Kilian Rueckl1,2, Armin Runer1, Anna Jungwirth-Weinberger1, Maximilian F Kasparek3, Martin Faschingbauer4, Friedrich Boettner5. 1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. 2. Department of Orthopedic, University of Wuerzburg, Wuerzburg, Germany. 3. Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria. 4. Department of Orthopedic Surgery, Ulm University Hospital, University of Ulm, Ulm, Germany. 5. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. boettnerf@hss.edu.
Abstract
INTRODUCTION: Advanced valgus osteoarthritis (OA) is one of the most challenging indications for total knee arthroplasty (TKA). There is no information in the literature about the optimal timing of surgery. The current study investigates the impact of the preoperative deformity and degree of arthritis on postoperative outcome after TKA. MATERIAL AND METHODS: The study evaluated 133 knees in 107 patients with valgus OA that failed nonoperative treatment with a minimum 2-year follow-up. Mechanical alignment, Kellgren and Lawrence (K/L) score, and minimal joint space width (minJSW) were measured on AP- and hip-to-ankle radiographs. All knees had advanced OA (i.e., K/L grades 3 or 4 and less than 50% minJSW). Pre- and postoperative WOMAC, VR-12, UCLA, VAS, ROM were recorded. RESULTS: There was no difference in clinical outcome (WOMAC, UCLA, VR-12, VAS or ROM) between patients with different degrees of valgus deformities (< 5.0 deg., 5.0-9.9 deg., 10.0-14.9 deg., ≥ 15.0 deg.). There was also no correlation between K/L score or minimal joint space width and any of the outcome parameters. CONCLUSIONS: The degree of valgus deformity and the grade of osteoarthritis do not predict the outcome of TKA in patients with valgus OA. Since the risk of complication and the need for implant constraint increases with increasing deformity and instability of the knee, surgery appears to be justified in patients with advanced OA that failed nonoperative treatment, regardless of the degree of deformity.
INTRODUCTION: Advanced valgus osteoarthritis (OA) is one of the most challenging indications for total knee arthroplasty (TKA). There is no information in the literature about the optimal timing of surgery. The current study investigates the impact of the preoperative deformity and degree of arthritis on postoperative outcome after TKA. MATERIAL AND METHODS: The study evaluated 133 knees in 107 patients with valgus OA that failed nonoperative treatment with a minimum 2-year follow-up. Mechanical alignment, Kellgren and Lawrence (K/L) score, and minimal joint space width (minJSW) were measured on AP- and hip-to-ankle radiographs. All knees had advanced OA (i.e., K/L grades 3 or 4 and less than 50% minJSW). Pre- and postoperative WOMAC, VR-12, UCLA, VAS, ROM were recorded. RESULTS: There was no difference in clinical outcome (WOMAC, UCLA, VR-12, VAS or ROM) between patients with different degrees of valgus deformities (< 5.0 deg., 5.0-9.9 deg., 10.0-14.9 deg., ≥ 15.0 deg.). There was also no correlation between K/L score or minimal joint space width and any of the outcome parameters. CONCLUSIONS: The degree of valgus deformity and the grade of osteoarthritis do not predict the outcome of TKA in patients with valgus OA. Since the risk of complication and the need for implant constraint increases with increasing deformity and instability of the knee, surgery appears to be justified in patients with advanced OA that failed nonoperative treatment, regardless of the degree of deformity.
Authors: Kevin I Perry; Nicholas L Strasser; William S Harmsen; Mark W Pagnano; Robert T Trousdale Journal: Orthopedics Date: 2015-08 Impact factor: 1.390
Authors: Richard Kijowski; Donna G Blankenbaker; Paul T Stanton; Jason P Fine; Arthur A De Smet Journal: Radiology Date: 2006-04-26 Impact factor: 11.105