سامانه مدیریت نشریات علمی دانشگاه علوم پزشکی مشهد

Jabalameli, Mahmoud, Askari, Alireza, Yahyazadeh, Hooman, Bagheridard, Abolfazl, Jabalameli, Mohammad, Dolikhani, Mohammadreza, Sadighi, Mehrdad. (1404). Promising Results of Total Knee Arthroplasty in Patients with Severe Varus Deformity with High Constrained Prosthesis: A Prospective Study. , 13(10), 631-637. doi: 10.22038/abjs.2025.86586.3934
Mahmoud Jabalameli; Alireza Askari; Hooman Yahyazadeh; Abolfazl Bagheridard; Mohammad Jabalameli; Mohammadreza Dolikhani; Mehrdad Sadighi. "Promising Results of Total Knee Arthroplasty in Patients with Severe Varus Deformity with High Constrained Prosthesis: A Prospective Study". , 13, 10, 1404, 631-637. doi: 10.22038/abjs.2025.86586.3934
Jabalameli, Mahmoud, Askari, Alireza, Yahyazadeh, Hooman, Bagheridard, Abolfazl, Jabalameli, Mohammad, Dolikhani, Mohammadreza, Sadighi, Mehrdad. (1404). 'Promising Results of Total Knee Arthroplasty in Patients with Severe Varus Deformity with High Constrained Prosthesis: A Prospective Study', , 13(10), pp. 631-637. doi: 10.22038/abjs.2025.86586.3934
Jabalameli, Mahmoud, Askari, Alireza, Yahyazadeh, Hooman, Bagheridard, Abolfazl, Jabalameli, Mohammad, Dolikhani, Mohammadreza, Sadighi, Mehrdad. Promising Results of Total Knee Arthroplasty in Patients with Severe Varus Deformity with High Constrained Prosthesis: A Prospective Study. , 1404; 13(10): 631-637. doi: 10.22038/abjs.2025.86586.3934

Promising Results of Total Knee Arthroplasty in Patients with Severe Varus Deformity with High Constrained Prosthesis: A Prospective Study

The Archives of Bone and Joint Surgery
مقاله 6، دوره 13، شماره 10، دی 2025، صفحه 631-637    اصل مقاله (683.64 K)
نوع مقاله: RESEARCH PAPER
شناسه دیجیتال (DOI): 10.22038/abjs.2025.86586.3934
نویسندگان
Mahmoud Jabalameli1؛ Alireza Askari1؛ Hooman Yahyazadeh2؛ Abolfazl Bagheridard1؛ Mohammad Jabalameli1؛ Mohammadreza Dolikhani3؛ Mehrdad Sadighi* 4
1Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
2Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran- Department of Orthopedic Surgery, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
3Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran- Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran- Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran- Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده
Objectives: The existing literature does not provide a clear definition of the outcomes of total knee arthroplasty (TKA) and prosthesis constraint in patients with severe varus deformity. In this study, for the first time, we evaluated the outcomes of TKA and the relationship between prosthesis constraint and these outcomes in patients with severe varus deformity (>30 degrees).
Methods: This prospective cohort study was conducted on 41 patients (54 knees) with varus deformity greater than 30 degrees who underwent TKA between April 2013 and April 2019. The patients were divided into two groups based on the type of prosthesis (high constraint and low constraint). Surgical outcomes were evaluated using the Knee Society Score (KSS), Oxford Knee Score (OKS), range of motion (ROM), and postoperative complications.
Results: High-constrained prostheses (HCP) and low-constrained prostheses (LCP) were used in 44 and 10 knees, respectively. The mean follow-up duration was 77.11 ± 6.55 months. The mean KSS, KSS function, OKS, and ROM significantly improved after surgery compared to preoperative values (P<0.05). The mean improvement in the KSS function score after surgery was significantly higher in patients with HCP compared to those with LCP (p = 0.021). No significant differences were observed for the other variables. No cases required revision.
Conclusion: This prospective non-randomized study, conducted on 41 patients (54 knees) with severe varus deformity (>30º) who underwent total knee arthroplasty (TKA), demonstrated that the mean improvement in the Knee Society Score (KSS) function score after surgery was greater for high-constrained prostheses (HCP, N = 44) compared to low-constrained prostheses (LCP, N = 10). The HCP group included 40 Legacy Constrained Condylar Knees (LCCK) and four hinged knee prostheses, while the LCP group included posterior-stabilizing (PS) prostheses. The mean follow-up duration was 6.5 years. Given the small sample size, randomized clinical trials are needed to validate our preliminary findings.
        Level of evidence: III
کلیدواژه‌ها
Constrained prosthesis؛ Functional score؛ Knee osteoarthritis؛ Severe varus؛ Total knee arthroplasty
مراجع
  1. Carlson AK, Rawle RA, Wallace CW, et al. Characterization of synovial fluid metabolomic phenotypes of cartilage morphological changes associated with osteoarthritis. Osteoarthritis Cartilage. 2019;27(8):1174-1184. doi:10.1016/j.joca.2019.04.007.
  2. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3):355-69. doi:10.1016/j.cger.2010.03.001.
  3. Elhence A, Gupta S, Roy S, et al. Total Knee Arthroplasty in End-Stage Knee Osteoarthritis with Tibia Stress Fractures- A Propensity Score Matched Comparative Study. Arch Bone Jt Surg. 2025;13(5):281-290. doi:10.22038/abjs.2024.78268.3601.
  4. Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-1602. doi: 10.1016/S0140-6736(16)31678-6.
  5. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-1759. doi: 10.1016/S0140-6736(19)30417-9.
  6. Zheng K, Zhu F, Zhang W, et al. Total Knee Arthroplasty Using Adjusted Restricted Kinematic Alignment for the Treatment of Severe Varus Deformity: Technical Note. Orthop Surg. 2022;14(8):1892-1901. doi:10.1111/os.13354.
  7. Saragaglia D, Sigwalt L, Refaie R, Rubens-Duval B, Lateur G, Pailhé R. Influence of the post-operative axis on the clinical results of total knee replacement for severe varus deformities:
 

