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Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy
Purpose Primary TKA in valgus knees with a deformity of more than ten degrees may prove challenging, since bone and soft tissue abnormalities make accurate axis restoration, component orientation and joint stability attainment a difficult task. The purpose of this study was to determine which approa...
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| Published in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2011-11, Vol.19 (11), p.1834-1842 |
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| container_end_page | 1842 |
| container_issue | 11 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
| container_volume | 19 |
| creator | Nikolopoulos, D. D. Polyzois, I. Apostolopoulos, A. P. Rossas, C. Moutsios-Rentzos, A. Michos, I. V. |
| description | Purpose
Primary TKA in valgus knees with a deformity of more than ten degrees may prove challenging, since bone and soft tissue abnormalities make accurate axis restoration, component orientation and joint stability attainment a difficult task. The purpose of this study was to determine which approach is optimal in these patients, by comparing the standard medial parapatellar approach to a lateral parapatellar combined with a tibial tubercle osteotomy (TTO).
Methods
Forty-four valgus knees—with an axis deviation ranging from 15 to 36 degrees (mean 24°)—were dealt with primary TKA and followed up for a minimum period of 7 years. Lateral parapatellar arthrotomy combined with TTO was performed in 22 individuals (Group A) and a standard medial parapatellar capsulotomy in the remaining patients (Group B). The International Knee Society System Score (IKSS) was used for clinical evaluation. Radiological assessment was performed yearly postoperatively using long films for assessment of the anatomical axis.
Results
The postoperative IKSS scores showed no significant statistical difference between groups A and B (
P
|
| doi_str_mv | 10.1007/s00167-011-1474-4 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_902366756</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2487757141</sourcerecordid><originalsourceid>FETCH-LOGICAL-c402t-58f8899d37175e5cdb3fdc2c336de7e5f01d4e6c687aa4cea298463b53c9a37c3</originalsourceid><addsrcrecordid>eNqFkU2L1jAUhYMozuvoD3AjwY2rar7aNO5k8AsG3IzrcpvczpuxbWqSzvD-EX-vKR0VBHGVwH3Oybk5hDzn7DVnTL9JjPFGV4zziiutKvWAHLiSstJS6YfkwIwSlWB1c0aepHTDWLkq85icCa5aJQ0_kB9XIcNIv82IFGI-xrCMkPKJ-pkmvMWI9BbG6zXtiMMhxMnn01tqw7RA9CnMNAwUaMowO4iOTuh8sSxDWCDjOEKksCwxgD1uqt7P6Oidz0eafb-hee0x2hFpSBlDDtPpKXk0wJjw2f15Tr5-eH918am6_PLx88W7y8oqJnJVt0PbGuOk5rrG2rpeDs4KK2XjUGM9MO4UNrZpNYCyCMK0qpF9La0Bqa08J6923xLv-4opd5NPdss8Y1hTZ5iQTaPr5r9kicElq40o5Mu_yJuwxrmsUaBWM6lYWyC-QzaGlCIO3RL9BPHUcdZt5XZ7uV0pt9vK7VTRvLg3Xvvyyb8Vv9osgNiBVEbzNcY_L__b9ScXnrJ4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>898703408</pqid></control><display><type>article</type><title>Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy</title><source>EBSCOhost SPORTDiscus with Full Text</source><source>Springer Nature</source><source>Wiley-Blackwell Read & Publish Collection</source><creator>Nikolopoulos, D. D. ; Polyzois, I. ; Apostolopoulos, A. P. ; Rossas, C. ; Moutsios-Rentzos, A. ; Michos, I. V.</creator><creatorcontrib>Nikolopoulos, D. D. ; Polyzois, I. ; Apostolopoulos, A. P. ; Rossas, C. ; Moutsios-Rentzos, A. ; Michos, I. V.</creatorcontrib><description>Purpose
Primary TKA in valgus knees with a deformity of more than ten degrees may prove challenging, since bone and soft tissue abnormalities make accurate axis restoration, component orientation and joint stability attainment a difficult task. The purpose of this study was to determine which approach is optimal in these patients, by comparing the standard medial parapatellar approach to a lateral parapatellar combined with a tibial tubercle osteotomy (TTO).
