Management of advanced varus knee deformity in total knee arthroplasty: surgical strategies and radiographic outcomes

Öz

Total knee arthroplasty for advanced varus knee deformity poses significant technical challenges due to pronounced medial cartilage loss and soft-tissue contracture. Proper preoperative planning aims to restore the mechanical axis through precise bone cuts and sequential soft-tissue balancing. Recent evidence indicates that mild residual varus alignment yields comparable outcomes to neutral alignment, while excessive postoperative varus should be avoided. When appropriate implant selection and soft-tissue balance are achieved, postoperative radiographic alignment and clinical function demonstrate successful correction and durable results.

Anahtar Kelimeler

• Advanced varus deformity
• Total knee arthroplasty
• Surgical planning

İleri varus diz deformitesinin total diz artroplastisinde yönetimi: cerrahi stratejiler ve radyografik sonuçlar

Öz

İleri varus deformitesine sahip dizlerde total diz artroplastisi, belirgin medial kıkırdak kaybı ve yumuşak doku kontraktürleri nedeniyle önemli teknik zorluklar içerir. Doğru preoperatif planlama, kemik kesileri ve yumuşak doku gevşetmeleri ile deformitenin mekanik aks üzerinde düzeltilmesi hedeflenir. Literatürde hafif rezidüel varus açısının nötr aksla benzer sonuçlar verdiği, aşırı varusun ise olumsuz etkileri olduğu gösterilmiştir. Uygun implant seçimi ve yumuşak doku dengesi sağlandığında, cerrahi sonrası radyografik hizalanma ve klinik sonuçlar başarılı olmaktadır.

Anahtar Kelimeler

• İleri varus deformitesi
• Total diz artroplastisi
• Cerrahi planlama

Kaynakça

1. Wan XF, Yang Y, Wang D, et al. Comparison of Outcomes After Total Knee Arthroplasty Involving Postoperative Neutral or Residual Mild Varus Alignment: A Systematic Review and Meta-analysis. Orthop Surg. 2022;14(2):177-189.
2. Kwak IH, Lee SS, Lee J, Lee DH. Effects of Severe Varus Deformity on Soft Tissue Balancing in Total Knee Arthroplasty. J Clin Med. 2022;12(1):263.
3. Chaiyakit P, Petcharat B, Hongku N, Iawsuwan A. Complete Release of the Superficial Medial Collateral Ligament in Total Knee Arthroplasty. Arthroplast Today. 2024;25:101301.
4. Ryu JJ, Kim YH, Choi CH. The additional tibial stem extension is not mandatory for the stability of 5 mm metal block augmented tibial prosthesis construct in primary total knee arthroplasty: 5-year minimum follow-up results. Knee Surg Relat Res. 2023;35(1):5.
5. George JC, Chittaranjan BS, Babu S, Mohan B. Cruciate-retaining Arthroplasty in Patients with Severe Varus Deformity: A Retrospective Comparative Study. J Orthop Case Rep. 2024;14(4):176-180.