Chaiyakit P, Wattanapreechanon P. Coronal plane stability of cruciate-retaining total knee arthroplasty in valgus gonarthrosis patients: A mid-term evaluation using stress radiographs. World J Orthop 2024; 15(8): 764-772 [PMID: 39165866 DOI: 10.5312/wjo.v15.i8.764]
Corresponding Author of This Article
Pichayut Wattanapreechanon, MD, Lecturer, Surgeon, Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Samsen Rd., Dusit, Bangkok 10300, Thailand. pichayut@nmu.ac.th
Research Domain of This Article
Orthopedics
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Aug 18, 2024; 15(8): 764-772 Published online Aug 18, 2024. doi: 10.5312/wjo.v15.i8.764
Coronal plane stability of cruciate-retaining total knee arthroplasty in valgus gonarthrosis patients: A mid-term evaluation using stress radiographs
Pruk Chaiyakit, Pichayut Wattanapreechanon
Pruk Chaiyakit, Pichayut Wattanapreechanon, Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
Author contributions: Chaiyakit P was the guarantor, designed the study and writing and revised the article critically for important intellectual content; Wattanapreechanon P participated in data acquisition, data analysis, and data interpretation, initial draft the manuscript, and submission process of the manuscript.
Institutional review board statement: This study was reviewed and approved by the institutional review board committee of Navamindradhiraj University (Bangkok, Thailand; COA157/2563).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pichayut Wattanapreechanon, MD, Lecturer, Surgeon, Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Samsen Rd., Dusit, Bangkok 10300, Thailand. pichayut@nmu.ac.th
Received: April 16, 2024 Revised: July 1, 2024 Accepted: July 10, 2024 Published online: August 18, 2024 Processing time: 119 Days and 4.6 Hours
Abstract
BACKGROUND
Total knee arthroplasty (TKA) using implants with a high level of constraint has generally been recommended for patients with osteoarthritis (OA) who have valgus alignment. However, studies have reported favorable outcomes even with cruciate-retaining (CR) implants.
AIM
To evaluate the coronal plane stability of CR-TKA in patients with valgus OA at the mid-term follow-up.
METHODS
Patients with primary valgus OA of the knee who underwent TKA from January 2014 to January 2021 were evaluated through stress radiography using a digital stress device with 100 N of force on both the medial and lateral side. Gap openings and degrees of angulation change were determined. Descriptive statistical analysis was performed for both continuous and categorical variables. Inter-rater reliability of the radiographic measurements was evaluated using Cronbach’s alpha.
RESULTS
This study included 25 patients (28 knees) with a mean preoperative mechanical valgus axis of 11.3 (3.6-27.3) degrees. The mean follow-up duration was 3.4 (1.04-7.4) years. Stress radiographs showed a median varus and valgus gap opening of 1.6 (IQR 0.6-3.0) mm and 1.7 (IQR 1.3-2.3) mm and varus and valgus angulation changes of 2.5 (IQR 1.3-4.8) degrees and 2.3 (IQR 2.0-3.6) degrees, respectively. No clinical signs of instability, implant loosening, or revision due to instability were observed throughout this case series.
CONCLUSION
The present study demonstrated that using CR-TKA for patients with valgus OA of the knee promoted excellent coronal plane stability.
Core Tip: Cruciate-retaining total knee arthroplasty (CR-TKA) for knee valgus osteoarthritis (OA) has been associated with high rates of postoperative tibiofemoral instability. Our study utilized a digital ligament stress device to objectively measure the coronal stability of CR-TKA in patients with knee valgus OA at a mean follow of 3 years and found no significant instability, with a median varus and valgus gap change of < 2 mm. All patients were satisfied with their knee without revision due to instability, loosening, or patellar-related complication. We also describe the step-by-step details of the surgical technique used to ensure good exposure and soft tissue balance.