Methods
Forty-four valgus knees—with an axis deviation ranging from 15 to 36 degrees (mean 24°)—were dealt with primary TKA and followed up for a minimum period of 7 years. Lateral parapatellar arthrotomy combined with TTO was performed in 22 individuals (Group A) and a standard medial parapatellar capsulotomy in the remaining patients (Group B). The International Knee Society System Score (IKSS) was used for clinical evaluation. Radiological assessment was performed yearly postoperatively using long films for assessment of the anatomical axis.
Results
The postoperative IKSS scores showed no significant statistical difference between groups A and B (
P
< 0.05). In the alignment parameter, however, residual valgus deviation occurred in 9% of patients from Group A and in 32% from Group B. No late-onset instability was displayed.
Conclusion
Lateral parapatellar approach combined with TTO may prove highly beneficial in significant valgus deformities, as the anatomical axis is restored accurately and soft tissue release of the lateral contracted structures facilitated to an important extent.
Level of evidence
I.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-011-1474-4</identifier><identifier>PMID: 21484391</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee - methods ; Bones ; Evaluation ; Female ; Humans ; Joint Capsule - surgery ; Joint Deformities, Acquired - surgery ; Joint replacement surgery ; Knee ; Knee Joint - surgery ; Knees ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Orthopedics ; Osteotomy - methods ; Patella - surgery ; Patients ; Reoperation ; scoring ; Sports ; Statistics, Nonparametric ; Surgery ; Tibia - surgery ; Transplants & implants ; Treatment Outcome</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2011-11, Vol.19 (11), p.1834-1842</ispartof><rights>Springer-Verlag 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c402t-58f8899d37175e5cdb3fdc2c336de7e5f01d4e6c687aa4cea298463b53c9a37c3</citedby><cites>FETCH-LOGICAL-c402t-58f8899d37175e5cdb3fdc2c336de7e5f01d4e6c687aa4cea298463b53c9a37c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21484391$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nikolopoulos, D. D.</creatorcontrib><creatorcontrib>Polyzois, I.</creatorcontrib><creatorcontrib>Apostolopoulos, A. P.</creatorcontrib><creatorcontrib>Rossas, C.</creatorcontrib><creatorcontrib>Moutsios-Rentzos, A.</creatorcontrib><creatorcontrib>Michos, I. V.</creatorcontrib><title>Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
Primary TKA in valgus knees with a deformity of more than ten degrees may prove challenging, since bone and soft tissue abnormalities make accurate axis restoration, component orientation and joint stability attainment a difficult task. The purpose of this study was to determine which approach is optimal in these patients, by comparing the standard medial parapatellar approach to a lateral parapatellar combined with a tibial tubercle osteotomy (TTO).
Methods
Forty-four valgus knees—with an axis deviation ranging from 15 to 36 degrees (mean 24°)—were dealt with primary TKA and followed up for a minimum period of 7 years. Lateral parapatellar arthrotomy combined with TTO was performed in 22 individuals (Group A) and a standard medial parapatellar capsulotomy in the remaining patients (Group B). The International Knee Society System Score (IKSS) was used for clinical evaluation. Radiological assessment was performed yearly postoperatively using long films for assessment of the anatomical axis.
Results
The postoperative IKSS scores showed no significant statistical difference between groups A and B (
P
< 0.05). In the alignment parameter, however, residual valgus deviation occurred in 9% of patients from Group A and in 32% from Group B. No late-onset instability was displayed.
Conclusion
Lateral parapatellar approach combined with TTO may prove highly beneficial in significant valgus deformities, as the anatomical axis is restored accurately and soft tissue release of the lateral contracted structures facilitated to an important extent.
