Treatment Of Knee Deformityes By Total Knee Replacement

ObjectiveWe evaluated the recent and mid-term results of total knee replacement(TKR) for the patients with severe knee deformity.we expected that we can provide instructions for operative technique.MethodsA retrospective study was made on 96 knees of 72 patients (1997.1-2007. 10)with knee deformities by Total knee replacement.There were 12 cases of rheumatoid arthritis,osteoarthritis in 40 cases,8 cases of ankylosing spondylitis,Septic Arthritis 2 cases,2 cases of tuberculosis.TKR was performed to All the knee with 20°-40°valgus or varus deformity,or 20°-90°fixed flexion contracture deformity.Knee deformity was corrected through releasing the soft tissue,secondary appropriate osteotomy,choosing a suitable joint prosthesis.84 knees (64 cases) were followed up,each patients were followed-up at 3,6,12 months postoperatively and then annually.The distance of knees,degree of knee deformity,the range of the joint motion of knee,HSS (Hospital for Special Surgery) knee rating score system were used to evaluate the clinical efficacy of surgery.ResultsAll the patients'incision healed smoothly.All patients were followed up for 1 - 8 years,with an average follow-up period was 4.2 years.At the least follow-up,no loosening evidence of prosthesis was seen in all patients.All the knee joint deformity were corrected postoperatively . Preoperative flexion deformity from 20°- 90°decreased to postoperative 0°-10°. The preoperative deformity both varus and valgus from 20°-40°decreased to postoperative 0°- 10°.The distance of knees of patients with valgus or varus deformity from15-25cm decreased to postoperative 0- 5cm.The average range of the joint motion of the knee increased from 33.4°preoperatively to 94.6°at the last follow-up . The average HSS score increased from preoperative 38.1points to postoperative 90.2 points.The rate of good to excellent was 96.4%.All patients are able to stand and walk,up and down stairs,and can accomplish stand up and sit down independently.One case of patients had deep venous thrombosis,and cured by antibiotic treatment.One case of patients was infected at six months after total knee replacement , and carried out the revision.One case of patients took place hydrops articuli at 10 days following total knee replacement,and recoveried by arthrocentesis,pressure dressing.ConclusionIt is sure that the effect of treatment of knee deformity by Total knee replacement.Through the soft tissue of the knee joint release,the secondary appropriate osteotomy,choosing a suitable joint prostheses we can achieve satisfactory results in recent and mid-term.Long-term effect need to be further follow-up.