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Prothèses totales sur genu valgum

  • Chapter
La gonarthrose

Part of the book series: Approche pratique en orthopédie-traumatologie ((APPRPRAT))

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Conclusion

La majorité des gonarthroses sur genu valgum ne pose pas des problèmes techniques plus difficiles que les genu varum et les résultats sont comparables.

L’équilibre ligamentaire est basé sur la conservation de l’espace du compartiment interne sain et la réaxation du genou se fait au prix de libérations bien codifiées, par certains, des parties molles externes et permet de rééquilibrer en même temps l’angle Q et la fémoro-patellaire. Jusqu’à 20† de déformation, on peut implanter des prothèses non contraintes avec conservation du ligament croisé postérieur.

Les grandes déformations, à partir de 20†, posent des problèmes techniques plus difficiles, en particulier quand il y a une déformation osseuse extra-articulaire (après une ostéotomie hypercorrigée ou un cal vicieux traumatique).

L’utilisation de prothèses postéro-stabilisées, en sacrifiant les ligaments croisés et en relachant largement la concavité, peut permettre de corriger des déformations importantes, comme le montre la littérature, mais au prix d’inconvénients dont les plus gênants sont l’ascension de l’interligne articulaire lié à un plateau épais, l’abaissement de la rotule, la tension du système extenseur et des axes vasculo-nerveux et l’allongement du membre.

Dans ces cas très particuliers, on peut aussi choisir des prothèses non contraintes associées à des ostéotomies pour corriger la déformation osseuse. Il est préférable de faire en même temps la prothèse et l’ostéotomie, plutôt que de faire les deux opérations successivement. Les ostéotomies surajoutées n’ont donc pas péjoré les résultats de ces prothèses, qui sont par ailleurs meilleurs que ceux de la littérature, pour des indications comparables.

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  1. Centre hospitalier Lyon-Sud, rue du Grand-Revoyet, 69310, Pierre-Bénite, France

    J. L. Lerat, A. Godenèche, B. Moyen & J. L. Besse

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Lerat, J.L., Godenèche, A., Moyen, B., Besse, J.L. (2006). Prothèses totales sur genu valgum . In: La gonarthrose. Approche pratique en orthopédie-traumatologie. Springer, Paris. https://doi.org/10.1007/2-287-30285-9_27

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  • DOI: https://doi.org/10.1007/2-287-30285-9_27

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-287-30052-3

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