COMBINED TOTAL KNEE ARTHROPLASTY AND CORRECTIVE OSTEOTOMY FOR DEGENERATIVE JOINT DISEASE WITH MAJOR AXIAL DEVIATION: A SERIES OF 10 CASES

Abstract

Purpose: We report our experience with 10 cases of osteotomy performed at the same time as total hip arthroplasty.

Material and methods: This series included ten knees in ten patients, mean age 63 years. The knees were divided into two groups: five with tibial deviations in one or two planes (three callus deformities, one congenital varus, and one coxalgia sequela) and six mono- or biplanar femoral deviations (three callus deformities, two congenital valgus, and one coxalgia sequela). The principal extra-articular deviation was greater than 10° in all cases. A total knee arthroplasty preserved the posterior cruciate ligament in nine cases with a non-cemented femoral stem implant and cemented tibial implant with or with out a stem. The tibial osteotomies were all in the proximal metaphysis. The femoral osteotomy was in the distal metaphysis in four cases, subtro-chanteric with derotation in one and in the diaphysis with derotation in one. The correction osteotomy was performed before the prosthesis bone cut. Complementary osteosynthesis was used in all cases.

Results: Minimal follow-up was 12 months with a mean of 19.6 months. Bone healing was achieved in all cases. Complete weight bearing was achieved at a mean 2.5 months. The mean postoperative HSS score was 76. Results were excellent in four knees, good in four, fair in one and poor in one. Mean joint amplitude was 105°. Radiographically, complete tibial correction was obtained for three knees (two biplanar corrections); for two knees the biplanar correction was incomplete in one plane. Among the four biplanar femoral deviations, complete correction was achieved in three and incomplete frontal correction in one, with two varus overcorrections in the frontal plane on the single plane deviations.

Discussion: We used this method to avoid intra-articular correction of extra-articular deviations, a source of complications.

Conclusion: Combining osteotomy with total knee arthroplasty during the same operation for patients with major axial deviation and degenerative joint disease provides satisfactory results in 80% of the cases.