Abstract：Objective To observe the clinical effect of sliding osteotomy of lateral femur condyle for correcting fixed valgus deformity in primary total knee arthroplasty (TKA).Methods From May 2017 to June 2020，15 patients (17 knees)with Fixed valgus knees deformity including 5 men(5 knees)and 10 women(12 knees)underwent primary total knee arthmplasty.Average age was 69.5 years(range 59~76 years).The average weight was 73.6 kg(range 64.5~89.0 kg)and average body height was 170.5 cm(range 156~178 cm).The diagnoses of the patients were osteoarthritis in 13 cases(15 knees)and rheumatoid arthritis in 2 cases(2 knees).All patients were rated as type Ⅱ according to Krackow classification of valgus knee.During primary TKA，sliding osteotomy lateral femoral condyle for restoring soft tissue balance and correcting valgus deformity were performed via a medial parapatellar approach.Posterior stabilized prosthesis was employed in all cases.Properative and postoperative imaging parameters and clinical outcomes were evaluated.Results Average followup was 30.5 months(range 3~50 months).The tibiofemoral angle was corrected from preoperative (199.5±3.3)° to postoperative (172.4±1.5)°(P＜0.05).The femoral transepicondylar angle (FTEA) was significant improved from preoperative (80.3±1.7)°to postoperative (89.5±1.5)° (P＜0.05).According to knee society score(KSS) criterion.The clinical score improved from preoperative (33.2±6.5) to postoperative (89.1±1.2) and the functional score improved from (41.9±7.5) to (82.3±5.1)，the range of movement increased from preoperative (62.0±10.1)° before surgery to postoperative (115.0±10.7)°.There was significant statistic difference(P＜0.05).At the last follow-up，the X-ray showed that the position of the prosthesis was good，patella dislocation was not detected and complete union was found at the osteotomy site.The clinical mediolateral instability was not detected.Conclusion Sliding osteotomy of lateral femur condyle is safe and effective for correcting fixed valgus deformity in primary TKA.Restoration of lower limb alignment and balance soft tissue may be achieved with satisfactory clinical outcomes.
［1］Stern SH，Moeckel BH，Insall JN.Total knee arthroplasty in valgus knees［J］.Clin Orthop Relat Res，1991(273)：5-8.
［2］Krackow KA.The technique of total knee arthroplasty［M］.Baltimore：CV Mosby，1990：249-372.
［3］Healy WL，Iorio R，Lemos DW.Medial reconstruction during total knee arthroplasty for severe valgus deformity［J］.Clin Orthop Relat Res，1998(356)：161-169.
［4］Frederick F.Buechel.A sequential threestep lateral release for correcting fixed valgus knee deformities during total knee arthroplasty［J］.Clin Orthop Relat Res，1990(260)：170-175.
［5］Whiteside LA.Selective ligament release in total knee arthroplasty of the knee in valgus［J］.Clin Orthop Relat Res，1999(367)：130-140.
［6］Ranawat AS，Ranawat CS，Elkus M，et al.Total knee arthroplasty for severe valgus deformity［J］.J Bone Joint Surg(Am)，2005，87 Suppl 1(Pt 2)：271-284.
［7］Krackow KA，Mihako WM.Flexion-extension joint gap changes after lateral structure release for valgus deformity correction in total knee arthroplasty：a cadaveric study［J］.J Arthroplasty，1999，14(8)：994-1004.
［8］Easley ME，Insall JN，Scuderi GR，et al.Primary constrained condylar knee arthroplasty for the arthritic valgus knee［J］.Clin Orthop Relat Res，2000(380)：58-64.
［9］Jacob M.Conjeski，MD，Giles R.et al.Lateral femoral epicondylar osteotomy for correction of fixed valgus deformity in total knee arthroplasty：A technical note［J］.J Arthroplasty，2018，33(2)：386-390.
［10］Yoshioka Y，Siu D，Cooke TD.The anatomy and functional axes of the femur［J］.J Bone Joint Surg(Am)，1987，69(6)：873-880.
［11］Stiehl JB，Abbott BD.Morphology of the transepicondylar axis and its application in primary and revision total knee arthroplasty［J］.J Arthroplasty，1995，10(6)：785-789.
［12］Krackow KA，Jones MM，Teeny SM，et al.Primary total knee arthroplasty in patients with fixed valgus deformity［J］.Clin Orthop Relat Res，1991(273)：9-18.
［13］Scior W，Hilber F，Hofstetter M，et al.Shortterm and midterm results of lateral condyle sliding osteotomy in the treatment of valgus total knee arthroplasty：A successful therapy option in Grade 2 valgus total knee arthroplasty［J］.Knee，2018，25(3)：466-472.
［14］Feng Li，Ning Liu，Zijian Li，et al.Lateral femoral sliding osteotomy in total knee arthroplasty with valgus deformity greater than twenty degrees［J］.Int Orthop，2019，43(11)：2511-2517.
［15］Mullaji AB，Shetty GM.Lateral epicondylar osteotomy using computer navigation in total knee arthroplasty for rigid valgus deformities［J］.J Arthroplasty，2010，25(1)：166-169.
［16］Brilhault J，Lautman S，Favard L，et al.Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity［J］.J Bone Joint Surg(Br)，2002，84(8)：1131-1137.
［17］Mullaji AB，Shetty GM.Surgical technique：Computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA［J］.Clin Orthop Relat Res，2013(471)：1484-1491.
［18］Richard Scott.Total knee arthroplasty：A Technique Manual［M］.3rd.Elsevier，2020：39-48.
［19］Touzopoulos P，Drosos GI，Ververidis A，et al.Constrained implants in total knee replacement［J］.Surg Technol Int，2015(26)：307-316.
［20］Clarke HD，Fuchs R，Scuderi GR，et al.Clinical results in valgus total knee arthroplasty with the "pie crust" technique of lateral soft tissue releases［J］.J Arthroplast，2005，20(8)：1010-1014.
［21］Matsuda S，Miura H，Nagamine R，et al.Anatomical analysis of the femoral condyle in normal and osteoarthritic knees［J］.J Orthop Res，2004，22(1)：104-109.
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