Skip to main content

Advertisement

SpringerLink
Log in

Severity of valgus knee osteoarthritis has no effect on clinical outcomes after total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Advanced valgus osteoarthritis (OA) is one of the most challenging indications for total knee arthroplasty (TKA). There is no information in the literature about the optimal timing of surgery. The current study investigates the impact of the preoperative deformity and degree of arthritis on postoperative outcome after TKA.

Material and methods

The study evaluated 133 knees in 107 patients with valgus OA that failed nonoperative treatment with a minimum 2-year follow-up. Mechanical alignment, Kellgren and Lawrence (K/L) score, and minimal joint space width (minJSW) were measured on AP- and hip-to-ankle radiographs. All knees had advanced OA (i.e., K/L grades 3 or 4 and less than 50% minJSW). Pre- and postoperative WOMAC, VR-12, UCLA, VAS, ROM were recorded.

Results

There was no difference in clinical outcome (WOMAC, UCLA, VR-12, VAS or ROM) between patients with different degrees of valgus deformities (< 5.0 deg., 5.0–9.9 deg., 10.0–14.9 deg., ≥ 15.0 deg.). There was also no correlation between K/L score or minimal joint space width and any of the outcome parameters.

Conclusions

The degree of valgus deformity and the grade of osteoarthritis do not predict the outcome of TKA in patients with valgus OA. Since the risk of complication and the need for implant constraint increases with increasing deformity and instability of the knee, surgery appears to be justified in patients with advanced OA that failed nonoperative treatment, regardless of the degree of deformity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Mancuso CA, Ranawat CS, Esdaile JM, Johanson NA, Charlson ME (1996) Indications for total hip and total knee arthroplasties. Results of orthopaedic surveys. J Arthroplast 11(1):34–46

    Article  CAS  Google Scholar 

  2. Liang MH, Cullen KE, Poss R (1982) Primary total hip or knee replacement: evaluation of patients. Ann Intern Med 97(5):735–739

    Article  CAS  Google Scholar 

  3. Perry KI, Strasser NL, Harmsen WS, Pagnano MW, Trousdale RT (2015) Minimal preoperative degenerative arthritis may not predict poor tka outcome. Orthopedics 38(8):e681-684. https://doi.org/10.3928/01477447-20150804-54

    Article  PubMed  Google Scholar 

  4. Chang CB, Yoo JH, Koh IJ, Kang YG, Seong SC, Kim TK (2010) Key factors in determining surgical timing of total knee arthroplasty in osteoarthritic patients: age, radiographic severity, and symptomatic severity. J Orthop Traumatol Off J Italian Soc Orthop Traumatol 11(1):21–27. https://doi.org/10.1007/s10195-010-0086-y

    Article  Google Scholar 

  5. Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Belisle P, Liang MH, Ferland D, Phillips CB, Mahomed N, Tanzer M, Sledge C, Fossel AH, Katz JN (2002) Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthr Rheum 46(12):3327–3330. https://doi.org/10.1002/art.10631

    Article  Google Scholar 

  6. Gidwani S, Tauro B, Whitehouse S, Newman JH (2003) Do patients need to earn total knee arthroplasty? J Arthroplast 18(2):199–203. https://doi.org/10.1054/arth.2003.50021

    Article  CAS  Google Scholar 

  7. Kennedy LG, Newman JH, Ackroyd CE, Dieppe PA (2003) When should we do knee replacements? Knee 10(2):161–166

    Article  Google Scholar 

  8. Peck CN, Childs J, McLauchlan GJ (2014) Inferior outcomes of total knee replacement in early radiological stages of osteoarthritis. Knee 21(6):1229–1232. https://doi.org/10.1016/j.knee.2014.08.018

    Article  CAS  PubMed  Google Scholar 

  9. Boettner F, Renner L, Arana Narbarte D, Egidy C, Faschingbauer M (2016) Total knee arthroplasty for valgus osteoarthritis: the results of a standardized soft-tissue release technique. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 24(8):2525–2531. https://doi.org/10.1007/s00167-016-4054-9

    Article  Google Scholar 

  10. Idusuyi OB, Morrey BF (1996) Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Jt Surg Am Vol 78(2):177–184

    Article  CAS  Google Scholar 

  11. Asp JP, Rand JA (1990) Peroneal nerve palsy after total knee arthroplasty. Clin Orthop Relat Res 261:233–237

    Google Scholar 

  12. Cooke TD, Sled EA, Scudamore RA (2007) Frontal plane knee alignment: a call for standardized measurement. J Rheumatol 34(9):1796–1801

