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Preoperative valgus deformity has twice the risk of failure as compared to varus deformity after total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to assess whether preoperative valgus or varus deformity affected survivorship after total knee arthroplasty (TKA) and to quantify the risk factors for implant failure in a registry-based population.

Methods

The Emilia-Romagna Registry of Prosthetic Orthopedic Implants was examined regarding TKAs performed on patients with a preoperative diagnosis of valgus or varus deformity. Demographics, implant characteristic and survivorships were investigated and compared. A total of 2327 TKA procedures performed from 2000 to 2016 were included in the study. Six hundred and forty primary TKAs with a diagnosis of valgus deformity were evaluated with a median follow-up of 3.3 years; 1687 primary TKAs with a diagnosis of varus deformity were evaluated with a median follow-up of 2.5 years.

Results

Bi-compartmental, cemented posterior stabilised fixed-bearing implants were preferred. For both diagnoses, the implant survivorship rate was greater than 98% in the first year. However, the survival curve of the TKAs implanted for valgus deformity showed a greater slope in the first 3 years as compared to the survival curve of those implanted for varus deformity. Valgus deformity had a 2.1-fold higher risk for revision as compared with varus deformity. Infection was a major cause of implant failure in TKAs for varus deformity, 9/24 (37.5%), while its incidence was lower for valgus deformity, 1/21 (4.8%).

Conclusions

Preoperative valgus alignment showed a twofold risk of failure as compared to varus alignment after TKA. This should be considered in daily practice, and surgeons are called on to pay more attention when performing TKAs on such patients. Prospective randomised controlled trials are, therefore, necessary to better understand the role of preoperative coronal knee deformity in implant failure.

Level of evidence

Prognostic study, level III.

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Acknowledgements

The authors wish to express their gratitude to Audrey Pisani and Arianna Neely for their editing assistance.

Funding

This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy

    Antonio Mazzotti, Fabrizio Perna & Cesare Faldini

  2. Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy

    Davide Golinelli

  3. IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy

    Irene Quattrini

  4. Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy

    Susanna Stea & Barbara Bordini

Authors
  1. Antonio Mazzotti
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  2. Fabrizio Perna
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  3. Davide Golinelli
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  4. Irene Quattrini
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  7. Cesare Faldini
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Correspondence to Davide Golinelli.

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Conflict of interest

Antonio Mazzotti, Fabrizio Perna, Davide Golinelli, Irene Quattrini, Susanna Stea, Barbara Bordini and Cesare Faldini declare that they have no conflict of interest.

Ethical approval

Ethical approval was not necessary due to the features of the registry; the standard practice of data collection was used for all patients in the region, using a specific format which protected the identity of the patient.

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Mazzotti, A., Perna, F., Golinelli, D. et al. Preoperative valgus deformity has twice the risk of failure as compared to varus deformity after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 3041–3047 (2019). https://doi.org/10.1007/s00167-018-5331-6

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  • DOI: https://doi.org/10.1007/s00167-018-5331-6

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