Parameswaran Apurve, Annasamudram Abhijith, Gautam Deepak, Apsingi Sunil, Dannana Chandra Sekhar, Eachempati Krishna Kiran
Department of Orthopaedics, Medicover Hospitals, HITEC City, Hyderabad, Telangana, India.
Department of Orthopaedics, BVP Medicover Hospital, Navi Mumbai, Maharashtra, India.
J Orthop. 2024 Dec 28;66:71-76. doi: 10.1016/j.jor.2024.12.041. eCollection 2025 Aug.
The aims of this study were to (a) identify the dynamic patterns of varus deformity among osteoarthritic knees, (b) describe their surgical implications, and (c) compare post-operative lower limb alignment, clinical outcomes and satisfaction among patients with different deformity patterns managed intra-operatively based on deductions drawn from the same.
Patients with primary osteoarthritis of the knee with an intra-articular varus deformity, undergoing computer-navigation assisted total knee arthroplasty using a sub-vastus approach and the "femur-first" measured resection technique between October 2019 and June 2020 were recruited. Following surgical exposure, the coronal knee deformity was assessed during full extension and 15°, 30°, 45°, 60°, 75°, and 90° of flexion. The levels of bony and/or soft-tissue pathology were identified based on the deformity pattern noted. Mechanical bone resection and indicated soft-tissue releases were performed. Post-operative alignment and outcomes were compared among knees with different deformity patterns.
In all, 127 patients (59.1 % women) with a mean age of 62.4 years were available for follow-up. The mean duration of follow-up was 24.7 months. Five patterns of varus deformity emerged, each indicating different levels of pathology: (i) pattern-1: the deformity increased on flexion, (ii) pattern-2: the deformity decreased on flexion, (iii) pattern-3: the deformity remained constant throughout flexion, (iv) pattern-4: the deformity increased initially, then decreased on flexion, and (v) pattern-5: the deformity decreased initially, then increased on flexion. Individualized soft-tissue release helped restore alignment within 3° of the mechanical axis in all knees. At the two years' follow-up, the clinical outcomes and patient satisfaction were comparable among patients with all deformity patterns.
Knees with primary varus osteoarthritis demonstrate simple dynamic patterns of coronal deformity. An understanding of these patterns permits identification of the levels of pathology and helps in their optimal management, resulting in uniformly satisfactory outcomes.
本研究的目的是：（a）确定骨关节炎膝关节内翻畸形的动态模式；（b）描述其手术意义；（c）根据术中推断，比较不同畸形模式患者术中处理后的下肢对线、临床结果和满意度。
招募2019年10月至2020年6月期间因膝关节原发性骨关节炎伴关节内翻畸形，采用股直肌下入路和“股骨优先”测量截骨技术进行计算机导航辅助全膝关节置换术的患者。手术暴露后，在膝关节完全伸直以及屈曲15°、30°、45°、60°、75°和90°时评估冠状面膝关节畸形。根据所记录的畸形模式确定骨和/或软组织病变的程度。进行机械性骨切除和必要的软组织松解。比较不同畸形模式膝关节的术后对线和结果。
共有127例患者（59.1%为女性）可供随访，平均年龄62.4岁。平均随访时间为24.7个月。出现了五种内翻畸形模式，每种模式表明不同程度的病变：（i）模式1：畸形在屈曲时增加；（ii）模式2：畸形在屈曲时减少；（iii）模式3：畸形在整个屈曲过程中保持不变；（iv）模式4：畸形最初增加，然后在屈曲时减少；（v）模式5：畸形最初减少，然后在屈曲时增加。个体化软组织松解有助于所有膝关节的对线恢复至机械轴的3°范围内。在两年随访时，所有畸形模式患者的临床结果和患者满意度相当。
原发性内翻骨关节炎膝关节表现出简单的冠状面畸形动态模式。了解这些模式有助于确定病变程度并有助于对其进行最佳处理，从而产生一致令人满意的结果。
