会评分和牛津膝关节评分均有所改善，并且对置换结果满意。分期畸形矫正后再进行关节置换，能够使用标准的初次关节置换植入物，结果可预测，术后护理也较为灵活。这种方法还可能在畸形矫正后显著改善患者症状，从而推迟关节置换手术。
