Subscribe to RSS
DOI: 10.1055/s-0039-1694047
Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement
Funding This study was financially supported by the Urmia University of Medical Sciences.
Abstract
Total knee arthroplasty is a challenging task in patients with severe varus deformity. In most of these patients, an extensive medial release is needed that may lead to instability. Medial epicondylar osteotomy may be a better substitute for complete medial collateral release. Fourteen patients with bilateral knee osteoarthritis and severe varus deformity were enrolled in this study. In one side, the patients underwent medial epicondylar osteotomy for mediolateral imbalance if the only option was superficial medial collateral ligament (MCL) release. In contralateral side, the extensive medial release was performed and MCL was released either by pie-crusting technique or by subperiosteally release. The results of the two sides were compared. Patients were followed up for 12 months after the operation. Physical examination, clinical questionnaires, and radiography findings were recorded. Union of the osteotomies fragment and complications was evaluated. The mean varus angle before surgery was 21.6 ± 4.7 degrees, which was corrected to 8.6 ± 2.9 degrees after operation with an extensive medial release. The mean varus angle of contralateral side was 22.6 ± 1.7 degrees, which was corrected to 7.5 ± 2.3 degrees following medial femoral epicondyle osteotomy. There was no significant difference in varus correction (p = 0.1). Medial joint line opening in valgus stress test was 2.7 ± 0.4 mm in the osteotomized side and 3.5 ± 0.9 mm in contralateral side. Mean range of motion for the osteotomized side was 97.8 ± 4.3 degrees and 100.7 ± 2.7 degrees for contralateral side (p = 0.6). Nonunion occurred in a case in the osteotomized side and no medial instability was observed in medial release or osteotomies sides. No statistical difference was recorded based on clinical questionnaires (Oxford and WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] scores). Medial epicondylar osteotomy is a safe technique with the well-controlled medial extensive release in the patients with severe varus deformity during total knee arthroplasty.
Note
The study was confirmed by the ethics committee of Urmia University of Medical Sciences.
Publication History
Received: 26 October 2018
Accepted: 18 June 2019
Article published online:
08 August 2019
© 2019. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Mihalko WM, Saleh KJ, Krackow KA, Whiteside LA. Soft-tissue balancing during total knee arthroplasty in the varus knee. J Am Acad Orthop Surg 2009; 17 (12) 766-774
- 2 Mullaji AB, Shetty GM. Surgical technique: computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA. Clin Orthop Relat Res 2013; 471 (05) 1484-1491
- 3 Verdonk PC, Pernin J, Pinaroli A, Ait Si Selmi T, Neyret P. Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach. Knee Surg Sports Traumatol Arthrosc 2009; 17 (06) 660-666
- 4 Tang Q, Yu HC, Shang P. et al. Selective medial soft tissue release combined with tibial reduction osteotomy in total knee arthroplasty. J Orthop Surg Res 2017; 12 (01) 174
- 5 Bellemans J, Vandenneucker H, Van Lauwe J, Victor J. A new surgical technique for medial collateral ligament balancing: multiple needle puncturing. J Arthroplasty 2010; 25 (07) 1151-1156
- 6 Bellemans J. Multiple needle puncturing: balancing the varus knee. Orthopedics 2011; 34 (09) e510-e512
- 7 Chang MJ, Lim H, Lee NR, Moon YW. Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res 2014; 26 (02) 61-67
- 8 Heesterbeek PJ, Wymenga AB. Correction of axial and rotational alignment after medial and lateral releases during balanced gap TKA. A clinical study of 54 patients. Acta Orthop 2010; 81 (03) 347-353
- 9 Engh GA, Ammeen D. Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity. Clin Orthop Relat Res 1999; (367) 141-148
- 10 Verdonk PC, Pernin J, Pinaroli A, Ait Si Selmi T, Neyret P. Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach. Knee Surg Sports Traumatol Arthrosc 2009; 17 (06) 660-666
- 11 Matsumoto T, Kuroda R, Kubo S, Muratsu H, Mizuno K, Kurosaka M. The intra-operative joint gap in cruciate-retaining compared with posterior-stabilised total knee replacement. J Bone Joint Surg Br 2009; 91 (04) 475-480
- 12 D'Lima DD, Patil S, Steklov N, Colwell Jr CW. An ABJS best paper: dynamic intraoperative ligament balancing for total knee arthroplasty. Clin Orthop Relat Res 2007; 463 (463) 208-212
- 13 Mullaji AB, Shetty GM. Surgical technique: computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA. Clin Orthop Relat Res 2013; 471 (05) 1484-1491
- 14 Dennis DA, Komistek RD, Walker SA, Cheal EJ, Stiehl JB. Femoral condylar lift-off in vivo in total knee arthroplasty. J Bone Joint Surg Br 2001; 83 (01) 33-39
- 15 Sim JA, Lee YS, Kwak JH, Yang SH, Kim KH, Lee BK. Comparison of complete distal release of the medial collateral ligament and medial epicondylar osteotomy during ligament balancing in varus knee total knee arthroplasty. Clin Orthop Surg 2013; 5 (04) 287-291