Clinical Application And Treatment Of New Classification Of Varus Knee

Background:This study presents a new classification of osteoarthritis related to knee varus deformity.This classification comes from the combination of conventional radiographs,stress radiographs(when needed)and clinical examination.In addition,we compared the proximal medial tibial resection in total knee arthroplasty(TKA)with the traditional medial soft tissue release technique.Methods:This study included 130 patients with knee arthroplasty for varus deformity,which had taken coronal alignment on full-leg standing radiographs before the surgery.Measure different mechanical and anatomical angles and combine these findings with the patient's basic clinical examination.Radiographs are repeatedly measured on 2 different occasions to determine the reliability of the observer.Cross-sectional studies such as computed tomography or magnetic resonance imaging are used to further refine the observation of different degrees of wear.In addition,in the discussion of surgical techniques,we performed 40 total knee arthroplasties(TKA)in 27 patients with ?10°tibio-femoral varus deformity.The traditional medial soft tissue release technique was applied to 20 patients.The proximal medial tibia was used for bone resection in the other 20 patients(vertical osteotomy group).Total operating time,knee range of motion(ROM),HSS score,and tibio-femoral medial-lateral gap ratio in 0°,90°,and 130°flexion at postoperative 6 months were compared.Result:Knee varus deformity can be intra-articular or extra-articular.Intra-articular deformity can be corrected or fixed.In the case of a fixed deformity,the condition of the lateral ligament needs to be considered.Extra-articular deformities can be metaphyseal or diaphyseal.The possibility of intra-articular correction depends on the degree of deformity and its distance from the joint.Of the Surgical technique study,the total operation time of the vertical osteotomy group is shorter.In the vertical osteotomy group,the ratio of the medial and lateral tibial voids at 130° flexion was close to 1(p =0.000).There was no significant difference in ROM,HSS score,or at 0° and 90° flexion at 6 months postoperatively tibial-femoral medial and lateral femoral space ratios.Conclusions:This new classification method can better define the varus deformity,which can help the surgeon to better select the implant in the preoperative planning.This classification can also be used as a tool for further prospective studies of varus deformity.In severely varus knees,the medial proximal humeral bone resection can be considered as an alternative technique to reduce total operative time and to obtain medial-lateral,soft-tissue balance in deep flexion.