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International Orthopaedics

, Volume 43, Issue 2, pp 333–341 | Cite as

Total knee arthroplasty in patients with varus deformities greater than ten degrees: survival analysis at a mean ten year follow-up

  • Benjamin Puliero
  • Henri Favreau
  • David Eichler
  • Philippe Adam
  • François Bonnomet
  • Matthieu EhlingerEmail author
Original Paper

Abstract

Introduction

Total knee arthoplasty (TKA) is a secure procedure with more than 90% survival at ten years. The purpose of this study was to report both clinical and radiological outcomes of TKA with a varus > 10°. The second objective was to identify risk factors for failure or bad clinical results. Our hypothesis was that results and survey are comparable to TKA with lesser deformities.

Methods

Eighty-two TKA (69 patients) between January 2004 and December 2008 with a varus > 10° were reviewed retrospectively. The endpoints were clinical (range of motion, IKS knee score, Oxford, and SF-12) and radiological (HKA post-operative and the existence of radiolucent lines or loosening at last follow-up).

Results

Sixty-three TKA (55 patients) were assessed with a mean follow-up of 10.9 years. The global IKS score significantly increased (p = 0.04). Seven TKA needed a revision: two for sepsis, four for aseptic loosening, and one for polyethylene wear, with an overall survival of 91.6% at ten years. For aseptic loosening, the survival rate was 94.7% at ten years. Risk factors for failure were age (p = 0.001), weight (p = 0.04), and a post-operative HKA lesser than 175° (p = 0.05) for aseptic loosening.

Discussion

The hypothesis was confirmed: the results showed a significant improvement of function and quality of life with a survival rate comparable to those found in the literature for greater varus but also inferior to 10°. Three risk factors have been identified suggesting increased surveillance in these cases.

Conclusion

The results of this survey confirm the work hypothesis. Total knee arthroplasty in patients with important axial deformities is a confirmed, reliable, patient-friendly and predictable good outcome procedure.

Keywords

Total knee arthroplasty Varus Complication Risk factors Coronal deformity 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

