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J Knee Surg 2023; 36(03): 292-297
DOI: 10.1055/s-0041-1731737
Original Article

Correction of Varus Alignment with Peripheral Osteophyte Removal during Total Knee Arthroplasty: An Assessment with Computer Navigation

Nobuhiro Nishihara
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Hironari Masuda
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Naoya Shimazaki
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
2   Department of Orthopaedic Surgery, Shimazaki Hospital, Ibaraki, Japan
,
Seikai Toyooka
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Hirotaka Kawano
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
,
Takumi Nakagawa
1   Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Abstract

Techniques for symmetrical balancing in flexion and extension have been described; however, the ideal technique is unclear. This study aimed to clarify whether resection of peripheral osteophytes could restore neutral hip–knee–ankle (HKA) angle of varus deformity of arthritic knees. Data from 90 varus arthritic knees that had undergone total knee arthroplasty (TKA) using a nonimage-based navigation system were analyzed. The change in the coronal mechanical axis, while applying manual valgus stress at extension and 90 degrees of knee flexion, was recorded after the following sequential procedures: (1) anterior cruciate ligament (ACL) sectioning, (2) subperiosteal stripping of the deep medial collateral ligament (MCL) from the underlying osteophytes on the medial tibia, and (3) complete removal of peripheral osteophytes from the proximal medial tibia and distal medial femoral condyle. Repeated measures of analysis of variance (ANOVA) were performed to compare the varus angle among each step, and a post hoc analysis by paired t-test was utilized to compare the parameters between baseline and each step. The varus alignment with valgus stress at extension and 90 degrees of flexion (mean: 6.0 ± 3.6 and 5.2 ± 3.9 degrees of varus, respectively) was significantly corrected to a near-neutral mechanical axis (mean: 0.9 ± 2.4 and 1.4 ± 4.2 degrees of varus, respectively) after peripheral osteophyte resection (p < 0.01, both). In many cases, varus deformity of arthritic knees could be corrected to near-neutral HKA angle by applying manual valgus stress after complete peripheral osteophyte resection. These procedures could facilitate soft tissue balancing in TKA, minimizing the risk of overrelease of the medial soft tissues.

Keywords

varus deformity - peripheral osteophyte resection - total knee arthroplasty - hip-knee-ankle angle


Publication History

Received: 20 January 2021

Accepted: 31 May 2021

Article published online:
16 July 2021

© 2021. Thieme. All rights reserved.

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