Influence of the post-operative axis on the clinical results of total knee replacement for severe varus deformities: does a slight residual varus improve the results?

Abstract : PURPOSE: Some recent articles have suggested that in the case of large varus deformity, it may be advantageous to leave some residual post-operative varus as a means of improving functional outcome. The objective of this study is to compare the results of total knee replacement (TKR) performed for significant varus deformity (HKA < 170°) where there is a residual post-operative varus (HKA < 180°) to the results of TKR for significant varus deformity with either neutral post-operative (HKA = 180°) or mild valgus post-operative alignment (HKA > 180°). METHODS: This series was made up of 208 knees. The mean pre-operative HKA angle was 166 ± 3° (154-169°), of which 150 were followed up for a mean 8.5 years (58 lost to follow-up). Based on post-operative radiographs, two groups were formed: group 1 (88 knees) in which post-operative alignment was 177.8 ± 1° (175-179°) and group 2 (62 knees) in which post-operative alignment was 181 ± 1° (180-184°). RESULTS: The mean international knee society (IKS) score for group 1 was 178.8 ± 22 points (113-200) and 181.7 ± 22 points (95-200) for group 2. Oxford knee score was 20.4 ± 9 points (12-45) in group 1 and 19.2 ± 9 (12-50) in group 2. The results were slightly better in group 2 (in slight valgus) but this difference was not statistically significant (p = 0.44 and 0.4). CONCLUSION: The results of knee replacement performed for severe varus deformity are not adversely affected by post-operative valgus alignment. There is in fact a trend towards superior results for neutral or valgus alignment than slight residual varus, but this difference was not statistically significant.
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https://hal.archives-ouvertes.fr/hal-02264096
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Submitted on : Tuesday, August 6, 2019 - 11:37:33 AM
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Dominique Saragaglia, Loïc Sigwalt, Ramsay Refaie, Brice Rubens-Duval, Gabriel Lateur, et al.. Influence of the post-operative axis on the clinical results of total knee replacement for severe varus deformities: does a slight residual varus improve the results?. International Orthopaedics, Springer Verlag, 2019, 43 (7), pp.1621-1626. ⟨10.1007/s00264-018-4092-7⟩. ⟨hal-02264096⟩

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