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KMID : 0377619920570050313
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Korean Jungang Medical Journal
1992 Volume.57 No. 5 p.313 ~ p.313
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CORRECTION OF SEVERE DEFORMITY IN TOTAL KNEE REPLACEMENT
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Cameron, H. U
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Abstract
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Knee deformity can be classified as intra-articular deformity of an extra articular deformity. While virtually any intra-articular deformity can be corrected by ligament release to allow the use of a semi-constrained knee, the capacity to correct extra articular deformity is limited to about 15 degrees. If the extra articular deformity is greater than this, correction by an interval osteotomy is preferable. The osteotomy can be done concomitantly but this necessitates the use of along stem implant.
The common problem seen is over correction following a tibial osteotomy. Recorrection is best carried out via a dome osteotomy to avoid further shortening and the new position may have to be secured by a T-plate under heavy compression.
INtra-articular deformities are due to bone loss, ligament scarring and ligamentous laxity. Bone loss of more than 1.2 cm is best made good by grafting. Ligamentous laxity can usually be overcome by using thicker components on both femoral and tibial sides to avoid shifting the joint line. If a significant proximal shift of the joint line occurs, a patella baja results and therefore a proximal shift of the patella may be reguired. Severe multiligament laxity on occasion requires the use of a fully constrained prosthesis.
A fixed deformity due to ligament scarring can be corrected by soft tissue release from the concave side of the deformity. If the soft tissues are released as a sleeve instability does not result.
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