Residual Mild Varus Alignment and Neutral Mechanical Alignment Have Similar Outcome after Total Knee Arthroplasty for Varus Osteoarthritis in Five-Year Follow-Up

Zhiqi Zhang; Can Liu; Zhiwen Li; Peihui Wu; Shu Hu; Weiming Liao

doi:10.1055/s-0038-1677497

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2020; 33(02): 200-205
DOI: 10.1055/s-0038-1677497

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Residual Mild Varus Alignment and Neutral Mechanical Alignment Have Similar Outcome after Total Knee Arthroplasty for Varus Osteoarthritis in Five-Year Follow-Up

Authors

Zhiqi Zhang

¹Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
Can Liu

¹Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
Zhiwen Li

¹Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
Peihui Wu

¹Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
Shu Hu

¹Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
Weiming Liao

¹Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

Abstract

The effect of residual varus on survival rate and function in patients with varus knee osteoarthritis (OA) was considered an important issue for successful primary total knee arthroplasty (TKA). In this study, we compared the midterm clinical and functional outcomes in patients with different residual varus. A retrospective review of 175 patients (219 knees) with varus OA was > 3° for the hip-knee-ankle (HKA) who underwent primary TKA after exclusions and loss to follow-up from 237 patients (281 knees). The mean follow-up period was 5.2 ( ± 1.1) years. Patients were divided into four groups according to the first postoperative HKA angle from weight-bearing full-leg radiographs: “valgus” group (HKA angle > 0°, n = 44), “neutral” group (–3° ≤ HKA angle < 0°, n = 86), “mild varus” group (–6° ≤ HKA angle < –3°, n = 62), and “severe varus” group (HKA angle < –6°, n = 27). Survival analysis, Knee Society Score (KSS, including knee score and functional score), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared among the four groups. No knee required revision surgery during follow-up. For the KSS knee score and functional score at the last follow-up, the neutral and mild varus groups were better compared with the valgus and severe varus groups (p < 0.05), and there were no significant differences between the neutral and mild varus groups (p > 0.05). WOMAC scores of the neutral and mild varus groups were also better compared with the valgus and severe varus groups (p < 0.05), and there were no significant differences between the neutral and mild varus groups at the last follow-up. The postoperative HKA angle was significantly changed in valgus group between first and at the last follow-up when compared with the other three groups (p < 0.05). Leaving an HKA angle at < 6° varus had the same excellent functional outcome as neutral mechanical alignment after TKA for varus-type OA in the 5-year follow-up, using mechanically aligned technique. Caution is advised when leaving valgus or leaving severe varus after TKA.

Keywords

TKA - varus alignment - osteoarthritis

Full Text

References

References
1 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
2 Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 2016; 28 (01) 1-15
3 Dunbar MJ, Haddad FS. Patient satisfaction after total knee replacement: new inroads. Bone Joint J 2014; 96-B (10) 1285-1286
4 Magnussen RA, Weppe F, Demey G, Servien E, Lustig S. Residual varus alignment does not compromise results of TKAs in patients with preoperative varus. Clin Orthop Relat Res 2011; 469 (12) 3443-3450
5 Vanlommel L, Vanlommel J, Claes S, Bellemans J. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2325-2330
6 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
7 Matziolis G, Adam J, Perka C. Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement. Arch Orthop Trauma Surg 2010; 130 (12) 1487-1491
8 Bonner TJ, Eardley WG, Patterson P, Gregg PJ. The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 2011; 93 (09) 1217-1222
9 Nishikawa K, Okazaki K, Matsuda S. , et al. Improved design decreases wear in total knee arthroplasty with varus malalignment. Knee Surg Sports Traumatol Arthrosc 2014; 22 (11) 2635-2640
10 Meding JB, Fish MD, Berend ME, Ritter MA, Keating EM. Predicting patellar failure after total knee arthroplasty. Clin Orthop Relat Res 2008; 466 (11) 2769-2774
11 Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty 2018; 33 (12) 3678-3684
12 Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL. Do patient-specific guides improve coronal alignment in total knee arthroplasty?. Clin Orthop Relat Res 2012; 470 (03) 895-902
13 Hatayama K, Terauchi M, Saito K, Higuchi H. Does residual varus alignment cause increasing varus laxity at a minimum of five years after total knee arthroplasty?. J Arthroplasty 2017; 32 (06) 1808-1813
14 Meneghini RM, Grant TW, Ishmael MK, Ziemba-Davis M. Leaving residual varus alignment after total knee arthroplasty does not improve patient outcomes. J Arthroplasty 2017; 32 (9S): S171-S176
15 Nishida K, Matsumoto T, Takayama K. , et al. Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2017; 25 (11) 3488-3494
16 Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991; 73 (05) 709-714
17 Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it?. J Arthroplasty 2009; 24 (6, Suppl): 39-43
18 Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 2009; 24 (04) 560-569
19 D'Lima DD, Chen PC, Colwell Jr CW. Polyethylene contact stresses, articular congruity, and knee alignment. Clin Orthop Relat Res 2001; (392) 232-238
20 Morgan SS, Bonshahi A, Pradhan N, Gregory A, Gambhir A, Porter ML. The influence of postoperative coronal alignment on revision surgery in total knee arthroplasty. Int Orthop 2008; 32 (05) 639-642
21 Huang TW, Lee CY, Lin SJ, Lee MS, Hsu RW, Shen WJ. The influence of alignment on midterm outcome after total knee arthroplasty in patients with marked coronal femoral bowing. J Arthroplasty 2015; 30 (09) 1531-1536
22 Nedopil AJ, Singh AK, Howell SM, Hull ML. Does calipered kinematically aligned TKA restore native left to right symmetry of the lower limb and improve function?. J Arthroplasty 2018; 33 (02) 398-406
23 Woon JTK, Zeng ISL, Calliess T. , et al. Outcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA: a meta-analysis and subgroup analysis of randomised trials. Arch Orthop Trauma Surg 2018; 138 (09) 1293-1303
24 Delport H, Labey L, Innocenti B, De Corte R, Vander Sloten J, Bellemans J. Restoration of constitutional alignment in TKA leads to more physiological strains in the collateral ligaments. Knee Surg Sports Traumatol Arthrosc 2015; 23 (08) 2159-2169