Desenlaces funcionales asociados a las diferentes técnicas de reemplazo total de rodilla en pacientes adultos con deformidades extra-articulares: Revisión sistemática de la literatura
DOI:
https://doi.org/10.1016/j.rccot.2020.09.006Palabras clave:
reemplazo total de rodilla, osteoartritis, deformidad extraarticular, osteotomíaResumen
Introducción: El reemplazo total de rodilla (RTR) en pacientes con deformidades extraarticulares es un desafío. Se han descrito diferentes intervenciones como la corrección con cortes intraarticulares y la realización de osteotomías concomitantes. El objetivo del estudio es evaluar los desenlaces funcionales asociados a las diferentes técnicas de RTR en pacientes con deformidades extra-articulares.
Materiales y Métodos: Revisión sistemática de la literatura. Se incluyeron estudios que evaluaran desenlaces funcionales del RTR primario en pacientes adultos con osteoartritis y deformidades extra-articulares. Se describen el tipo de deformidad e intervención, escalas de funcionalidad y rango de movilidad.
Resultados: Se incluyeron 29 estudios para un total de 401 rodillas. La deformidad del eje mecánico más frecuente fue varo, con un promedio menor a 20º en la mayoría de estudios.
El "Knee score" (KS) promedio postoperatorio en el grupo de RTR con cortes intra-articulares y guías convencionales osciló entre 85 y 96,5; con cortes guiados por navegación entre 82 y 95; y en el grupo con osteotomía concomitante entre 60,7 y 97. El "Function Score" (FS) postoperatorio promedio estuvo entre 69,5 y 91,4, 80 y 95,4, y 72,3 y 90 respectivamente. Se reportaron más complicaciones en el grupo de RTR más osteotomía concomitante.
Discusión: El RTR con cortes intra-articulares y balance de tejidos blandos, con guías convencionales o por navegación, es una opción viable especialmente en casos de deformidades extra-articulares leves. En casos con deformidades mayores se puede considerar la realización concomitante de osteotomía correctora.
Nivel de evidencia: IV
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