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Minimal under-correction gives better outcomes following total knee arthroplasty in severe varus knees—myth or reality?—analysis of one hundred sixty two knees with varus greater than fifteen degrees

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Abstract

Purpose of the study

To document and compare the functional outcome of neutral alignment and under-correction after total knee arthroplasty (TKA) in severe varus knees of more than 15° at three and 12 months post-surgery.

Materials and methods

One hundred twenty-four consecutive patients (163 TKAs) of an average age of 61.9 years (52–79) with a pre-operative varus more than 15° were managed with jig-based TKA. Based on the post-operative mechanical femorotibial alignment (FTMA), they were categorised into three groups, namely neutral (180 + 3°), mild varus (173° to 176°) and severe varus (172° and below). The outcomes of these three groups were assessed at three and 12 months by the Oxford knee score and the WOMAC score were calculated and co-related to the extent of correction.

Results

At three months, knees in the mild varus group (n = 88) had the best results with an Oxford knee score of 41.76 + 1.44 and a WOMAC score of 19.29 + 2.93 compared to the severe varus group and the neutral alignment group which had Oxford knee scores (OKS) of 37.43 + 2.51 and 31.91 + 3.51 and WOMAC scores of 22.57 + 1.51 and 24.46 + 4.15 respectively. However at 12 months, knees in all the groups (neutral, mild varus, severe varus) had similar good functional outcomes with OKS of 39.08 + 1.68, 39.24 + 1.88, 39.29 + 1.11 and WOMAC scores of 17.42 + 2.15, 16.48 + 2.11, 16.14 + 1.21 respectively. A scatter plot done for post-operative FTMA and the functional outcome score for both scores showed a bell curve with the best outcome corresponding to a FTMA of 175° at 3 months and equal distribution for both scores at 12 months.

Conclusion

The results of our study showed that minimal under-correction gave superior functional outcomes at three months. But this advantage was temporary and both, under-correction and neutral alignment achieved equally good outcomes at one year. Considering the increased prosthesis longevity associated with neutral alignment, we propose that neutral alignment must be aimed for during TKA for knees with severe varus.

Study Design

Prospective study

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Abbreviations

TKA:

total knee arthroplasty

FTMA:

mechanical femorotibial alignment

PACS:

picture archiving and communication system

OKS:

Oxford knee score

WOMAC:

Western University and McMaster University Osteoarthritis index

ADL:

activities of daily living

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Authors and Affiliations

  1. Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India

    Raja Bhaskara Rajasekaran, Dhanasekara Raja Palanisami, Rajkumar Natesan & Shanmuganathan Rajasekaran

Authors
  1. Raja Bhaskara Rajasekaran
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  2. Dhanasekara Raja Palanisami
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  3. Rajkumar Natesan
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  4. Shanmuganathan Rajasekaran
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Corresponding author

Correspondence to Raja Bhaskara Rajasekaran.

Ethics declarations

The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki.

Conflict of interest

The authors declare that they have no conflict of interest.

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Level of Evidence: Level II

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Rajasekaran, R.B., Palanisami, D.R., Natesan, R. et al. Minimal under-correction gives better outcomes following total knee arthroplasty in severe varus knees—myth or reality?—analysis of one hundred sixty two knees with varus greater than fifteen degrees. International Orthopaedics (SICOT) 44, 715–723 (2020). https://doi.org/10.1007/s00264-018-4240-0

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  • DOI: https://doi.org/10.1007/s00264-018-4240-0

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