Level of evidence
I.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthroplasty, Replacement, Knee - methods</subject><subject>Bones</subject><subject>Evaluation</subject><subject>Female</subject><subject>Humans</subject><subject>Joint Capsule - surgery</subject><subject>Joint Deformities, Acquired - surgery</subject><subject>Joint replacement surgery</subject><subject>Knee</subject><subject>Knee Joint - surgery</subject><subject>Knees</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Osteotomy - methods</subject><subject>Patella - surgery</subject><subject>Patients</subject><subject>Reoperation</subject><subject>scoring</subject><subject>Sports</subject><subject>Statistics, Nonparametric</subject><subject>Surgery</subject><subject>Tibia - surgery</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNqFkU2L1jAUhYMozuvoD3AjwY2rar7aNO5k8AsG3IzrcpvczpuxbWqSzvD-EX-vKR0VBHGVwH3Oybk5hDzn7DVnTL9JjPFGV4zziiutKvWAHLiSstJS6YfkwIwSlWB1c0aepHTDWLkq85icCa5aJQ0_kB9XIcNIv82IFGI-xrCMkPKJ-pkmvMWI9BbG6zXtiMMhxMnn01tqw7RA9CnMNAwUaMowO4iOTuh8sSxDWCDjOEKksCwxgD1uqt7P6Oidz0eafb-hee0x2hFpSBlDDtPpKXk0wJjw2f15Tr5-eH918am6_PLx88W7y8oqJnJVt0PbGuOk5rrG2rpeDs4KK2XjUGM9MO4UNrZpNYCyCMK0qpF9La0Bqa08J6923xLv-4opd5NPdss8Y1hTZ5iQTaPr5r9kicElq40o5Mu_yJuwxrmsUaBWM6lYWyC-QzaGlCIO3RL9BPHUcdZt5XZ7uV0pt9vK7VTRvLg3Xvvyyb8Vv9osgNiBVEbzNcY_L__b9ScXnrJ4</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Nikolopoulos, D. D.</creator><creator>Polyzois, I.</creator><creator>Apostolopoulos, A. P.</creator><creator>Rossas, C.</creator><creator>Moutsios-Rentzos, A.</creator><creator>Michos, I. 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D. ; Polyzois, I. ; Apostolopoulos, A. P. ; Rossas, C. ; Moutsios-Rentzos, A. ; Michos, I. 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D.</au><au>Polyzois, I.</au><au>Apostolopoulos, A. P.</au><au>Rossas, C.</au><au>Moutsios-Rentzos, A.</au><au>Michos, I. V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>19</volume><issue>11</issue><spage>1834</spage><epage>1842</epage><pages>1834-1842</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
Primary TKA in valgus knees with a deformity of more than ten degrees may prove challenging, since bone and soft tissue abnormalities make accurate axis restoration, component orientation and joint stability attainment a difficult task. The purpose of this study was to determine which approach is optimal in these patients, by comparing the standard medial parapatellar approach to a lateral parapatellar combined with a tibial tubercle osteotomy (TTO).
Methods
Forty-four valgus knees—with an axis deviation ranging from 15 to 36 degrees (mean 24°)—were dealt with primary TKA and followed up for a minimum period of 7 years. Lateral parapatellar arthrotomy combined with TTO was performed in 22 individuals (Group A) and a standard medial parapatellar capsulotomy in the remaining patients (Group B). The International Knee Society System Score (IKSS) was used for clinical evaluation. Radiological assessment was performed yearly postoperatively using long films for assessment of the anatomical axis.
Results
The postoperative IKSS scores showed no significant statistical difference between groups A and B (
P
< 0.05). In the alignment parameter, however, residual valgus deviation occurred in 9% of patients from Group A and in 32% from Group B. No late-onset instability was displayed.
Conclusion
Lateral parapatellar approach combined with TTO may prove highly beneficial in significant valgus deformities, as the anatomical axis is restored accurately and soft tissue release of the lateral contracted structures facilitated to an important extent.
Level of evidence
I.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>21484391</pmid><doi>10.1007/s00167-011-1474-4</doi><tpages>9</tpages></addata></record> |
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| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2011-11, Vol.19 (11), p.1834-1842 |
| issn | 0942-2056 1433-7347 |
| language | eng |
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| source | EBSCOhost SPORTDiscus with Full Text; Springer Nature; Wiley-Blackwell Read & Publish Collection |
| subjects | Aged Aged, 80 and over Arthroplasty, Replacement, Knee - methods Bones Evaluation Female Humans Joint Capsule - surgery Joint Deformities, Acquired - surgery Joint replacement surgery Knee Knee Joint - surgery Knees Male Medicine Medicine & Public Health Middle Aged Orthopedics Osteotomy - methods Patella - surgery Patients Reoperation scoring Sports Statistics, Nonparametric Surgery Tibia - surgery Transplants & implants Treatment Outcome |
| title | Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy |
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