    PubMed  Google Scholar 

  13. Buckland-Wright JC, Macfarlane DG, Williams SA, Ward RJ (1995) Accuracy and precision of joint space width measurements in standard and macroradiographs of osteoarthritic knees. Ann Rheum Dis 54(11):872–880

    Article  CAS  Google Scholar 

  14. Vignon E, Brandt KD, Mercier C, Hochberg M, Hunter D, Mazzuca S, Powell K, Wyman B, Le Graverand MP (2010) Alignment of the medial tibial plateau affects the rate of joint space narrowing in the osteoarthritic knee. Osteoarthr Cartil/OARS Osteoarthr Res Soc 18(11):1436–1440. https://doi.org/10.1016/j.joca.2010.08.012

    Article  CAS  Google Scholar 

  15. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502

    Article  CAS  Google Scholar 

  16. Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160. https://doi.org/10.3758/brm.41.4.1149

    Article  PubMed  Google Scholar 

  17. Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Jt Surg Br Vol 92(9):1253–1258. https://doi.org/10.1302/0301-620x.92b9.24394

    Article  CAS  Google Scholar 

  18. Lim JT, Luscombe KL, Jones PW, White SH (2006) The effect of preoperative symptom severity on functional outcome of total knee replacement–patients with the lowest preoperative scores achieve the lowest marks. Knee 13(3):216–219. https://doi.org/10.1016/j.knee.2006.01.006

    Article  CAS  PubMed  Google Scholar 

  19. Meftah M, White PB, Ranawat AS, Ranawat CS (2016) Long-term results of total knee arthroplasty in young and active patients with posterior stabilized design. Knee 23(2):318–321. https://doi.org/10.1016/j.knee.2015.10.008

    Article  PubMed  Google Scholar 

  20. Meding JB, Ritter MA, Faris PM, Keating EM, Harris W (2001) Does the preoperative radiographic degree of osteoarthritis correlate to results in primary total knee arthroplasty? J Arthroplast 16(1):13–16. https://doi.org/10.1054/arth.2001.16501

    Article  CAS  Google Scholar 

  21. Guermazi A, Niu J, Hayashi D, Roemer FW, Englund M, Neogi T, Aliabadi P, McLennan CE, Felson DT (2012) Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ (Clin Res Ed) 345:e5339. https://doi.org/10.1136/bmj.e5339

    Article  Google Scholar 

  22. Kijowski R, Blankenbaker DG, Stanton PT, Fine JP, Smet AAD (2006) Radiographic findings of osteoarthritis versus arthroscopic findings of articular cartilage degeneration in the tibiofemoral joint. Radiology 239(3):818–824. https://doi.org/10.1148/radiol.2393050584

    Article  PubMed  Google Scholar 

  23. Rueckl K, Boettner F, Maza N, Runer A, Bechler U, Sculco P (2017) The posterior–anterior flexed view is better than the anterior–posterior view for assessing osteoarthritis of the knee. Skelet Radiol. https://doi.org/10.1007/s00256-017-2815-2

    Article  Google Scholar 

  24. Rueckl K, Runer A, Bechler U, Faschingbauer M, Boelch SP, Sculco PK, Boettner F (2019) The posterior–anterior-flexed view is essential for the evaluation of valgus osteoarthritis. A prospective study on 134 valgus knees. BMC Musculoskeletl Disord 20(1):636. https://doi.org/10.1186/s12891-019-3012-3

    Article  Google Scholar 

  25. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS (2003) Factors affecting the durability of primary total knee prostheses. J Bone Jt Surg Am Vol 85-a(2):259–265

    Article  Google Scholar 

  26. Maempel JF, Riddoch F, Calleja N, Brenkel IJ (2015) Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients. Acta Orthop 86(4):451–456. https://doi.org/10.3109/17453674.2015.1040304

    Article  PubMed  PubMed Central  Google Scholar 

  27. Stern SH, Moeckel BH, Insall JN (1991) Total knee arthroplasty in valgus knees. Clin Orthop Relat Res 273:5–8

    Google Scholar 

  28. Ritter MA, Davis KE, Davis P, Farris A, Malinzak RA, Berend ME, Meding JB (2013) Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Jt Surg Am Vol 95(2):126–131. https://doi.org/10.2106/jbjs.k.00607

    Article  Google Scholar 

  29. Martin JR, Beahrs TR, Stuhlman CR, Trousdale RT (2016) Complex primary total knee arthroplasty: long-term outcomes. J Bone Jt Surg Am Vol 98(17):1459–1470. https://doi.org/10.2106/jbjs.15.01173

