Surgical procedures and outcomes of cruciate-retaining total knee arthroplasty in treatment of valgus deformity of knee

doi:10.3877/cma.j.issn.1674-134X.2021.05.004

Abstract

Abstract:

Objective

To explore the surgical procedures of posterior cruciate-retaining (CR) total knee arthroplasty (TKA) for the treatment of knee valgus deformity and evaluate the short-term outcomes.

Methods

A retrospective study was carried out to analyze all the cases of CR TKA for valgus knee in Shanghai Changhai Hospital from April 2017 to October 2020, excluding patients who were not the same surgeon or patients with missing important parameters. Finally 28 cases were included. The valgus knees were classified by the hip-knee-ankle(HKA)and anatomic valgus angulation (AVA)angles. The range of motion, Western Ontario and McMaster Universities osteoarthritis index (WOMAC)function score and intraoperative posterior cruciate ligament(PCL)retention were recorded pre- and post-operation. The outcomes of CR TKA were evaluated. Paired sample t test was used to compare those with normal distribution before and after operation, and paired rank sum test was used to those who did not conform to normal distribution.

Results

The mean follow-up time was (14±12)months. There was no revision case. According to Keblish classification, mild valgus was found in 13 cases (46.4%) and moderate valgus in 15 cases (53.6%). All the alignments were neutrally restored within HKA±3 ° after operation. The postoperative WOMAC score was (45±12), which was significantly lower than that before operation (t=11.788, P<0.001), and the maximum flexion angle of knee joint after operation was 133(116, 140)°, which was significantly larger than that before and after operation (Z=-4.383, P<0.001). There were also significant differences between the pre- and post-operation data in different valgus, sex, age, body mass index(BMI) and prosthesis subgroups(all P<0.05). There was one case of tibial avulsion fracture and two cases of PCL release during the operation, but the outcomes were good.

Conclusions

From the short-term outcomes, CR TKA is feasible in the treatment of valgus deformity of the knee, which can restore neutral alignment and obtain good postoperative range of motion and function score. However, the severe valgus knee and the long-term outcomes should be further confirmed. The retention of PCL during operation is the key, and the retention rate of PCL can be significantly improved by using methods such as bone island preservation.

Key words: Arthroplasty, replacement, knee, Knee prosthesis, Surgical procedures, Treatment outcome

Yiming Wang, Yongjin Zhang, Shuo Li, Yihong Xu, Tingxuan Song, Weichuang Cai, Weidong Xu. Surgical procedures and outcomes of cruciate-retaining total knee arthroplasty in treatment of valgus deformity of knee[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(05): 540-546.

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References 29

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分类	亚组	例数	术前	术后	t值	P值
Keblish分型	轻度	13	85±14	49±12	8.010	<0.001
	中度	15	89±16	42±11	9.260	<0.001
性别	男	9	92±11	45±11	8.636	<0.001
	女	19	85±16	46±12	8.699	<0.001
年龄	<70岁	11	83±11	45±10	7.515	<0.001
	≥70岁	17	90±17	45±13	9.176	<0.001
BMI	<24 kg/m²	12	89±15	50±9	7.098	<0.001
	≥24 kg/m²	16	85±15	42±13	9.236	<0.001
假体	ATTUNE	8	84±17	42±11	5.482	0.001
	LEGION	20	88±14	47±12	10.326	<0.001

分类	亚组	例数	术前	术后	t值	P值
Keblish分型	轻度	13	85±14	49±12	8.010	<0.001
	中度	15	89±16	42±11	9.260	<0.001
性别	男	9	92±11	45±11	8.636	<0.001
	女	19	85±16	46±12	8.699	<0.001
年龄	<70岁	11	83±11	45±10	7.515	<0.001
	≥70岁	17	90±17	45±13	9.176	<0.001
BMI	<24 kg/m²	12	89±15	50±9	7.098	<0.001
	≥24 kg/m²	16	85±15	42±13	9.236	<0.001
假体	ATTUNE	8	84±17	42±11	5.482	0.001
	LEGION	20	88±14	47±12	10.326	<0.001

分类	亚组	例数	术前	术后	统计值	P值
Keblish分型	轻度(±s)	13	105±14	128±9	t＝-5.035	<0.001
	中度[M(P₂₅，P₇₅)]	15	110(95，115)	135(115，140)	Z＝-3.305	0.001
性别	男性(±s)	9	106±13	126±12	t＝-4.243	0.003
	女性(±s)	19	106±13	130±9	t＝-7.071	<0.001
年龄	<70岁(±s)	11	112±14	129±10	t＝-3.450	0.006
	≥70岁[M(P₂₅，P₇₅)]	17	105(95，110)	135(117，140)	Z＝-3.634	<0.001
BMI	<24 kg/m²(±s)	12	100±11	125±11	t＝-5.623	<0.001
	≥24 kg/m² [M(P₂₅，P₇₅)]	16	110(101，120)	135(121，140)	Z＝-3.308	0.001
假体	ATTUNE [M(P₂₅，P₇₅)]	8	115(110，124)	137(127，140)	Z＝-2.388	0.017
	LEGION(±s)	20	103±13	127±10	t＝-6.951	<0.001

分类	亚组	例数	术前	术后	统计值	P值
Keblish分型	轻度(±s)	13	105±14	128±9	t＝-5.035	<0.001
	中度[M(P₂₅，P₇₅)]	15	110(95，115)	135(115，140)	Z＝-3.305	0.001
性别	男性(±s)	9	106±13	126±12	t＝-4.243	0.003
	女性(±s)	19	106±13	130±9	t＝-7.071	<0.001
年龄	<70岁(±s)	11	112±14	129±10	t＝-3.450	0.006
	≥70岁[M(P₂₅，P₇₅)]	17	105(95，110)	135(117，140)	Z＝-3.634	<0.001
BMI	<24 kg/m²(±s)	12	100±11	125±11	t＝-5.623	<0.001
	≥24 kg/m² [M(P₂₅，P₇₅)]	16	110(101，120)	135(121，140)	Z＝-3.308	0.001
假体	ATTUNE [M(P₂₅，P₇₅)]	8	115(110，124)	137(127，140)	Z＝-2.388	0.017
	LEGION(±s)	20	103±13	127±10	t＝-6.951	<0.001

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