The Treatment Of TKA For Severe Valgus Knee Deformity

Objective: To evaluate the short and mid-term clinical efficacy of total knee arthroplasty(TKA) as the treatment of severe valgus knee.To understand the complications of TKA, describe the knee anatomy, valgus knee indexing, type, and causes of formation. To describes the amount of osteotomy in TKA; how to release and balance the soft tissue around the joint; how to choose the reasonable type of prosthesis; and to provide a reference for future clinical TKA treatment of severe valgus knee deformity.Methods: A retrospective analysis of 18 patients with 20 cases of severe valgus knee deformity treated with TKA from January 2012 to December 2015 in Chenzhou First People's Hospital.. Among these18 patients, there were 6 males and 12 females. The average age was 66 years(range 50-76). There were 6 patientswith osteoarthritis, 8 with rheumatoid arthritis, and 4 with traumatic arthritis. For all patients, we measured pre-operative knee valgus angles,theirknee scoring system(KSS) scores, tibiofemoral angles(FTA), and ranges of motion(ROM).After operations,we followed patients for 12-24 months with an average follow-up time of16 months. During the follow up, we recorded the valgus angles,KSSscores, FTA, and ROM again at 6 and12 months post-operation. We evaluated the clinical effect of TKA treatment of severe valgus knee by comparing the measurements pre- and post-donation for each patient.Results: 18 patients were operated successfully. All cases were followed up after operation. The mean and standard deviation(SD) of FTA was 32.25±1.00° before operation; and were6.17 ± 0.83 ° and 6.32 ±0.71 ° at 6 months and 12 months post-donation, respectively. The knee joint activity was 66.65 ±3.31 degrees; and were 100.90 ± 2.43°and 105.8±2.68° at 6 months and 12 months post-donation, respectively. The mean and SD of KSS knee score and functional scorewas45.35 ± 1.63 and50.20 ± 2.88, respectively. At 6 months and 12 months post-operation,KSS knee score was 87.95 ±2.58 and 90.20 ±2.91; and KSS function score was 85.30±2.11 and 87.25±1.94, respectively. The post-operative FTA, joint activity and KSS score were statistically significantly improved as compared with their pre-operative measures(P < 0.05).Regarding post-operative complications, 1 case hadpoor wound healing,but after symptomatic treatmentto strengthen the skin incision, the incision healed well withno incision dehiscence. Two patients had deep vein thrombosis but no people dad pulmonary embolism, blood vesselornerve injury symptoms. After knee replacement, no patient had infection, periprosthetic fracture, prosthesis loosening ordislocation.Conclusion: The short- and mid-term clinical results of TKA to treatment severe knee valgus were improved significantly. Through detailed preoperative preparation, understandingthe preoperative indications and contraindications,minimizing the risk of surgery, refining accurate intraoperative osteotomy,and proper postoperative functional exercise, the clinical results were satisfactory.