    Article  Google Scholar 

  30. Miyasaka KC, Ranawat CS, Mullaji A (1997) 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 345:29–37

    Article  Google Scholar 

  31. Bruzzone M, Ranawat A, Castoldi F, Dettoni F, Rossi P, Rossi R (2010) The risk of direct peroneal nerve injury using the Ranawat “inside-out” lateral release technique in valgus total knee arthroplasty. J Arthroplast 25(1):161–165. https://doi.org/10.1016/j.arth.2008.08.016

    Article  Google Scholar 

  32. Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Jt Surg Am Vol 87:271–284. https://doi.org/10.2106/jbjs.e.00308

    Article  Google Scholar 

  33. Rose HA, Hood RW, Otis JC, Ranawat CS, Insall JN (1982) Peroneal-nerve palsy following total knee arthroplasty. A review of The Hospital for Special Surgery experience. J Bone Jt Surg Am Vol 64(3):347–351

    Article  CAS  Google Scholar 

  34. Nercessian OA, Ugwonali OF, Park S (2005) Peroneal nerve palsy after total knee arthroplasty. J arthroplast 20(8):1068–1073. https://doi.org/10.1016/j.arth.2005.02.010

    Article  Google Scholar 

  35. Barlow BT, McLawhorn AS, Westrich GH (2017) The cost-effectiveness of dual mobility implants for primary total hip arthroplasty: a computer-based cost-utility model. J Bone Jt Surg Am Vol 99(9):768–777. https://doi.org/10.2106/jbjs.16.00109

    Article  Google Scholar 

  36. Baker PN, Rushton S, Jameson SS, Reed M, Gregg P, Deehan DJ (2013) Patient satisfaction with total knee replacement cannot be predicted from pre-operative variables alone: a cohort study from the national joint registry for England and Wales. Bone Jt J 95-b(10):1359–1365. https://doi.org/10.1302/0301-620x.95b10.32281

    Article  CAS  Google Scholar 

  37. Völlner F, Herl F, Greimel F, Benditz A, Renkawitz T, Grifka J, Craiovan B, Weber M (2020) The effects of soft tissue lateral release on the stability of the ligament complex of the knee. Arch Orthop Trauma Surg 140(7):933–940. https://doi.org/10.1007/s00402-020-03422-6

    Article  PubMed  PubMed Central  Google Scholar 

  38. Savov P, Mielke E, Windhagen H, Calliess T, Richter A, Ettinger M (2020) Higher revision rate for posterior cruciate-retaining than posterior-stabilized total knee arthroplasty for the treatment of valgus osteoarthritis. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03618-w

    Article  PubMed  PubMed Central  Google Scholar 

  39. Peterfy C, Li J, Zaim S, Duryea J, Lynch J, Miaux Y, Yu W, Genant HK (2003) Comparison of fixed-flexion positioning with fluoroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: test–retest reproducibility. Skelet Radiol 32(3):128–132. https://doi.org/10.1007/s00256-002-0603-z

    Article  CAS  Google Scholar 

  40. Reichmann WM, Maillefert JF, Hunter DJ, Katz JN, Conaghan PG, Losina E (2011) Responsiveness to change and reliability of measurement of radiographic joint space width in osteoarthritis of the knee: a systematic review. Osteoarthr Carti/OARS Osteoarthr Res Soc 19(5):550–556. https://doi.org/10.1016/j.joca.2011.01.023

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Kilian Rueckl, Armin Runer, Anna Jungwirth-Weinberger & Friedrich Boettner

  2. Department of Orthopedic, University of Wuerzburg, Wuerzburg, Germany

    Kilian Rueckl

  3. Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria

    Maximilian F. Kasparek

  4. Department of Orthopedic Surgery, Ulm University Hospital, University of Ulm, Ulm, Germany

    Martin Faschingbauer

Authors
  1. Kilian Rueckl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Armin Runer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Jungwirth-Weinberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maximilian F. Kasparek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Martin Faschingbauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Friedrich Boettner
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: FB, KR, MFK; Material preparation, data collection and analysis: KR, AR, AJ, MF; Draft of the manuscript: KR; Scientific supervision: FB.

Corresponding author

Correspondence to Friedrich Boettner.

Ethics declarations

Conflict of interest

Author FB has received royalties from Smith and Nephew and OrthoDevelopment and is consultant for Smith and Nephew, OrthoDevelopment, DePuy and Medtronic. He receives research support as a principal investigator for DePuy. All other authors declare they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The study received IRB approval by the institutional review board at the Hospital for Special Surgery (IRB number: 2017 – 0418).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rueckl, K., Runer, A., Jungwirth-Weinberger, A. et al. Severity of valgus knee osteoarthritis has no effect on clinical outcomes after total knee arthroplasty. Arch Orthop Trauma Surg 141, 1385–1391 (2021). https://doi.org/10.1007/s00402-021-03785-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-03785-4

Keywords

Search

Navigation