| Objective: To investigate the effect of correction of valgus deformity on knee function and patellar position in patients with valgus knee after TKA.Methods: The clinical and imaging data of 118 patients with valgus knee deformity who underwent total knee arthroplasty(TKA)in the Department of Orthopedics,Affiliated Hospital of Jining Medical College from January 2013 to December 2018 were retrospectively analyzed and followed up.The patients were divided into three groups according to the HKA measured by X-ray one month after operation : neutral position group(±3°),mild valgus group(3°-6°)and severe valgus group(>6°).The clinical efficacy was evaluated by Western Ontario and Mc Master Universities Osteoarthritis Index(WOMAC)and Knee Society Score(KSS).Patella tilt angle(ε angle),fit angle(θ angle),Insall-Salvati Idex(ISI)represent the patella position.Postoperative observation indicators included HKA,femoral angle(α angle),tibial angle(β angle),femoral prosthesis flexion angle(γ angle),and tibial prosthesis posterior slope angle(δ angle).By comparing the preoperative and postoperative data of patients between groups,the effect of postoperative HKA on postoperative clinical indicators and scores was analyzed by linear regression.Results: There was no significant difference in preoperative data among the three groups except HKA(9.22±4.08 vs 8.71±5.60 vs13.745.89).Compared with preoperative data,postoperative HKA,ROM,WOMAC scores and KSS scores were significantly improved,ISI was significantly reduced and ε angle was significantly increased.The comparison of postoperative data between groups showed that compared with the neutral position group,the KSS-knee score(85.93±3.15 vs83.11±4.20)and KSS total score(162.54±5.28 vs 157.54±5.64)in the mild valgus group were significantly lower,and the α angle(95.32±1.08 vs 96.72±0.86)and ε angle(7.30±1.45 vs 8.61±2.78)were significantly increased.Severe valgus group.Compared with the neutral position group,WOMAC-pain(3.61±0.97 vs 4.92±1.77),WOMAC-rigidity(3.03±0.77 vs 4.04±0.91),WOMAC-total score(10.41±1.61 vs 13.29±2.73),KSS-knee score(85.93±3.15 vs 77.33±3.50),KSS-function score(76.61±4.09 vs 68.96±6.25),KSS-total score(162.54±5.28 vs146.29±7.03)were significantly lower.Angle α(95.32±1.08 vs98.68±1.25)and Angle ε(7.30±1.45 vs 13.82±3.66)increased significantly.Compared to the mild valgus group.In severe valgus group,ROM(117.00±18.91 vs 110.63±10.35),WOMAC-rigidity(3.26±0.56 vs4.04±0.91),WOMAC-total score(11.00±1.44 vs 13.29±2.73),KSS-knee score(83.11±4.20 vs 77.33±3.50),KSS-function score(74.43±3.16 vs68.96±6.25),KSS-total score(157.54±5.64 vs 146.29±7.03)were significantly decreased.The α angle(96.72±0.86 vs 98.68±1.25)and εangle(8.61±2.78 vs 13.82±3.66)increased significantly.Linear regression analysis showed that postoperative HKA had significant effects on WOMAC-pain,WOMAC-rigidity,WOMAC-total score,KSS scores,α angle,ε angle and θ angle(P<0.001).Conclusion: A slight lack of valgus correction almost did not affect the short-term efficacy after TKA,but when the residual valgus angle > 6°,the scores were significantly decreased.Insufficient valgus correction will not lead to significant changes in patellar height,but may increase the risk of poor patellar tracking. |
PDF Full Text Request