Lv SJ, Wang XJ, Huang JF, Mao Q, He BJ, Tong PJ. Total knee arthroplasty in Ranawat II valgus deformity with enlarged femoral valgus cut angle: A new technique to achieve balanced gap. World J Clin Cases 2022; 10(19): 6406-6416 [PMID: 35979319 DOI: 10.12998/wjcc.v10.i19.6406]
Corresponding Author of This Article
Pei-Jian Tong, MD, Chief Doctor, Department of Orthopedics and Traumatology, The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. 351653161@qq.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective 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/
Shuai-Jie Lv, Jie-Feng Huang, Qiang Mao, Bang-Jian He, Pei-Jian Tong, Department of Orthopedics and Traumatology, The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Xiao-Jian Wang, The First Clinical Medical School, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Author contributions: Tong PJ and Lv SJ conceived and coordinated the study, designed, performed, and analyzed the experiments, and wrote the paper; He BJ and Lv SJ carried out the data collection and analysis, and revised the paper; all authors reviewed the results and approved the final version of the manuscript.
Supported bythe Project of Excellent Young Talents of Traditional Chinese Medicine of Zhejiang Province, No. 2019ZQ016; and the Zhejiang Medical and Health Science and Technology Young Talents Program, No. 2019RC059.
Institutional review board statement: This study was approved by the hospital ethics and review committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (No. 2019-K-207-01).
Informed consent statement: All patients provided informed consent for this study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pei-Jian Tong, MD, Chief Doctor, Department of Orthopedics and Traumatology, The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. 351653161@qq.com
Received: July 23, 2021 Peer-review started: July 23, 2021 First decision: September 2, 2021 Revised: September 10, 2021 Accepted: April 21, 2022 Article in press: April 21, 2022 Published online: July 6, 2022 Processing time: 335 Days and 23.9 Hours
ARTICLE HIGHLIGHTS
Research background
Total knee arthroplasty (TKA) for Ranawat Type II valgus deformity (VD) of the knee is challenging and technical due to resection and soft tissue balance.
Research motivation
Unreasonable osteotomy and soft tissue release in pursuit of neutral femorotibial mechanical axis (FTMA) will increase joint instability, limited prosthesis use, and complications.
Research objectives
This study aimed to provide a new technique of surgical resection, soft tissue release, and FTMA for the VD of the knee during TKA.
Research methods
Sixty-one patients had a valgus cut angle (VCA) of 5°-7° in the new theory TKA group (NT-TKA). We chose to sacrifice the 2° FTMA to reduce the risk of survival failure, joint installation, and consumption of constrained procedures if the FTMA still cannot return to the neutral position after the maximum soft tissue release. Forty-two patients in the conventional TKA group (C-TKA) were treated with a VCA of 3°-5° and pursuit of neutral FTMA.
Research results
The constrained prosthesis usage and complications in NT-TKA were lower than those in C-TKA (P = 0.002 and P = 0.034, respectively). The KSS at 1 mo post-operation for NT-TKA was higher than that in C-TKA (P = 0.007).
Research conclusions
Adopting 5°-7° VCA for VD and sacrificing 2° neutral FTMA for severe VD which cannot be completely corrected during TKA can reduce the need for soft tissue release, maintain early joint stability, reduce the use of constrained prostheses, and minimize postoperative complications.
Research perspectives
This series of surgical technique for VD of the knee during TKA have certain clinical guiding significance.
