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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?

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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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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France

    Dominique Saragaglia, Loïc Sigwalt, Brice Rubens-Duval, Gabriel Lateur & Régis Pailhé

  2. Department of Trauma and Orthopaedics, Wansbeck Hospital, Ashington, Northumberland, UK

    Ramsay Refaie

Authors
  1. Dominique Saragaglia
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  2. Loïc Sigwalt
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  3. Ramsay Refaie
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  4. Brice Rubens-Duval
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  5. Gabriel Lateur
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  6. Régis Pailhé
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Corresponding author

Correspondence to Dominique Saragaglia.

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Conflict of interest

The authors declare that they have no conflict of interest related to this article. D. Saragaglia receives royalties from B-Braun related to the e-Motion Knee Prosthesis. The other authors had, sometimes, financial support for attending orthopaedics meetings.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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

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Saragaglia, D., Sigwalt, L., Refaie, R. 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 (SICOT) 43, 1621–1626 (2019). https://doi.org/10.1007/s00264-018-4092-7

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