233. NON-CONSTRAINED TOTAL KNEE ARTHROPLASTY NAVIGATED WITH OSTEOTOMY OF THE LATERAL CONDYLE FOR DEGENERATIVE DISEASE ON SEVERE GENU VALGUM: REVIEW OF 15 PATIENTS.

Abstract

Purpose of the study: TKA on genu valgum raises serious problems for the ligament balance. Excessive release of the lateral retracted ligaments exposes the knee to potential instability in the frontal plane. To resolve this problem and avoid implantation of a constrained TKA, we opted for osteotomy of the lateral condyle removing the insertion of the lateral collateral ligament and the popliteal muscle after release of the fascia lata. The purpose of our study was to evaluate the functional and radiographic outcomes of these patients.

Material and methods: This was a retrospective study from 2002 to 2006. All patients with degenerative joint disease of the knee with severe and/or fixed genu valgum were included. These patients were implanted with a navigated posterostabilised Wallaby TKA (Navitrack) associated with osteotomy of the lateral condyle fixed with screws after acquisition of the ligament balance. The diagnosis and surgical history were noted. The preoperative alignement was determined on the full limb x-ray and from navigation data. The following variables were reviewed: polyethylene height, lowering of the lateral condyle, blood loss, operative time. The postoperative alignment was established at least one year after surgery. Intraoperative, postoperative and late complications were noted. The Knee Society function scores were used.

Results: Fifteen patients, mean age 70 years were reviewed at mean 35 months. The mean duration of the operative time was 136 min with mean blood loss of 620 ml. The mean PE height was 13 mm. All operated knees were corrected with mean alignment improving from 17.71 to 1.5 valgus postoperatively. The function score improved from 35 preoperatively to 79 at last follow-up. There were no cases of patellar instability or secondary laxity. Two patients developed late reflex dystrophy. The only case of revision concerned one non-union of the lateral condyle (screw removed at four months) but had a function score of 85 at last follow-up.

Discussion: Performing an osteotomy of the lateral condyle in complement with the navigated posterostabilised TKA for fixed genu valgum enabled good relaxation and satisfactory functional results so that totally constrained implants can be avoided.