PA: consulting activity for Depuy-Synthes

FB: consulting activity for Serf, Amplitude

ME: consulting activity Depuy-Synthes, Newclip, Lepine

BP, DE, HF: None

References

  1. 1.
    Ritter MA (2009) The anatomical graduated component total knee replacement: a long-term evaluation with 20-year survival analysis. J Bone Joint Surg (Br) 91B:745–749.  https://doi.org/10.1302/0301-620X.91B6.21854 CrossRefGoogle Scholar
  2. 2.
    Fernandez-Fernandez R, Rodriguez-Merchan EC (2015) Better survival of total knee replacement in patients older than 70 years: a prospective study with 8 to 12 years follow-up. Arch Bone Joint Surg 3:22–28Google Scholar
  3. 3.
    Rand JA, Ilstrup DM (1991) Survivorship analysis of total knee arthroplasty: cumulative rates of survival of 9200 total knee arthroplasties. J Bone Joint Surg Am 73A:397–409CrossRefGoogle Scholar
  4. 4.
    Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS (2003) Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 85A:259–265CrossRefGoogle Scholar
  5. 5.
    Furnes O, Espehaug B, Lie SA, Vollset SE, Engesaeter LB, Havelin LI (2002) Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994–2000. Acta Orthop Scand 73:117–129.  https://doi.org/10.1080/000164702753671678 CrossRefGoogle Scholar
  6. 6.
    Lygre SH, Vollset SE, Furnes O (2011) Failure of total knee arthroplasty with or without patella resurfacing. Acta Orthop 82:282–292CrossRefGoogle Scholar
  7. 7.
    Sundberg M, Lidgren L, W-Dahl A, Robertsson O. Swedish Knee Arthroplasty Register ; Lund University. http://www.myknee.se/pdf/SVK
  8. 8.
    Gøthesen O, Espehaug B, Havelin L, Petursson G, Lygre S, Ellison P et al (2013) Survival rates and causes of revision in cemented primary total knee replacement: a report from the Norwegian Arthroplasty Register 1994–2009. Bone Joint J 95:636–642CrossRefGoogle Scholar
  9. 9.
    Argenson JN, Boisgard S, Parratte S, Descamps S, Bercovy M, Bonnevialle P et al (2013) Survival analysis of total knee arthroplasty at a minimum 10 years’ follow-up: a multicenter French nationwide study including 846 cases. Orthop Traumatol Surg Res 99:385–390CrossRefGoogle Scholar
  10. 10.
    Teeny SM, Krackow KA, Hungerford DS, Jones M (1991) Primary total knee arthroplasty in patients with severe varus deformity. A comparative study. Clin Orthop Relat Res 273:19–31Google Scholar
  11. 11.
    Karachalios T, Sarangi PP, Newman JH (1994) Severe varus and valgus deformities treated by total knee arthroplasty. J Bone Joint Surg Br 76:938–942CrossRefGoogle Scholar
  12. 12.
    Ritter MA, Faris GW, Faris PM, Davis KE (2004) Total knee arthroplasty in patients with angular varus or valgus deformities of > or = 20 degrees. J Arthroplast 19:862–866.  https://doi.org/10.1016/j.arth.2004.03.009
  13. 13.
    Harrysson OL, Robertsson O, Nayfeh JF (2004) Higher cumulative revision rate of knee arthroplasties in younger patients with osteoarthritis. Clin Orthop Relat Res 421:162–168CrossRefGoogle Scholar
  14. 14.
    Mullaji AB, Padmanabhan V, Jindal G (2005) Total knee arthroplasty for profound varus deformity: technique and radiological results in 173 knees with varus of more than 20 degrees. J Arthroplast 20:550–561CrossRefGoogle Scholar
  15. 15.
    Charnley J (1972) The long-term results of a low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surgery (Br) 54:61–76CrossRefGoogle Scholar
  16. 16.
    Devane PA, Robinson EJ, Bourne RB, Rorabeck CH, Nayak NN, Horne JG (1997) Measurement of polyethylene wear in acetabular components inserted with and without cement. A randomized trial. J Bone Joint Surg Am 79:682–689CrossRefGoogle Scholar
  17. 17.
    Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
  18. 18.
    Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ et al (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg (Br) 89:1010–1014CrossRefGoogle Scholar
  19. 19.
    Ornetti P, Perruccio AV, Roos EM, Lohmander LS, Davis AM, Maillefert JF (2009) Psychometric properties of the French translation of the reduced KOOS and HOOS (KOOS-PS and HOOS-PS). Osteoarthr Cartil 17:1604–1608CrossRefGoogle Scholar
  20. 20.
    Liu HC, Kuo FC, Huang CC, Wang JW (2015) Mini-midvastus total knee arthroplasty in patients with severe varus deformity. Orthopedics 38:e112–e117CrossRefGoogle Scholar
  21. 21.
    Kim MS, Koh IJ, Choi YJ, Kim YD, In Y (2017) Correcting severe Varus deformity using trial components during total knee arthroplasty. J Arthroplast 32:1488–1495CrossRefGoogle Scholar
  22. 22.
    Czekaj J, Fary C, Gaillard T, Lustig S (2017) Does low-constraint mobile bearing knee prosthesis give satisfactory results for severe coronal deformities? A five to twelve year follow up study. Int Orthop 41:1369–1377CrossRefGoogle Scholar
  23. 23.
    Saragaglia D, Sigwalt L, Gaillot J, Morin V, Rubens-Duval B, Pailhé R (2017) Results with eight and a half years average follow-up on two hundred and eight e-Motion FP® knee prosthesis, fitted using computer navigation for knee osteoarthritis in patients with over ten degrees genu varum. Int Orthop.  https://doi.org/10.1007/s00264-017-3618-8
  24. 24.
    Hofmann AA, Evanich JD, Ferguson RP, Camargo MP (2001) Ten- to 14-year clinical follow up of the cementless natural knee system. Clin Orthop Relat Res 388:85–94CrossRefGoogle Scholar
  25. 25.
    Roberts VI, Esler CN, Harper WM (2007) A 15-year follow-up study of 4606 primary total knee replacements. J Bone Joint Surg (Br) 89:1452–1456CrossRefGoogle Scholar
  26. 26.
    Abdel MP, Bonadurer GF, Jenning MT, Hanssen AD (2015) Increased aseptic tibial failures in patients with BMI ≥35 and well-aligned total knee arthroplasties. J Arthroplast 30:2181–2184CrossRefGoogle Scholar
  27. 27.
    Fehring TK, Fehring KA, Anderson LA, Otero JE, Springer BD (2017) Catastrophic varus collapse of the tibia in obese total knee arthroplasty. J Arthroplast 32:1625–1629CrossRefGoogle Scholar
  28. 28.
    Kim YH, Park JW, Kim JS, Park SD (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38:379–385CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de HautepierreHôpitaux Universitaires de StrasbourgStrasbourg cedexFrance
  2. 2.Laboratoire ICube, CNRS UMR 7357IlkirchFrance

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