Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee
Purpose Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional var...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2020-05, Vol.28 (5), p.1579-1586 |
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| creator | Lee, Han-Jun Lim, Jung-Won Lee, Dong-Hoon Kim, Dong-Hyun Park, Yong-Beom |
| description | Purpose
Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional varus distal femoral cutting yielded satisfactory clinical and radiological outcomes.
Methods
A total of 77 patients (91 knees) with varus knee (hip–knee–ankle axis ≥ 10°) and lateral femoral bowing > 5° underwent navigation-assisted primary TKA using individualized intentional varus distal femoral cutting. Knee Society scores, Western Ontario and McMaster Universities scores, and radiographs for limb alignment, implant alignment, and aseptic loosening were evaluated. Subgroup analyses were performed according to the limb alignment and coronal femoral component alignment (0° ± 3° vs. varus of > 3°).
Results
All clinical outcomes significantly improved at the final follow-up (
p |
| doi_str_mv | 10.1007/s00167-019-05577-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2246250130</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2244872285</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-248cd3815997efdf180185fe65c14ef00da1e3dff81f8da33a50293c653127f53</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhS0EokPhBVggS2zYBK7tOE6WqCo_UiUWwDry2NdTlyQe_DMVvA1vitOZgsSChWVfnXM-S_cQ8pzBawag3iQA1qkG2NCAlEo17AHZsFaIRolWPSQbGFrecJDdGXmS0g1AfbbDY3ImGBdQz4b8-jz53XWmZbEYGxNiRJN9WGhJftlRv1h_8Lboyf9EW8eMyyrriR50LIk6nEOskyk5r4EJtU00B-r0oQrbCWko2YQZU03Tvc6-EhK99fmaTjrjGr6HbMPtytCLPdG_LYhPySOnp4TPTvc5-fru8svFh-bq0_uPF2-vGiOUzA1ve2NFz-QwKHTWsR5YLx120rAWHYDVDIV1rmeut1oILYEPwnSyLkM5Kc7JqyN3H8P3gimPs08Gp0kvGEoaOW87LoEJqNaX_1hvQol1KXeutlec9yuQH10mhpQiunEf_azjj5HBuBY4Hgsca4HjXYEjq6EXJ3TZzmj_RO4bqwZxNKQqLTuMf__-D_Y3rPSpuA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2244872285</pqid></control><display><type>article</type><title>Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee</title><source>SpringerNature Journals</source><source>Access via Wiley Online Library</source><creator>Lee, Han-Jun ; Lim, Jung-Won ; Lee, Dong-Hoon ; Kim, Dong-Hyun ; Park, Yong-Beom</creator><creatorcontrib>Lee, Han-Jun ; Lim, Jung-Won ; Lee, Dong-Hoon ; Kim, Dong-Hyun ; Park, Yong-Beom</creatorcontrib><description>Purpose
Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional varus distal femoral cutting yielded satisfactory clinical and radiological outcomes.
Methods
A total of 77 patients (91 knees) with varus knee (hip–knee–ankle axis ≥ 10°) and lateral femoral bowing > 5° underwent navigation-assisted primary TKA using individualized intentional varus distal femoral cutting. Knee Society scores, Western Ontario and McMaster Universities scores, and radiographs for limb alignment, implant alignment, and aseptic loosening were evaluated. Subgroup analyses were performed according to the limb alignment and coronal femoral component alignment (0° ± 3° vs. varus of > 3°).
Results
All clinical outcomes significantly improved at the final follow-up (
p
< 0.05 in all). The mechanical axis angle changed from 13.1° ± 2.7° to 2.8° ± 1.5°. The coronal femoral component angle at the final follow-up was 2.8° ± 1.3°. Radiolucent lines were observed in 6 cases (6.6%) and were less than 2 mm in all cases without progression. In subgroup analyses, no significant differences were observed in clinical outcomes (n.s. in all) and in the incidence of radiolucent lines (n.s. in limb alignment, n.s. in coronal femoral component alignment).
Conclusions
Individualized intentional varus distal femoral cutting yielded favorable clinical outcomes without complications at 5-year follow-up. Slight under-correction using intentional varus distal femoral cutting could be a viable option in patients with varus knee and lateral femoral bowing during navigation-assisted TKA.
