A Total Knee Arthroplasty in 50-Year Old Woman with Post-traumatic Knee Osteoarthritis with Ipsilateral Femoral Extraarticular Deformity: A Case Report
TKA in PTKOA with Extraarticular Deformity
DOI:
https://doi.org/10.31282/joti.v5n2.100Keywords:
primary arthoplasty, knee joint, extraarticular deformity, total knee arthroplastyAbstract
Introduction: Extraarticular deformities in patients with post-traumatic knee osteoarthritis presents a challenge in total knee arthroplasty (TKA), as considerations should be made regarding whether or not the associated extraarticular deformity should be corrected to maximize outcomes. This case report aims to describe the challenge in managing post-traumatic knee osteoarthritis secondary to ipsilateral extraarticular deformity by primary TKA.
Case Presentation: A 50-years old female complained pain on her right knee since 10 years prior to admission, with a history of fractured right femur 35 years ago. Active and passive range of motion of the knee demonstrated a lack 5o of extension and 100o in flexion, with 3 cm leg length discrepancy. Plan X-Ray was in accordance with knee osteoarthritis, with femoral shaft angulation of 17.74o in coronal plane and 12.59o in sagittal plane. Primary TKA was performed without intervention to the femoral shaft deformity, resulting in satisfactory functional outcome up to 3 months post operatively.
Discussion: Extraarticular deformities in patients with PTKOA require special consideration in restoring mechanical axis, soft tissue balancing, and implant placement. The degree of angulation is one of the things to consider in TKA. Some literatures stated that extraarticular deformity should be corrected to maximally restore alignment; however, some others believed that additional corrective osteotomy if often not needed regardless the degree of angulation. By performing soft tissue balancing properly and careful placement of the implant, it was proven that the functional outcome could also be satisfactory without performing additional corrective osteotomy.
Conclusion: The management of extraarticular deformity in patients undergoing TKA requires careful preoperative planning, and considerations should be made regarding the need for additional osteotomy to maximize postoperative outcome and minimize complications.
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REFERENCES
Wang X shan, Zhou Y xin, Shao H yi, Yang D jin, Huang Y, Duan F fang. Total Knee Arthroplasty in Patients with Prior Femoral and Tibial Fractures: Outcomes and Risk Factors for Surgical Site Complications and Reoperations. Orthop Surg. 2020;12(1):210-217. doi:10.1111/os.12610
Fosco M, Ben R, Fantasia R, Dallari D, Tigani D. Concepts in Computer Assisted Total Knee Replacement Surgery. Recent Adv Hip Knee Arthroplast. Published online 2012. doi:10.5772/28352
Bae DK, Song SJ, Park CH, Ko YW, Lee H. A Comparison of the Medium-Term Results of Total Knee Arthroplasty Using Computer-Assisted and Conventional Techniques to Treat Patients With Extraarticular Femoral Deformities. J Arthroplasty. 2017;32(1):71-78. doi:10.1016/j.arth.2016.06.030
Badhe NP, Forster IW. Single stage osteotomy and total knee arthroplasty for tibio-femoral malunion with osteoarthritis of the knee. Eur J Orthop Surg Traumatol. 2001;11(3):177-181. doi:10.1007/BF02747663
Rajgopal A, Vasdev A, Dahiya V, Tyagi VC, Gupta H. Total knee arthroplasty in extra articular deformities: A series of 36 knees. Indian J Orthop. 2013;47(1):35-39. doi:10.4103/0019-5413.106893
Mann JW, Scuderi GR, Insall JN. Total Knee Replacement with Associated Extra-Articular Angular Deformity of the Femur. In: Surgical Techniques in Total Knee Arthroplasty. Springer, New York, NY; 2002:635-639. doi:10.1007/0-387-21714-2_86
Wolff AM, Hungerford DS, Pepe CL. The effect of extraarticular varus and valgus deformity on total knee arthroplasty. Clin Orthop Relat Res. 1991;271. doi:10.1097/00003086-199110000-00007
Wang JW, Wang CJ. Total knee arthroplasty for arthritis of the knee with extra-articular deformity. J Bone Jt Surg. 2002;84(10). doi:10.2106/00004623-200210000-00005
Ritter MA, Faris GW. Total knee replacement following extra-articular deformities. Orthopedics. 2003;26(9).
