Predicting the Feasibility of Correcting Mechanical Axis in Large Varus Deformities With Unicompartmental Knee Arthroplasty

• Published in: The Journal of arthroplasty 2018-02, Vol.33 (2), p.372-378
• Main Authors: Kleeblad, Laura J., van der List, Jelle P., Pearle, Andrew D., Fragomen, Austin T., Rozbruch, S. Robert
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Bone Malalignment - diagnostic imaging; Bone Malalignment - surgery; deformity correction; Feasibility Studies; Female; Humans; joint line obliquity; Knee Joint - surgery; lower limb alignment; Male; mechanical axis; Middle Aged; Osteoarthritis, Knee - diagnostic imaging; Osteoarthritis, Knee - surgery; unicompartmental knee arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.09.052

Due to disappointing historical outcomes of unicompartmental knee arthroplasty (UKA), Kozinn and Scott proposed strict selection criteria, including preoperative varus alignment of ≤15°, to improve the outcomes of UKA. No studies to date, however, have assessed the feasibility of correcting large preoperative varus deformities with UKA surgery. The study goals were therefore to (1) assess to what extent patients with large varus deformities could be corrected and (2) determine radiographic parameters to predict sufficient correction. In 200 consecutive robotic-arm assisted medial UKA patients with large preoperative varus deformities (≥7°), the mechanical axis angle (MAA) and joint line convergence angle (JLCA) were measured on hip-knee-ankle radiographs. It was assessed what number of patients were corrected to optimal (≤4°) and acceptable (5°-7°) alignment, and whether the feasibility of this correction could be predicted using an estimated MAA (eMAA, preoperative MAA−JLCA) using regression analyses. Mean preoperative MAA was 10° of varus (range, 7°-18°), JLCA was 5° (1°-12°), postoperative MAA was 4° of varus (−3° to 8°), and correction was 6° (1°-14°). Postoperative optimal alignment was achieved in 62% and acceptable alignment in 36%. The eMAA was a significant predictor for optimal postoperative alignment, when corrected for age and gender (P < .001). Patients with large preoperative varus deformities (7°-18°) could be considered candidates for medial UKA, as 98% was corrected to optimal or acceptable alignment, although cautious approach is needed in deformities >15°. Furthermore, it was noted that the feasibility of achieving optimal alignment could be predicted using the preoperative MAA, JLCA, and age.