PDF herunterladen
J Knee Surg 2023; 36(08): 866-872
DOI: 10.1055/s-0042-1744192
Original Article

The “Wind Surf” Deformity—Correcting Fixed Flexion Deformity and Hyperextension in Bilateral CAS TKA

Anoop Jhurani 
1   Joint Replacement Unit, Fortis Hospital, Jaipur, Rajasthan, India
,
Neil P. Sheth
2   Department of Orthopaedic Surgery, University of Pennysylvania, Philadelphia, Pennsylvania
,
Piyush Agarwal
1   Joint Replacement Unit, Fortis Hospital, Jaipur, Rajasthan, India
,
Mukesh Aswal
1   Joint Replacement Unit, Fortis Hospital, Jaipur, Rajasthan, India
,
Mudit Srivastava
1   Joint Replacement Unit, Fortis Hospital, Jaipur, Rajasthan, India
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Severe knee arthritis can result in complex coronal and sagittal angular deformities. Windswept deformity is used to describe a varus deformity and contralateral valgus deformity. We recognized a new sagittal pattern at the time of computer-assisted surgery (CAS) in total knee arthroplasty (TKA) in which one knee has a fixed flexion deformity (FFD), while the contralateral knee has a hyperextension deformity. We propose to define it as “wind surf” deformity mimicking the opposite pull of the wind and a surfer. The incidence of “wind surf” deformity in this series was 0.96% among a cohort of 2,291 bilateral TKAs performed between 2013 and 2018. Twenty-two patients were identified with an FFD of 5° to 20° on one knee and recurvatum of −5° to −20° on the contralateral knee. Additional bone resection and soft-tissue releases were performed for the FFD with a goal to maintain residual 1° to 3° of flexion. Minimal bone resection and soft-tissue disruption were performed on the knee with hyperextension with a goal to maintain 5° to 7° of flexion. These opposite strategies applied with the help of CAS prevented recurrence resulting in satisfactory clinical results at 2-year follow-up. The “wind surf” deformity variant should be identified in patients presenting with severe knee arthritis to guide surgical treatment, prevent recurrence, and obtain favorable clinical patient outcomes.