        does a slight residual varus improve the results? Int Orthop. 2019;43(7):1621-1626. doi: 10.1007/s00264-018-4092-7.

  1. Verdonk PC, Pernin J, Pinaroli A, Ait Si Selmi T, Neyret P. Soft tissue balancing in varus total knee arthroplasty: an algorithmic approach. Knee Surg Sports Traumatol Arthrosc. 2009;17(6):660-6. doi:10.1007/s00167-009-0755-7.
  2. Hadi H, Jabal Amoli M, Bagherifard A, et al. The Effect of Total Knee Arthroplasty on Hindfoot Alignment in Patients with Severe Genu Varum and Genu Valgum. Arch Bone Jt Surg. 2020;8(3):413-419. doi: 10.22038/abjs.2019.33735.1883.
  3. Mirzatolooei F, Tabrizi A, Taleb H, Hashemian MK, Safari MB. Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement. J Knee Surg. 2021;34(2):142-146. doi: 10.1055/s-0039-1694047.
  4. Chiu KY, Yau WP. The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone. J Arthroplasty. 2005;20(1):131-2; author reply 132. doi: 10.1016/j.arth.2004.10.003.
  5. Vanlommel L, Vanlommel J, Claes S, Bellemans J. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc. 2013;21(10):2325-30. doi:10.1007/s00167-013-2481-4.
  6. Rossi R, Cottino U, Bruzzone M, Dettoni F, Bonasia DE, Rosso F. Total knee arthroplasty in the varus knee: tips and tricks. Int Orthop. 2019;43(1):151-158. doi: 10.1007/s00264-018-4116-3.
  7. Catonné Y, Sariali E, Khiami F, Rouvillain JL, Wajsfisz A, Pascal-Moussellard H. Same-stage total knee arthroplasty and osteotomy for osteoarthritis with extra-articular deformity. Part I: Tibial osteotomy, prospective study of 26 cases. Orthop Traumatol Surg Res. 2019;105(6):1047-1054. doi:10.1016/j.otsr.2019.04.010.
  8. Sharafat Vaziri A, Salkhori O, Razi M, et al. Practice Trends in Primary Total Knee Arthroplasty among Members of the Iranian Society of Knee Surgery, Arthroscopy, and Sports Traumatology. Arch Bone Jt Surg. 2025;13(6):359-366. doi: 10.22038/ABJS.2025.85348.3889.
  9. Oh SM, Bin SI, Kim JY, Lee BS, Kim JM. Impact of preoperative varus deformity on postoperative mechanical alignment and long-term results of "mechanical" aligned total knee arthroplasty. Orthop Traumatol Surg Res. 2019;105(6):1061-1066. doi:10.1016/j.otsr.2019.04.016.
  10. Saragaglia D, Sigwalt L, Gaillot J, Morin V, Rubens-Duval B, Pailhé R. Results with eight and a half years average follow-up on two hundred and eight e-Motion FP® knee prostheses, fitted using computer navigation for knee osteoarthritis in patients with over ten degrees genu varum. Int Orthop. 2018;42(4):799-804. doi:10.1007/s00264-017-3618-8.
