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Title: [Surgical technique of lateral unicompartmental knee arthroplasty and discussion of the maximum correction value in the treatment of knee valgus deformity].
Author: Liu X, Zheng K, Zhu F, Wang Y, Zhang L, Zhang W, Geng D, Zhou J, Xu Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2023 Oct 15; 37(10):1238-1245. PubMed ID: 37848319.
Abstract:
OBJECTIVE: To investigate the surgical technique and the short-term effectivenss of lateral unicompartmental knee arthroplasty (LUKA) through lateral approach in the treatment of valgus knee and to calculate the maximum value of the theoretical correction of knee valgus deformity. METHODS: A retrospective analysis was performed on 16 patients (20 knees) who underwent LUKA and met the selection criteria between April 2021 and July 2022. There were 2 males and 14 females, aged 57-85 years (mean, 71.5 years). The disease duration ranged from 1 to 18 years, with an average of 11.9 years. Knee valgus was staged according to Ranawat classification, there were 6 knees of type Ⅰ, 13 knees of type Ⅱ, and 1 knee of type Ⅲ. All patients were assigned the expected correction value of genu valgus deformity by preoperative planning, including the correction value of lateral approach, intra-articular correction value, and residual knee valgus deformity value. The actual postoperative corrected values of the above indicators were recorded and the theoretical maximum correctable knee valgus deformity values were extrapolated. The operation time, intraoperative blood loss, incision length, hospital stay, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), joint line convergence angle (JLCA), posterior tibial slope (PTS), range of motion (ROM), Hospital for Special Surgery (HSS) score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were also recorded for effectiveness evaluation. RESULTS: The patients' incision length averaged 13.83 cm, operation time averaged 85.8 minutes, intraoperative blood loss averaged 74.9 mL, and hospital stay averaged 6.7 days. None of the patients suffered any significant intraoperative neurological or vascular injuries. All patients were followed up 10-27 months, with a mean of 17.9 months. One patient with bilateral knee valgus deformities had intra-articular infection in the left knee at 1 month after operation and the remaining patients had no complication such as prosthesis loosening, dislocation, and infection. The ROM, HSS score, and WOMAC score of knee joint significantly improved at each time point after operation when compared to those before operation, and the indicators further improved with time after operation, the differences were all significant ( P<0.05). Imaging measurement showed that HKA, mLDFA, JLCA, and PTS significantly improved at 3 days after operation ( P<0.05) except for mMPTA ( P>0.05). Postoperative evaluation of the knee valgus deformity correction values showed that the actual intra-articular correction values ranged from 0.54° to 10.97°, with a mean of 3.84°. The postoperative residual knee valgus deformity values ranged from 0.42° to 5.30°, with a mean of 3.59°. The actual correction values of lateral approach ranged from 0.21° to 12.73°, with a mean of 4.26°. CONCLUSION: LUKA through lateral approach for knee valgus deformity can achieve good early effectiveness. Preoperative planning can help surgeons rationally allocate the correction value of knee valgus deformity, provide corresponding treatment strategies, and the maximum theoretical correction value of knee valgus deformity can reach 25°. 目的: 探讨经外侧入路行外侧单髁置换术（lateral unicompartmental knee arthroplasty，LUKA）治疗膝外翻的手术技巧和早期临床疗效，并推算理论最大可矫正膝外翻畸形值。. 方法: 回顾分析2021年4月—2022年7月收治且符合选择标准的16例（20膝）经外侧入路行LUKA治疗的膝外翻患者临床资料。其中男2例，女14例，年龄57～85岁，平均71.5岁。病程1～18年，平均11.9年。膝外翻根据Ranawat分型，Ⅰ型6膝，Ⅱ型13膝，Ⅲ型1膝。均通过术前规划分配膝外翻畸形的预期矫正值，包括外侧入路矫正值、关节内矫正值和残留膝外翻畸形值。记录上述指标术后实际矫正值，并推算理论最大可矫正膝外翻畸形值。同时记录手术时间、术中出血量、切口长度、住院时间、髋-膝-踝角（hip-knee-ankle angle，HKA）、股骨远端机械轴外侧角（mechanical lateral distal femoral angle，mLDFA）、胫骨近端机械轴内侧角（mechanical medial proximal tibia angle，mMPTA）、关节汇聚角（joint line convergence angle，JLCA）、胫骨后倾角（posterior tibial slope，PTS）、关节活动度（range of motion，ROM）、美国特种外科医院（HSS）评分及西安大略与麦克马斯特大学骨关节炎指数（WOMAC）评分进行疗效评价。. 结果: 患者切口长度平均13.83 cm，手术时间平均85.8 min，术中出血量平均74.9 mL，住院时间平均6.7 d。术中均未发生重要神经、血管损伤。所有患者均获随访，随访时间10～27个月，平均17.9个月。1例双膝外翻畸形患者术后1个月左侧关节内发生感染，余患者未发生假体松动、脱位及感染等并发症。术后各时间点膝关节ROM、HSS评分及WOMAC评分均较术前显著改善，术后随时间延长各指标进一步改善，差异均有统计学意义（ P<0.05）。影像学测量示，术后3 d除mMPTA与术前比较差异无统计学意义（ P>0.05）外，HKA、mLDFA、JLCA、PTS均较术前显著改善（ P<0.05）。膝外翻畸形矫正值的术后评估示，实际关节内矫正值为0.54°～10.97°，平均3.84°；术后残留膝外翻畸形值为0.42°～5.30°，平均3.59°；实际外侧入路矫正值为0.21°～12.73°，平均4.26°。. 结论: 经外侧入路行LUKA治疗膝外翻可取得良好早期疗效，术前规划能够帮助术者合理分配膝外翻畸形的矫正值，提供相应处理策略，且理论最大可矫正膝外翻畸形值可达25°。.

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