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Total knee arthroplasty in patients with varus deformities greater than ten degrees: survival analysis at a mean ten year follow-up

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Abstract

Introduction

Total knee arthoplasty (TKA) is a secure procedure with more than 90% survival at ten years. The purpose of this study was to report both clinical and radiological outcomes of TKA with a varus > 10°. The second objective was to identify risk factors for failure or bad clinical results. Our hypothesis was that results and survey are comparable to TKA with lesser deformities.

Methods

Eighty-two TKA (69 patients) between January 2004 and December 2008 with a varus > 10° were reviewed retrospectively. The endpoints were clinical (range of motion, IKS knee score, Oxford, and SF-12) and radiological (HKA post-operative and the existence of radiolucent lines or loosening at last follow-up).

Results

Sixty-three TKA (55 patients) were assessed with a mean follow-up of 10.9 years. The global IKS score significantly increased (p = 0.04). Seven TKA needed a revision: two for sepsis, four for aseptic loosening, and one for polyethylene wear, with an overall survival of 91.6% at ten years. For aseptic loosening, the survival rate was 94.7% at ten years. Risk factors for failure were age (p = 0.001), weight (p = 0.04), and a post-operative HKA lesser than 175° (p = 0.05) for aseptic loosening.

Discussion

The hypothesis was confirmed: the results showed a significant improvement of function and quality of life with a survival rate comparable to those found in the literature for greater varus but also inferior to 10°. Three risk factors have been identified suggesting increased surveillance in these cases.

Conclusion

The results of this survey confirm the work hypothesis. Total knee arthroplasty in patients with important axial deformities is a confirmed, reliable, patient-friendly and predictable good outcome procedure.

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Authors and Affiliations

  1. Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67098, Strasbourg cedex, France

    Benjamin Puliero, Henri Favreau, David Eichler, Philippe Adam, François Bonnomet & Matthieu Ehlinger

  2. Laboratoire ICube, CNRS UMR 7357, 30 Bd Sébastien Brant, 67400, Ilkirch, France

    Philippe Adam & Matthieu Ehlinger

Authors
  1. Benjamin Puliero
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  2. Henri Favreau
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  3. David Eichler
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  4. Philippe Adam
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  5. François Bonnomet
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  6. Matthieu Ehlinger
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Corresponding author

Correspondence to Matthieu Ehlinger.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

PA: consulting activity for Depuy-Synthes

FB: consulting activity for Serf, Amplitude

ME: consulting activity Depuy-Synthes, Newclip, Lepine

BP, DE, HF: None

Additional information

Level of evidence: IV, retrospective study.

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Puliero, B., Favreau, H., Eichler, D. et al. Total knee arthroplasty in patients with varus deformities greater than ten degrees: survival analysis at a mean ten year follow-up. International Orthopaedics (SICOT) 43, 333–341 (2019). https://doi.org/10.1007/s00264-018-4019-3

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  • DOI: https://doi.org/10.1007/s00264-018-4019-3

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