Yves Catonné1, Frédéric Khiami2, Elhadi Sariali2, Marc-Antoine Ettori2, Olivier Delattre3, Bruno Tillie4. 1. Hôpital Pitié-Salpêtrière, 47, boulevard de l'hôpital, 75013 Paris, France; Université Pierre et Marie Curie (Paris VI), 75013 Paris, France; Clinique Jouvenet, 6, square Jouvenet, 75016 Paris, France. Electronic address: yves.catonne@gmail.com. 2. Hôpital Pitié-Salpêtrière, 47, boulevard de l'hôpital, 75013 Paris, France; Université Pierre et Marie Curie (Paris VI), 75013 Paris, France. 3. Centre Hospitalo Universitaire de Fort de France, 92000 Fort de France, Martinique. 4. Clinique Bon Secours, 62000 Arras, France.
Abstract
BACKGROUND: Same-stage (1S) total knee arthroplasty (TKA) and femoral osteotomy (FO) may deserve consideration in patients with both knee osteoarthritis and severe extra-articular knee deformity (EKD). The objective of this study was to assess clinical and radiological outcomes and morbidity (complications and revisions) in 6 patients managed with S1-TKA-FO. HYPOTHESIS: 1S-TKA-FO produces satisfactory outcomes and is not associated with higher morbidity rates compared to two-stage TKA-TO or TKA with intra-articular EKD correction, while also significantly shortening total treatment duration. MATERIAL AND METHODS: A prospective study was performed in 6 patients managed with 1S-TKA-FO between 1999 and 2011; mean age was 64 years (range, 59-72 years) and mean body mass index was 29.5 (range, 26-35). The EKD was consistently greater than 10°. The cause was post-traumatic mal-union in 4 patients, constitutional EKD in 1 patient, and FO in 1 patient. In each patient, the clinical International Knee Society (IKS) score and the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA), were recorded prospectively before and after surgery. RESULTS: A long uncemented extension stem was used in all 6 patients and a posterior-stabilised implant in 5 patients. No hinged implants were used. In 4 patients, internal fixation of the FO was performed. Mean follow-up was 10 years (range, 4-15 years). From baseline to last follow-up, the mean IKS score increased from 46 to 161 and mean flexion from 95° (range, 70-110°) to 107° (range, 90-120°). The HKA measured radiographically was between 178° and 182° in all 6 patients. The complications consisted of deep vein thrombosis in 1 patient and knee stiffness requiring manipulation under general anaesthesia in 1 patient. No patient experienced mal-union or required revision surgery. DISCUSSION: Apart from a case-series study of 11 patients, very few data are available on 1S-TKA-FO. In our small population, no major complications were recorded. The encouraging long-term outcomes warrant a recommendation to perform 1S-TKA-FO in patients with knee osteoarthritis and an intra-femoral deformity greater than 10°. LEVEL OF EVIDENCE: IV, prospective observational cohort study.
BACKGROUND: Same-stage (1S) total knee arthroplasty (TKA) and femoral osteotomy (FO) may deserve consideration in patients with both knee osteoarthritis and severe extra-articular knee deformity (EKD). The objective of this study was to assess clinical and radiological outcomes and morbidity (complications and revisions) in 6 patients managed with S1-TKA-FO. HYPOTHESIS: 1S-TKA-FO produces satisfactory outcomes and is not associated with higher morbidity rates compared to two-stage TKA-TO or TKA with intra-articular EKD correction, while also significantly shortening total treatment duration. MATERIAL AND METHODS: A prospective study was performed in 6 patients managed with 1S-TKA-FO between 1999 and 2011; mean age was 64 years (range, 59-72 years) and mean body mass index was 29.5 (range, 26-35). The EKD was consistently greater than 10°. The cause was post-traumatic mal-union in 4 patients, constitutional EKD in 1 patient, and FO in 1 patient. In each patient, the clinical International Knee Society (IKS) score and the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA), were recorded prospectively before and after surgery. RESULTS: A long uncemented extension stem was used in all 6 patients and a posterior-stabilised implant in 5 patients. No hinged implants were used. In 4 patients, internal fixation of the FO was performed. Mean follow-up was 10 years (range, 4-15 years). From baseline to last follow-up, the mean IKS score increased from 46 to 161 and mean flexion from 95° (range, 70-110°) to 107° (range, 90-120°). The HKA measured radiographically was between 178° and 182° in all 6 patients. The complications consisted of deep vein thrombosis in 1 patient and knee stiffness requiring manipulation under general anaesthesia in 1 patient. No patient experienced mal-union or required revision surgery. DISCUSSION: Apart from a case-series study of 11 patients, very few data are available on 1S-TKA-FO. In our small population, no major complications were recorded. The encouraging long-term outcomes warrant a recommendation to perform 1S-TKA-FO in patients with knee osteoarthritis and an intra-femoral deformity greater than 10°. LEVEL OF EVIDENCE: IV, prospective observational cohort study.