Kubo Mitsuhiko, Hirobe Sho, Maeda Tsutomu, Kumagai Kosuke, Amano Yasutaka, Nosaka Yuki, Hasegawa Takahide, Imai Shinji
Department of Sports and Musculoskeletal Medicine Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
Department of Orthopaedic Surgery Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
Case Rep Orthop. 2024 Jul 25;2024:6699418. doi: 10.1155/2024/6699418. eCollection 2024.
Knee osteoarthritis (OA) with extra-articular deformity (EAD) is a rare condition for which achieving accurate alignment with total knee arthroplasty (TKA) is difficult. Extra-articular corrective osteotomy may be necessary for severe deformities. A 76-year-old man underwent TKA for knee OA with EAD due to malunion after fractures of the femur and tibia. The femoral varus and the tibial valgus/recurvatum deformities were mild and corrected by intra-articular osteotomy using navigation (i.e., navigation-assisted standard TKA). However, the femoral antecurvatum deformity was severe, and we performed extra-articular corrective osteotomy simultaneously with TKA. Navigation was used not only for TKA but also for extra-articular corrective osteotomies. The osteotomy site was fixed with a cemented stem and metaphyseal sleeve. The postoperative hip-knee-ankle angle was 1° varus, the femoral implant was implanted at 0.5° varus/0.5° flexion, and the tibial implant was implanted at 0.5° varus/0° posterior slope. Two years after surgery, improvements were obtained in the range of motion from 15°-95° to 0°-110°, the Knee Society Score from 39 to 92 points, and the functional score from 35 to 100 points. One-stage TKA with extra-articular corrective osteotomy achieved good clinical results due to accurate alignment using navigation and firm fixation of the osteotomy site using cemented-stem and metaphyseal sleeve without any fixation devices.
伴有关节外畸形（EAD）的膝关节骨关节炎（OA）是一种罕见病症，通过全膝关节置换术（TKA）实现精确对线较为困难。对于严重畸形可能需要进行关节外矫正截骨术。一名76岁男性因股骨和胫骨骨折畸形愈合导致伴有EAD的膝关节OA而接受TKA。股骨内翻和胫骨外翻/反屈畸形较轻，通过使用导航的关节内截骨术（即导航辅助标准TKA）进行了矫正。然而，股骨前弯畸形严重，我们在进行TKA的同时进行了关节外矫正截骨术。导航不仅用于TKA，还用于关节外矫正截骨术。截骨部位用骨水泥柄和干骺端套筒固定。术后髋-膝-踝角为1°内翻，股骨假体以0.5°内翻/0.5°屈曲植入，胫骨假体以0.5°内翻/0°后倾植入。术后两年，活动范围从15°-95°改善至0°-110°，膝关节协会评分从39分提高到92分，功能评分从35分提高到100分。通过导航精确对线以及使用骨水泥柄和干骺端套筒对截骨部位进行牢固固定（无需任何固定装置），一期TKA联合关节外矫正截骨术取得了良好的临床效果。
