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Custom TKA enables adequate realignment with minimal ligament release and grants satisfactory outcomes in knees that had prior osteotomies or extra-articular fracture sequelae

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To report the early clinical and radiographic outcomes of custom total knee arthroplasty (TKA) in knees that had prior osteotomies and/or extra-articular fracture sequelae.

Methods

The authors retrospectively analysed a consecutive series of 444 knees that received custom TKA between 2016 and 2019 and identified 41 knees that had prior extra-articular events (osteotomies or fracture sequelae). Patients responded to pre- and post-operative (> 12 months) questionnaires, including Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and Knee injury and Osteoarthritis Outcome Score (KOOS). Net improvements were calculated by subtracting pre- from post-operative scores. In addition to a preoperative CT scan, pre- and post-operative long-leg weight-bearing radiographs were obtained, on which the hip–knee–ankle (HKA) angle, femoral mechanical angle (FMA, between femoral mechanical axis and joint line) and tibial mechanical angle (TMA, between tibial mechanical axis and joint line) angles were measured, and alignment was planned within a ‘target zone’ of FMA and TMA within 85°–95° and HKA angle within 175°–183°. Agreements between preoperative, planned and post-operative angles were calculated using intra-class correlation coefficients (ICC).

Results

From the initial 41 knees, 3 had incomplete post-operative data and 1 was revised for painful stiffness due to uncorrected rotational malunion, leaving 37 knees for analysis. Twenty had prior osteotomies (tibia, n = 18, femur, n = 2), 8 had isolated fractures (tibial, n = 3; femoral, n = 5), and 9 had both osteotomies and fractures. Postoperative coronal alignments were 90.4° ± 2.4° for FMA, 89.3° ± 2.6° for TMA and 179.9° ± 3.0° for HKA angle. Agreements between planned and achieved alignments were fair to excellent, and 29 (78%) knees were within the ‘target zone’. At a mean follow-up of 15 ± 5 months, all clinical scores had improved significantly (p < 0.001).

Conclusions

Custom TKA granted satisfactory clinical outcomes and a low complication rate in knees that had prior osteotomies and/or extra-articular fracture sequelae. Using custom implants and strategies for coronal alignment, 29 (78%) of the 37 knees were successfully aligned within the ‘target zone’, and 35 (95%) of the 41 knees did not require ligament release.

Level of evidence

IV.

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Funding

The authors are grateful to "GCS Ramsay Santé pour l’Enseignement et la Recherche" for funding the statistical analysis and manuscript preparation for this study.

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Authors and Affiliations

  1. Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France

    Jeremy Daxhelet, Tarik Aït-Si-Selmi, Salvatore Ratano, Louka Bondoux & Michel P. Bonnin

  2. ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland

    Jacobus H. Müller & Mo Saffarini

  3. University Hospital “Saint Marina”, Varna, Bulgaria

    Kalin Mihov

Authors
  1. Jeremy Daxhelet
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  2. Tarik Aït-Si-Selmi
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  3. Jacobus H. Müller
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  4. Mo Saffarini
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  5. Salvatore Ratano
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  6. Louka Bondoux
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  7. Kalin Mihov
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  8. Michel P. Bonnin
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Corresponding author

Correspondence to Mo Saffarini.

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Conflict of interest

JD has nothing to declare. TASS reports personal fees from DePuy-Synthes and from Symbios. JHM has nothing to declare. MS has nothing to declare. SR has nothing to declare. LB has nothing to decalre. KM has nothing to declare. MPB reports personal fees from DePuy Synthes, Wright Medical, Integra and Symbios.

Ethical approval

All patients had provided written informed consent for the use of their data and images for research and publishing purposes and the institutional review board approved the study in advance (IRB reference number: COS-RGDS-2021-01-003-AITSISELMI-T; Ramsay Santé Comité d’Ethique).

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Daxhelet, J., Aït-Si-Selmi, T., Müller, J.H. et al. Custom TKA enables adequate realignment with minimal ligament release and grants satisfactory outcomes in knees that had prior osteotomies or extra-articular fracture sequelae. Knee Surg Sports Traumatol Arthrosc 31, 1212–1219 (2023). https://doi.org/10.1007/s00167-021-06619-3

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  • DOI: https://doi.org/10.1007/s00167-021-06619-3

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