Level of evidence
IV.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-019-05577-1</identifier><identifier>PMID: 31230123</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Alignment ; Ankle ; Arthroplasty (knee) ; Biomedical materials ; Bone implants ; Bowing ; Clinical outcomes ; Complications ; Cutting ; Femoral components ; Femur ; Hip ; Joint surgery ; Knee ; Loosening ; Medicine ; Medicine & Public Health ; Orthopedics ; Radiographs ; Radiography ; Restoration ; Subgroups ; Surgical implants</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020-05, Vol.28 (5), p.1579-1586</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-248cd3815997efdf180185fe65c14ef00da1e3dff81f8da33a50293c653127f53</citedby><cites>FETCH-LOGICAL-c375t-248cd3815997efdf180185fe65c14ef00da1e3dff81f8da33a50293c653127f53</cites><orcidid>0000-0002-3741-2311</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-019-05577-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-019-05577-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31230123$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Han-Jun</creatorcontrib><creatorcontrib>Lim, Jung-Won</creatorcontrib><creatorcontrib>Lee, Dong-Hoon</creatorcontrib><creatorcontrib>Kim, Dong-Hyun</creatorcontrib><creatorcontrib>Park, Yong-Beom</creatorcontrib><title>Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional varus distal femoral cutting yielded satisfactory clinical and radiological outcomes.
Methods
A total of 77 patients (91 knees) with varus knee (hip–knee–ankle axis ≥ 10°) and lateral femoral bowing > 5° underwent navigation-assisted primary TKA using individualized intentional varus distal femoral cutting. Knee Society scores, Western Ontario and McMaster Universities scores, and radiographs for limb alignment, implant alignment, and aseptic loosening were evaluated. Subgroup analyses were performed according to the limb alignment and coronal femoral component alignment (0° ± 3° vs. varus of > 3°).
Results
All clinical outcomes significantly improved at the final follow-up (
p
< 0.05 in all). The mechanical axis angle changed from 13.1° ± 2.7° to 2.8° ± 1.5°. The coronal femoral component angle at the final follow-up was 2.8° ± 1.3°. Radiolucent lines were observed in 6 cases (6.6%) and were less than 2 mm in all cases without progression. In subgroup analyses, no significant differences were observed in clinical outcomes (n.s. in all) and in the incidence of radiolucent lines (n.s. in limb alignment, n.s. in coronal femoral component alignment).
Conclusions
Individualized intentional varus distal femoral cutting yielded favorable clinical outcomes without complications at 5-year follow-up. Slight under-correction using intentional varus distal femoral cutting could be a viable option in patients with varus knee and lateral femoral bowing during navigation-assisted TKA.
Level of evidence
IV.</description><subject>Alignment</subject><subject>Ankle</subject><subject>Arthroplasty (knee)</subject><subject>Biomedical materials</subject><subject>Bone implants</subject><subject>Bowing</subject><subject>Clinical outcomes</subject><subject>Complications</subject><subject>Cutting</subject><subject>Femoral components</subject><subject>Femur</subject><subject>Hip</subject><subject>Joint surgery</subject><subject>Knee</subject><subject>Loosening</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Radiographs</subject><subject>Radiography</subject><subject>Restoration</subject><subject>Subgroups</subject><subject>Surgical implants</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc1u1DAUhS0EokPhBVggS2zYBK7tOE6WqCo_UiUWwDry2NdTlyQe_DMVvA1vitOZgsSChWVfnXM-S_cQ8pzBawag3iQA1qkG2NCAlEo17AHZsFaIRolWPSQbGFrecJDdGXmS0g1AfbbDY3ImGBdQz4b8-jz53XWmZbEYGxNiRJN9WGhJftlRv1h_8Lboyf9EW8eMyyrriR50LIk6nEOskyk5r4EJtU00B-r0oQrbCWko2YQZU03Tvc6-EhK99fmaTjrjGr6HbMPtytCLPdG_LYhPySOnp4TPTvc5-fru8svFh-bq0_uPF2-vGiOUzA1ve2NFz-QwKHTWsR5YLx120rAWHYDVDIV1rmeut1oILYEPwnSyLkM5Kc7JqyN3H8P3gimPs08Gp0kvGEoaOW87LoEJqNaX_1hvQol1KXeutlec9yuQH10mhpQiunEf_azjj5HBuBY4Hgsca4HjXYEjq6EXJ3TZzmj_RO4bqwZxNKQqLTuMf__-D_Y3rPSpuA</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Lee, Han-Jun</creator><creator>Lim, Jung-Won</creator><creator>Lee, Dong-Hoon</creator><creator>Kim, Dong-Hyun</creator><creator>Park, Yong-Beom</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3741-2311</orcidid></search><sort><creationdate>20200501</creationdate><title>Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee</title><author>Lee, Han-Jun ; Lim, Jung-Won ; Lee, Dong-Hoon ; Kim, Dong-Hyun ; Park, Yong-Beom</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-248cd3815997efdf180185fe65c14ef00da1e3dff81f8da33a50293c653127f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Alignment</topic><topic>Ankle</topic><topic>Arthroplasty (knee)</topic><topic>Biomedical materials</topic><topic>Bone implants</topic><topic>Bowing</topic><topic>Clinical outcomes</topic><topic>Complications</topic><topic>Cutting</topic><topic>Femoral components</topic><topic>Femur</topic><topic>Hip</topic><topic>Joint surgery</topic><topic>Knee</topic><topic>Loosening</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Radiographs</topic><topic>Radiography</topic><topic>Restoration</topic><topic>Subgroups</topic><topic>Surgical implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Han-Jun</creatorcontrib><creatorcontrib>Lim, Jung-Won</creatorcontrib><creatorcontrib>Lee, Dong-Hoon</creatorcontrib><creatorcontrib>Kim, Dong-Hyun</creatorcontrib><creatorcontrib>Park, Yong-Beom</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Han-Jun</au><au>Lim, Jung-Won</au><au>Lee, Dong-Hoon</au><au>Kim, Dong-Hyun</au><au>Park, Yong-Beom</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>28</volume><issue>5</issue><spage>1579</spage><epage>1586</epage><pages>1579-1586</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
Restoration of neutral alignment is considered key in total knee arthroplasty (TKA). However, this may be undesirable and can result in medial soft-tissue over-release in patients with varus knee and lateral femoral bowing. This study aimed to determine whether individualized intentional varus distal femoral cutting yielded satisfactory clinical and radiological outcomes.
Methods
A total of 77 patients (91 knees) with varus knee (hip–knee–ankle axis ≥ 10°) and lateral femoral bowing > 5° underwent navigation-assisted primary TKA using individualized intentional varus distal femoral cutting. Knee Society scores, Western Ontario and McMaster Universities scores, and radiographs for limb alignment, implant alignment, and aseptic loosening were evaluated. Subgroup analyses were performed according to the limb alignment and coronal femoral component alignment (0° ± 3° vs. varus of > 3°).
Results
All clinical outcomes significantly improved at the final follow-up (
p
< 0.05 in all). The mechanical axis angle changed from 13.1° ± 2.7° to 2.8° ± 1.5°. The coronal femoral component angle at the final follow-up was 2.8° ± 1.3°. Radiolucent lines were observed in 6 cases (6.6%) and were less than 2 mm in all cases without progression. In subgroup analyses, no significant differences were observed in clinical outcomes (n.s. in all) and in the incidence of radiolucent lines (n.s. in limb alignment, n.s. in coronal femoral component alignment).
Conclusions
Individualized intentional varus distal femoral cutting yielded favorable clinical outcomes without complications at 5-year follow-up. Slight under-correction using intentional varus distal femoral cutting could be a viable option in patients with varus knee and lateral femoral bowing during navigation-assisted TKA.
Level of evidence
IV.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31230123</pmid><doi>10.1007/s00167-019-05577-1</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-3741-2311</orcidid></addata></record> |
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| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020-05, Vol.28 (5), p.1579-1586 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2246250130 |
| source | SpringerNature Journals; Access via Wiley Online Library |
| subjects | Alignment Ankle Arthroplasty (knee) Biomedical materials Bone implants Bowing Clinical outcomes Complications Cutting Femoral components Femur Hip Joint surgery Knee Loosening Medicine Medicine & Public Health Orthopedics Radiographs Radiography Restoration Subgroups Surgical implants |
| title | Slight under-correction using individualized intentional varus femoral cutting leads to favorable outcomes in patients with lateral femoral bowing and varus knee |
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