Total Knee Arthroplasty Using an Intra-Articular Correction Method in Patients with Extra-Articular Deformity of the Femur

Dae Kyung Bae; Sang Jun Song; Kyoung Ho Yoon; Jung Ho Noh; Se Min Lee

doi:10.4055/jkoa.2010.45.3.204

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Bae, Song, Yoon, Noh, and Lee: Total Knee Arthroplasty Using an Intra-Articular Correction Method in Patients with Extra-Articular Deformity of the Femur

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(3): 204-209.

Published online: 9 June 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.3.204

Total Knee Arthroplasty Using an Intra-Articular Correction Method in Patients with Extra-Articular Deformity of the Femur

Dae Kyung Bae, M.D., Sang Jun Song, M.D., Kyoung Ho Yoon, M.D., Jung Ho Noh, M.D.^*, Se Min Lee, M.D.

Department of Orthopedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.

^*Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea.

Correspondence to: Sang Jun Song, M.D. Department of Orthopedic Surgery, School of Medicine, Kyung Hee University, #1, Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea. TEL: +82-2-958-9489, FAX: +82-2-964-3865, songsjun@khmc.or.kr

Received 11 June 2009 Accepted 6 April 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the result of total knee arthroplasty (TKA) using an intra-articular correction in patients with extra-articular deformity of the femur.

Materials and Methods

We performed 23 TKAs in 23 patients with extra-articular deformity of the femur. The mean age was 58.0 years and the follow-up period averaged 54.7 months. The American Knee Society's knee and function score were evaluated, and the mechanical axis (MA) was measured. Sixteen knees with a deformity in the distal third of the femur were assigned to group I and 7 knees with a deformity in the proximal or middle third were assigned to group II. Between groups differences in results were analyzed.

Results

The average knee score was 47.8 preoperatively and 91.6 at the last follow-up. The average function score was 46.9 preoperatively and 89.1 at the last follow-up. The MA averaged varus was 7.7° preoperatively and 1.0° postoperatively. The average knee score at the last follow-up was 90.1 in group I and 95.0 in group II. The average function score at the last follow-up was 87.8 in group I and 92.1 in group II. The MA averaged varus was 2.0° in group I and 1.3° in group II (p=0.042).

Conclusion

TKA in conjunction with intra-articular correction produced satisfactory results for patients with an extra-articular deformity of femur. The possibility of incomplete correction of limb alignment should be carefully considered, especially in cases with a severe deformity at the distal third of the femur.

Keywords: femur, extra-articular deformity, total knee arthroplasty

Figures and Tables

Figure 1

Preoperative radiograph of the knee, showing a deformity consisting of 16.8° of varus and 7.3° of flexion in the middle third of the femur.

Figure 2

Preoperative full-length anteroposterior radiograph of the lower extremity including the hip, knee, and ankle. The line perpendicular to the femoral mechanical axis shows the anticipated femoral condylar resection.

Figure 3

Pre and postoperative radiographs of total knee arthroplasty in patients with extra-articular deformity of the femur. (A) A 78-year-old man had the malunion of the femoral shaft. In the preoperative radiographs, the mechanical axis (MA) was varus 23.8° and the femorotibial angle (FTA) was varus 3.8°. (B) In the post operative 3.5 year radiographs, the MA was varus 0.8° and FTA was valgus 19.0°. There was no sign of loosening or infection.

Table 1

Demographics, Clinical, Radiographic Results between Extra-articular Deformity and Control Group

^*Deformity group, Group of cases which have the extra-articular deformity of the femur; ^†Control group, Group of cases which is matched with the deformity group, with respect to the age, gender, disgnosis, preoperative knee score, function score, range of motion, and mechanical axis. OA, Osteoarthritis; RA, Rhematoid arthritis; HA, Hemophilic arthritis.

Table 2

Demographics according to the Site of the Deformity

^*Group I, Group of cases in which the site of deformity is at the distal femur; ^†Group II, Group of cases in which the site of deformity is at the proximal femur or shaft.

Table 3

Clinical and Radiographic Results at Last Follow-up Period according to the Site of the Deformity

^*Group I, Group of cases in which the site of deformity is at the distal femur; ^†Group II, Group of cases in which the site of deformity is at the proximal femur or shaft.

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