Total Knee Arthroplasty: Does the Tibial Medial Side Defect Affect Outcome?

  • Mohammad Vahedian-Ardakani Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • SM Javad Mortazavi Mail Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Mahmoud Farzan Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Total knee arthroplasty, Osteoarthritis, Quality of life, Medial tibial defect, Varus deformity, Pain

Abstract

Primary knee osteoarthritis (OA) is one of the degenerative diseases that destroy auricular cartilage within knee joint and cause pain, varies deformity, decrease knee function. Total knee arthroplasty (TKA) is an effective intervention in order to relieve pain, improve function and QOL (quality of life) in patients with severe osteoarthritis of the knees that have different degrees of varus deformity. However, we are not aware of any study to shows if medial side defect in tibia has any association with outcome. We conceive this study of finding out if medial side defect of tibia affects the outcome. 124 patients (143 knees) with primary knee OA with different stages of defects participated in this study. Patients classified into two groups based on Rand classification of knee defects (patients with Rand I and II in group 1 and patients with Rand III and IV in group 2). Pain and knee alignment have been measured by Visual analog scale (VAS) and 3-joint X-ray and quality of life, knee function and radiographic have been measured by questionnaires of SF 36, WOMAC and KSS score. The mean follow-up was 18. 2 mounts (range 12 to 23 months). The results showed that all of the parameters improved significantly within groups (P≤0.001). Comparison TKA between two groups in the postoperative analysis shows that there was a significant difference between groups in pain, radiographic and functional KSS and WOMAC score (P≤0.05). So group 1 had better results in these parameters than group 2 after surgery. TKA is an effective intervention for all patients with severe osteoarthritis and varus deformity. However, the severity of medial tibial defects is an important determinant of outcome. Patients with a more severe deformity have less favorable outcome.

References

Cooper C, Litwic A. Epidemiology of osteoarthritis. Medicographia 2013;35:145-51.

Felson DT. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev 1988;10(1):1-28.

Felson DT, Naimark A, Anderson J, et al. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 1987;30(8):914-8.

Fosco M, Ben Ayda R, Amendola L, et al. Management of Bone Loss in Primary and Revision Knee Replacement Surgery. In: Fokter SK, editor. Recent Advances in Arthroplasty. 1st ed. Rijeka, Croatia: InTech; 2012: p. 387-395.

Franceschina MJ, Swienckowski JJ. Correction of varus deformity with tibial flip autograft technique in total knee arthroplasty. J Arthroplasty 1999;14(2):172-4.

Dixon MC, Parsch D, Brown RR, et al. The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of a uncapped proximal medial bone. J Arthroplasty 2004;19(1):19-22.

Elia EA, Lotke PA. Results of revision total knee arthroplasty associated with significant bone loss. Clin Orthop Relat Res 1991;(271):114-21.

El-Khadrawe T, Alex C. Autograft of tibial defects in primary total knee arthroplasty: reliability and cost effectiveness. Bull Alex Fac 2006;42(3):675-6.

Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989;(248):9-12.

Rissanen P, Aro S, Slatis H, et al. Health and quality of life before and after hip or knee arthroplasty. J Arthroplasty 1995;10(2):169-75.

Hawker G, Wright J, Coyte P, et al. Health-Related Quality of Life after Knee Replacement. J Bone Joint Surgv Am 1998;80(2):163-73.

Rand JA. Use of Metal Wedge Augmentation. Clin Orthop Relat Res 1991;(271):63-71.

Jones CA, Voaklander DC, Johnston DW, et al. The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Arch Intern Med 2001;161(3):454-60.

Published
2015-10-06
How to Cite
1.
Vahedian-Ardakani M, Mortazavi SJ, Farzan M. Total Knee Arthroplasty: Does the Tibial Medial Side Defect Affect Outcome?. Acta Med Iran. 53(8):462-465.
Section
Original Article(s)