Total Knee Arthroplasty in Severe Valgus Deformity Using a Modified Technique-A 10-Year Follow-Up Study

J Arthroplasty. 2019 Jan;34(1):40-46.e1. doi: 10.1016/j.arth.2018.09.002. Epub 2018 Sep 18.

Abstract

Background: Valgus knee deformity accounts for only 10% of total knee arthroplasties (TKAs), but is frequently considered the most challenging to manage. This study provides a 10-year follow-up on a previously reported series of severe valgus knees performed using an unconstrained mobile-bearing TKA with a modified technique to validate this technique.

Methods: A consecutive series of 275 predominantly cementless TKAs in 262 patients were performed for severe valgus (≥10°) deformity and prospectively followed to 10 years. Patient-reported outcome measures included the Oxford Knee Score, American Knee Society Score, Bartlett Patellar Score, and the Short Form 12 questionnaire.

Results: Average valgus deformity was reduced from 15.6° to 3.8° (P < .001). At a mean follow-up of 10.4 years (range, 9.5-14.1), 90 (34.4%) patients had died. Of the reviewed survivors, the mean Oxford Knee Score was 27.8 ± 9.8, with an American Knee Society clinical score of 85.6 ± 17.0 and a functional score of 65.1 ± 20.4, with 78% of patients reporting good to excellent results. To date, there has been 1 (0.36%) revision and 13 (4.73%) reoperations. Kaplan-Meier implant survival was 99.6% at 10 years.

Conclusion: Despite its challenging nature, the valgus knee is associated with excellent survivorship and satisfactory long-term results using this modified technique.

Level of evidence: Level IV.

Keywords: arthroplasty; knee; outcomes; technique; valgus.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / methods*
  • Data Collection
  • Disease Management
  • Female
  • Follow-Up Studies
  • Genu Valgum / complications*
  • Genu Valgum / surgery
  • Humans
  • Kaplan-Meier Estimate
  • Knee Joint / surgery*
  • Male
  • Middle Aged
  • Pain Perception
  • Patella
  • Patient Reported Outcome Measures
  • Prospective Studies
  • Reoperation
  • Severity of Illness Index
  • Weight-Bearing