Functional outcomes associated with the different total knee replacement techniques in adult patients with extra-articular deformities: A systematic review of the literature
DOI:
https://doi.org/10.1016/j.rccot.2020.09.006Keywords:
total knee replacement, osteoarthritis, extra-articular deformity, osteotomyAbstract
Background: Total knee replacement (TKR) in patients with extra-articular deformities is a challenging procedure for the surgeon. Different types of surgical techniques have been described, such as correction with intra-articular cuts, and concomitant osteotomies. The objective of this study is to evaluate the functional outcomes associated with the different TKR techniques in
patients with extra-articular deformities.
Methods: A systematic review of the literature was performed. Studies evaluating functional outcomes of primary TKR in adult patients with osteoarthritis and extra-articular deformities were included. The type of deformity and intervention, functional scales records, and range of motion were evaluated.
Results: A total of 29 studies were included with a total of 401 knees. The most frequent mechanical axis deformity was varus, with a mean range below 20º in most studies. The mean after surgery knee score (KS) in the TKR group with intra-articular cuts and conventional guides ranged between 85 and 96.5. Those with cuts guided by navigation had a score between 82 and 95, and between 60.7 and 97 in the group with concomitant osteotomy. The mean post-operative Function Score (FS) was between 69.5 and 91.4, 80 and 95.4, and 72.3 and 90, respectively. More complications were reported in the TKR plus concomitant osteotomy group.
Discussion: TKR with intra-articular cuts and soft tissue balance, with conventional guides or by navigation, is a viable option and should be preferred in cases of mild extra-articular deformities. In cases with major deformities, a concomitant corrective osteotomy should be considered.
Evidence Level: IV.
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