  11. Zhang Z, Liu C, Li Z, Wu P, Hu S, Liao W. Residual Mild Varus Alignment and Neutral Mechanical Alignment Have Similar Outcome after Total Knee Arthroplasty for Varus Osteoarthritis in Five-Year Follow-Up. J Knee Surg. 2020;33(2):200-205. doi:10.1055/s-0038-1677497.
  12. Goudarz Mehdikhani K, Morales Moreno B, Reid JJ, de Paz Nieves A, Lee YY, González Della Valle A. An Algorithmic, Pie-Crusting Medial Soft Tissue Release Reduces the Need for Constrained Inserts Patients With Severe Varus Deformity Undergoing Total Knee Arthroplasty. J Arthroplasty. 2016;31(7):1465-9. doi:10.1016/j.arth.2016.01.006.
  13. Sorrells RB, Murphy JA, Sheridan KC, Wasielewski RC. The effect of varus and valgus deformity on results of cementless mobile bearing TKA. Knee. 2007;14(4):284-8. doi: 10.1016/j.knee.2007.04.004.
  14. De Muylder J, Victor J, Cornu O, Kaminski L, Thienpont E. Total knee arthroplasty in patients with substantial deformities using primary knee components. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3653-9. doi:10.1007/s00167-014-3269-x.
  15. Mihalko WM, Saleh KJ, Krackow KA, Whiteside LA. Soft-tissue balancing during total knee arthroplasty in the varus knee. J Am Acad Orthop Surg. 2009;17(12):766-74. doi: 10.5435/00124635-200912000-00005.
  16. Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Soltani-Moghaddas SH. Cross-cultural adaptation and validation of the persian version of the oxford knee score in patients with knee osteoarthritis. Iran J Med Sci. 2014;39(6):529-35.
  17. Salavati M, Mazaheri M, Negahban H, et al. Validation of a Persian-version of Knee injury and Osteoarthritis Outcome Score (KOOS) in Iranians with knee injuries. Osteoarthritis Cartilage. 2008;16(10):1178-82. doi: 10.1016/j.joca.2008.03.004.
  18. Mullaji AB, Padmanabhan V, Jindal G. Total knee arthroplasty for profound varus deformity: technique and radiological results in 173 knees with varus of more than 20 degrees. J Arthroplasty. 2005;20(5):550-61. doi:10.1016/j.arth.2005.04.009.
  19. Lee BS, Lee SJ, Kim JM, Lee DH, Cha EJ, Bin SI. No impact of severe varus deformity on clinical outcome after posterior stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19(6):960-6. doi:10.1007/s00167-010-1316-9.
  20. Martin JR, Beahrs TR, Stuhlman CR, Trousdale RT. Complex Primary Total Knee Arthroplasty: Long-Term Outcomes. J Bone Joint Surg Am. 2016;98(17):1459-70. doi: 10.2106/JBJS.15.01173.
  21. Cholewinski P, Putman S, Vasseur L, et al. Long-term outcomes of primary constrained condylar knee arthroplasty. Orthop Traumatol Surg Res. 2015;101(4):449-54. doi:10.1016/j.otsr.2015.01.020.
 

 

 

 

آمار
تعداد مشاهده مقاله: 219
تعداد دریافت فایل اصل مقاله: 156