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Medial femoral epicondyle upsliding osteotomy with posterior stabilized arthroplasty provided good clinical outcomes such as constrained arthroplasty in primary total knee arthroplasty with severe valgus deformity

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A modified technique referred to as a medial femoral epicondyle upsliding osteotomy was proposed to address severe valgus deformity with unconstrained posterior stabilized (PS) arthroplasty. The study compared the effectiveness of the technique and PS arthroplasty with constrained arthroplasty during primary total knee arthroplasty (TKA).

Methods

Fifty-three patients presenting with valgus knees with a mean valgus angle (VA) greater than 30° were prospectively randomized and divided into two groups, and both groups received primary TKA. Upsliding osteotomy with PS arthroplasty was performed on the knees of 27 patients (group A), while the remaining 26 patients (group B) received a constrained arthroplasty. The Knee Society function score (KSF), Hospital for Special Surgery knee score (HSS), range of motion (ROM), mediolateral stability and hospitalization expenses were recorded. The hip–knee–ankle angle (HKA), femorotibial angle (FTA) and VA were analysed. Complications were also recorded.

Results

The patients received follow-up care for more than 50 months. The postoperative KSF, HSS and ROM showed marked improvement in both groups (p < 0.05). Radiological assessments showed that HKA, FTA and VA for group A were restored to (179.9 ± 3.0)°, (173.0 ± 2.4)° and (7.0 ± 2.4)°, respectively. For group B, the HKA, FTA and VA were restored to (181.5 ± 2.3)°, (172.5 ± 2.3)° and (7.5 ± 2.3)°, respectively. Only two patients from group A demonstrated mild medial laxity in their knees, and the remaining patients from both groups were stable medially and laterally. However, the total hospitalization expenses and material expenses of group A were less than those of group B because of the more expensive constrained prosthesis and stems. No late-onset loosening or recurrent valgus deformity was displayed.

Conclusions

Both medial femoral epicondyle upsliding osteotomy with PS arthroplasty and constrained arthroplasty showed good outcomes for the restoration of neutral limb alignment and soft tissue balance, which are demonstrated to be safe and effective techniques for correcting severely valgus knees. Therefore, the clinically important finding of this study is that medial femoral epicondyle upsliding osteotomy with PS arthroplasty can be an alternative method for correcting severe valgus knees.

Level of evidence

II.

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Acknowledgements

Study approval was obtained from the Clinical Trials and Biomedical Ethics Committee of Hospital, and all participants signed informed consents for the surgery. P.M. and Y.Z. contributed equally to this work and should be considered as equal first authors.

Funding

This research was funded by the National Natural Science Foundation of China Program (81501873 and 81601936), Science and Technology Support Project of Sichuan Province (2011FZ0040) and New Technique Program of West China Hospital (317).

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Authors and Affiliations

  1. Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People’s Republic of China

    Ping Mou, Yi Zeng, Fuxing Pei, Zongke Zhou, Bin Shen, Pengde Kang & Jing Yang

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  1. Ping Mou
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Correspondence to Jing Yang.

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All authors declare that they have no conflict of interest or personal relationships with other people or organizations that might inappropriately influence this study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Mou, P., Zeng, Y., Pei, F. et al. Medial femoral epicondyle upsliding osteotomy with posterior stabilized arthroplasty provided good clinical outcomes such as constrained arthroplasty in primary total knee arthroplasty with severe valgus deformity. Knee Surg Sports Traumatol Arthrosc 27, 2266–2275 (2019). https://doi.org/10.1007/s00167-018-5292-9

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