Akademik Veri Yönetim Sistemi
JBJS REVIEWS, cilt.9, sa.10, 2021 (ESCI)
Background: Medial coronal plane malalignment, also known as varus alignment, iscommonlyreported inosteoarthritic knees. Although thedegree of deformity provides some insight regarding the severity of the disease, it does not always reflect the potential complexity of the surgical treatment. Methods: This prospective observational study was conducted by analyzing the radiographs of 100 consecutive knees in patients undergoing total knee arthroplasty. For each knee, coronal alignment, expressed as the hip-knee-ankle angle, was measured on a full-leg standing radiograph and classified in 3 stages. The primary location of the varus deformity was identified as intra-articular and/or extra-articular. Additionally, knees were evaluated to assess for 10 radiographic featuresof varus deformity and then classified in 3 grades of osteoarthritis severity. Results: The mean (and standard deviation) preoperative varus deformity was 11 degrees +/- 66 degrees of varus (hip-knee-ankle, 169 degrees), as measured on standardized full-leg radiographs. Extra-articular varus deformity was observed in 14% of patients. A higher number of radiographic features of varus severity corresponded with higher degrees of deformity. Varus grade correlated strongly with stage of varus deformity. Twenty-three (100%) of 23 stage-III deformities had grade-C features; however, 13 (48%) of 27 stage-I patients also had grade-C disease. Conclusions: One of every 7 osteoarthritis patients with varus deformity had an extra-articular deformity, and 1 of 2 of these patients had severe intra-articular disease (grade C) despite limited coronal deformity (stage I). These findings reconfirm the need for individual deformity analysis that accounts for the degree, location, and severity of the varus deformity. This insight may help to formulate an algorithmic treatment approach specific to the epiphyseal knee anatomy of the patient and according to the surgical preferences of the surgeon. Clinical Relevance: Knee surgeons tend to consider knees with higher degrees of coronaldeformity asmoretechnicallydifficult, but thepresent study shows that knees with less deformity can still present with severe grades of osteoarthritis inside the knee, leadingtomore challengingjoint reconstruction.