Volume 17 | Issue 3 | July – September 2022 | Page 12-16 | Amyn M. Rajani, Kareena Rajani, Urvil A. Shah, Anmol RS Mittal, Richa Singhal
Authors: Amyn M. Rajani [1], Kareena Rajani [1], Urvil A. Shah [1], Anmol RS Mittal [1], Richa Singhal [1]
[1] Department of Orthopaedic Arthroscopic Knee and Shoulder (OAKS) Clinic, 707 Panchshil Plaza, N S Patkar Marg, opp. Ghanasingh Fine Jewels, next to Dharam Palace, Gamdevi, Mumbai, Maharashtra 400007.
Address of Correspondence
Dr. Amyn M. Rajani,
Department of Orthopaedic Arthroscopic Knee and Shoulder (OAKS) Clinic, 707 Panchshil Plaza, N S Patkar Marg, opp. Ghanasingh Fine Jewels, next to Dharam Palace, Gamdevi, Mumbai, Maharashtra 400007
E-mail: dramrajani@gmail.com
Abstract
Introduction: Tricompartmental knee osteoarthritis is a common, progressively debilitating condition. Total knee replacement has been established as the best modality of treatment in such cases. With 58% of arthritic knees having a varus deformity, literature is still bleak in terms of substantial long-term follow-up studies directed towards establishing the most proficient correction technique of these deformities.
Methods: 75 consecutive knees with degenerative osteoarthritis, who underwent total knee replacement between January 2009 and December 2011 were evaluated at a mean postoperative follow-up of 12.5±1 years. All of these patients underwent uniform, monitored rehabilitation. Radiological analysis using plain radiography, and functional outcome analysis using KOOS questionnaire was done at terminal follow-up. A retrospective analysis of the nature of deformity correction or postoperative limb alignment was done using immediate post-operative radiographs. Data was compiled on the SPSS-24 software and analyzed using Welch’s t-test.
Results: The mean age of patients was 64.02 years (Range: 49-79 years). 54 (72%) female and 21 (28%) male knees were evaluated. There was no noteworthy difference between the sides of affliction, with the left knee affected in 37 (49.3%) cases, and the right knee in 38 (50.7%) cases. Patients were segregated into three groups based on retrospective radiological analysis of postoperative femorotibial alignment, namely Varus (nv=59, mean varus=2.03o), Rectus (nr=5), and Valgus (ng=11, mean valgus=1.55o). The varus group had statistically insignificant (p>0.05), albeit better mean KOOS than the rectus and valgus groups (92.8 vs 92 vs 91.36) at terminal follow-up. A higher number of cases were able to kneel, and sit cross-legged in the varus group. There was no radiological sign of implant loosening or need for revision in any of the observed cases, irrespective of the group.
Conclusion: At a mean 12.5-year follow-up, patients who underwent under-correction of varus deformity had a favorable functional outcome and were able to carry out all the functional activities including the ability to sit cross-legged and kneel as adeptly as their counterparts. There was no sign of radiological complication in any case. Hence, under-correction of varus deformity during Total knee replacement provides excellent long-term functional, radiological, and implant related outcomes.
Keywords: Long-term, under-correction, varus, TKR, KOOS
References
1. Carr AJ, Robertsson O, Graves S et al. Knee replacement. Lancet. 2012; 379: 1331-1340.
2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5. https://doi.org/10.2106/00004623-200704000-00012.
3. Wylde V, Livesey C, Blom AW: Restriction in participation in leisure activities after joint replacement: an exploratory study. Age Ageing. 2012, 41:246-9. 10.1093/ageing/afr180
4. Conner-Spady BL, Bohm E, Loucks L, Dunbar MJ, Marshall DA, Noseworthy TW: Patient expectations and satisfaction 6 and 12 months following total hip and knee replacement. Qual Life Res. 2020, 29:705-19. 10.1007/s11136-019-02359-7
5. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P: What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012, 2:e000435. 10.1136/bmjopen-2011-000435
6. Maxwell JL, Felson DT, Niu J, et al.: Does clinically important change in function after knee replacement guarantee good absolute function? The multicenter osteoarthritis study. J Rheumatol. 2014, 41:60-4. 10.3899/jrheum.130313.
7. Scott CE, Howie CR, MacDonald D, Biant LC: Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010, 92:1253-8. 10.1302/0301-620X.92B9.24394
8. Wylde V, Artz N, Howells N, Blom AW: Kneeling ability after total knee replacement. EFORT Open Rev. 2019, 4:460-7. 10.1302/2058-5241.4.180085
9. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998 Aug;28(2):88-96
10. Rodríguez-Merchán, E. C. (2019). The stiff total knee arthroplasty: Causes, treatment modalities and results. EFORT Open Reviews, 4(10), 602–610. https://doi.org/10.1302/2058-5241.4.180105
11. de Achaval, S., Kallen, M. A., Amick, B., Landon, G., Siff, S., Edelstein, D., Suarez-Almazor, M. E. (2016). Patients’ expectations about total knee replacementoutcomes. Health Expectations, 19(2), 299–308. https://doi.org/10.1111/hex.12350
12. Irmola, T., Kangas, J., Eskelinen, A. et al. Functional outcome of total knee replacement: a study protocol for a prospective, double-blinded, parallel-group randomized, clinical controlled trial of novel, personalized and conventional implants. BMC Musculoskelet Disord 20, 443 (2019). https://doi.org/10.1186/s12891-019-2830-7
13. Nishida K, Matsumoto T, Takayama K, Ishida K, Nakano N, Matsushita T, Kuroda R, Kurosaka M. Remaining mild varus limb alignment leads to better clinical outcome in total knee replacementfor varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2017 Nov;25(11):3488-3494. doi: 10.1007/s00167-016-4260-5. Epub 2016 Aug 9. PMID: 27506810.
14. Rajasekaran RB, Palanisami DR, Natesan R, Rajasekaran S. Minimal under-correction gives better outcomes following total knee replacementin severe varus knees-myth or reality?-analysis of one hundred sixty two knees with varus greater than fifteen degrees. Int Orthop. 2020 Apr;44(4):715-723. doi: 10.1007/s00264-018-4240-0. Epub 2018 Nov 20. PMID: 30460462.
| How to Cite this article: Rajani AM, Rajani K, Shah UA, Mittal ARS, Singhal R. 12-year functional outcome of patients undergoing Total knee replacement with Under-correction of Varus Deformity. Journal of Trauma and Orthopaedic Surgery July-Sep 2022;17(3): 12-16. |
(Abstract Full Text HTML) (Download PDF)