Abstract
Aims
The aims of this prospective study were to determine the effect of osteophyte excision on deformity correction and soft-tissue gap balance in varus knees undergoing computer-assisted total knee arthroplasty (TKA).
Patients and Methods
Four-hundred twenty-five consecutive, cemented, cruciate-substituting TKAs were analysed. Pre-operative varus was calculated on long leg weight-bearing HKA film. Limb deformity in coronal (varus) and sagittal (flexion) planes, medial and lateral gap distances in maximum knee extension and 90° knee flexion and maximum knee flexion were recorded before and after excision of medial femoral and tibial osteophytes using computer navigation. Data was extracted and analysed to assess the effect of removal of osteophytes on the correction of deformity and soft tissue balance.
Results
Before removal of any osteophytes or soft tissue releases, 138 out of 425 (32%) achieved correction of deformity (HKA 180+2°). In the remaining knees, after osteophyte removal 183 knees (43%) achieved correction of deformity. Overall, 75% knees achieved deformity correction after removal of osteophytes. For the remaining 25% knees, additional procedures (such as capsular release, semimembranosus release, reduction osteotomy) were needed for deformity correction.
Conclusion
Three-fourths of all knees were aligned with no release or only removal of osteophytes. Excision of medial femoral and tibial osteophytes can be a useful, initial step towards achieving deformity correction and gap balance without having to resort to soft-tissue release during TKA in varus knees. This is useful information for surgeons to desist from any soft tissue releases till osteophytes have been meticulously excised.
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