Keywords

Windswept Deformity - wind surf deformity - navigation - TKA - FFD - recurvatum


Publikationsverlauf

Eingereicht: 07. März 2021

Angenommen: 25. Januar 2022

Artikel online veröffentlicht:
08. März 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Oni OO, Keswani H, Aganga MO. ‘Windswept deformity’. Arch Dis Child 1983; 58 (07) 541-543
    CrossrefPubMedSuche in Google Scholar
  • 2 Smyth EH. Windswept deformity. J Bone Joint Surg Br 1980; 62-B (02) 166-167
    CrossrefPubMedSuche in Google Scholar
  • 3 Shetty GM, Mullaji A, Khalifa AA, Ray A. Windswept deformities—an indication to individualise valgus correction angle during total knee arthroplasty. J Orthop 2016; 14 (01) 70-72
    CrossrefPubMedSuche in Google Scholar
  • 4 Meding JB, Anderson AR, Ritter MA, Faris PM, Keating EM. Windswept deformity in bilateral total knee arthroplasty. J Arthroplasty 2000; 15 (05) 562-566
    CrossrefPubMedSuche in Google Scholar
  • 5 Babu S, Vaish A, Vaishya R. Windswept deformities of the knee are challenging to manage. Knee Surg Relat Res 2020; 32 (01) 46
    CrossrefPubMedSuche in Google Scholar
  • 6 Temelli Y, Akalan NE. [Treatment approaches to flexion contractures of the knee]. Acta Orthop Traumatol Turc 2009; 43 (02) 113-120
    CrossrefPubMedSuche in Google Scholar
  • 7 Whiteside LA, Mihalko WM. Surgical procedure for flexion contracture and recurvatum in total knee arthroplasty. Clin Orthop Relat Res 2002; 40: 189-195
    CrossrefPubMedSuche in Google Scholar
  • 8 Baldini A, Castellani L, Traverso F, Balatri A, Balato G, Franceschini V. The difficult primary total knee arthroplasty: a review. Bone Joint J 2015; 97 (10 Suppl A): 30-39
    CrossrefPubMedSuche in Google Scholar
  • 9 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society Clinical Rating System. Clin Orthop Relat Res 1989; 248: 13-14
    CrossrefPubMedSuche in Google Scholar
  • 10 Murray DW, Fitzpatrick R, Rogers K. et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89 (08) 1010-1014
    CrossrefPubMedSuche in Google Scholar
  • 11 Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient-relevant outcomes following total hip or knee arthroplasty in osteoarthritis. J Rheumatol 1988; 15 (12) 1833-1840
    PubMedSuche in Google Scholar
  • 12 Lenssen AF, van Dam EM, Crijns YH. et al. Reproducibility of goniometric measurement of the knee in the in-hospital phase following total knee arthroplasty. BMC Musculoskelet Disord 2007; 8: 83
    Suche in Google Scholar
  • 13 Mullaji A, Lingaraju AP, Shetty GM. Computer-assisted total knee replacement in patients with arthritis and a recurvatum deformity. J Bone Joint Surg Br 2012; 94 (05) 642-647
    CrossrefPubMedSuche in Google Scholar
  • 14 Bennett D, Hanratty B, Thompson N, Beverland D. Measurement of knee joint motion using digital imaging. Int Orthop 2009; 33 (06) 1627-1631
    CrossrefPubMedSuche in Google Scholar
  • 15 Kawamura H, Bourne RB. Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 2001; 6 (03) 248-252
    CrossrefPubMedSuche in Google Scholar
  • 16 Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 2002; 84 (01) 50-53
    CrossrefPubMedSuche in Google Scholar
  • 17 Deep K, Picard F, Baines J. Dynamic knee behaviour: does the knee deformity change as it is flexed-an assessment and classification with computer navigation. Knee Surg Sports Traumatol Arthrosc 2016; 24 (11) 3575-3583
    CrossrefPubMedSuche in Google Scholar
  • 18 Hutt JR, LeBlanc MA, Massé V, Lavigne M, Vendittoli PA. Kinematic TKA using navigation: surgical technique and initial results. Orthop Traumatol Surg Res 2016; 102 (01) 99-104
    CrossrefPubMedSuche in Google Scholar
  • 19 Jhurani A, Agarwal P, Aswal M, Meena I, Srivastava M, Sheth NP. Do spacer blocks accurately estimate deformity correction and gap balance in total knee arthroplasty? A prospective study with computer navigation. Knee 2020; 27 (01) 214-220
    CrossrefPubMedSuche in Google Scholar
  • 20 Figgie III HE, Goldberg VM, Heiple KG, Moller III HS, Gordon NH. The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 1986; 68 (07) 1035-1040
    CrossrefPubMedSuche in Google Scholar
  • 21 Kim YH, Matsuda S, Kim TK. Clinical faceoff: do we need special strategies for Asian patients with TKA?. Clin Orthop Relat Res 2016; 474 (05) 1102-1107
    CrossrefPubMedSuche in Google Scholar
  • 22 Koo K, Silva A, Chong HC. et al. Genu recurvatum versus fixed flexion after total knee arthroplasty. Clin Orthop Surg 2016; 8 (03) 249-253
    CrossrefPubMedSuche in Google Scholar
  • 23 Quah C, Swamy G, Lewis J, Kendrew J, Badhe N. Fixed flexion deformity following total knee arthroplasty. A prospective study of the natural history. Knee 2012; 19 (05) 519-521
    CrossrefPubMedSuche in Google Scholar
  • 24 Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Genu recurvatum in total knee replacement. Clin Orthopaed Rel Res 2003; 416: 64-67
    CrossrefPubMedSuche in Google Scholar
  • 25 Lam LO, Swift S, Shakespeare D. Fixed flexion deformity and flexion after knee arthroplasty. What happens in the first 12 months after surgery and can a poor outcome be predicted?. Knee 2003; 10 (02) 181-185
    CrossrefPubMedSuche in Google Scholar
  • 26 Kim CW, Lee CR. Effects of femoral lateral bowing on coronal alignment and component position after total knee arthroplasty: a comparison of conventional and navigation-assisted surgery. Knee Surg Relat Res 2018; 30 (01) 64-73
    CrossrefPubMedSuche in Google Scholar