Postoperative alignment but not femoral coronal bowing is a significant longevity factor after total knee arthroplasty
Copyright © 2019 Elsevier Masson SAS. All rights reserved..
BACKGROUND: Femoral coronal bowing (FCB) has been reported to be a risk factor for mechanical malalignment after total knee arthroplasty (TKA). However, the effects of FCB on the long-term survivorship (when postoperative mechanical alignment (MA) is neutral after TKA) have not been determined.
HYPOTHESIS: The effects of FCB on the cumulative survivorship after TKA may be significantly smaller compared with those of MA.
PATIENTS AND METHODS: Consecutive 328 knees of 211 patients (10 males, 201 females) who underwent TKA between 1995 and 2009 (mean age of 64.2±6.7 years at the time of TKA, mean follow-up period of 11.9±2.5 years) were retrospectively evaluated. FCB and MA were evaluated using preoperative and immediate postoperative whole-leg anteroposterior radiographs, respectively. The patients were grouped according to FCB and postoperative MA, which included group A (FCB≤5°, MA≤3°), B (FCB>5°, MA≤3°), C (FCB>5°, MA>3°), and D (FCB≤5°, MA>3°). Primary end-point was defined as aseptic mechanical failures requiring revision TKA. Survivorship was assessed using the Kaplan-Meier method and compared using log-rank tests. Factors associated with the risk of aseptic mechanical failures were analyzed by Cox regression analysis. Preoperative and final follow-up clinical outcomes were assessed using Hospital for Special Surgery (HSS) scores.
RESULTS: Group A, B, C, and D included 190, 73, 40, and 25 knees, respectively. The 10-year survivorship was similar between group A and B (96.3±1.4% vs. 98.6±1.4%; p=0.733) and group C and D (87.3±5.3 vs. 87.6±6.7%; p=0.974); however, it was significantly higher in group B than in group C (p=0.036) and in group A than in group D (p=0.005). Age (OR=0.991; 95% CI 0.906-1.085; p=0.002) and MA>3° (OR=3.645; 95% CI 1.744-7.604; p=0.001) were associated with the risk of aseptic mechanical failures. The mean preoperative and final HSS scores in the four groups were not significantly different.
DISCUSSION: Marked FCB was not associated with long-term survivorship for knees with neutral alignment after TKA. However, non-neutral postoperative alignment reduced long-term survivorship for knees with marked FCB.
LEVEL OF EVIDENCE: III, Retrospective comparative cohort study.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:106 |
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| Enthalten in: |
Orthopaedics & traumatology, surgery & research : OTSR - 106(2020), 3 vom: 01. Mai, Seite 435-442 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kim, Changwan [VerfasserIn] |
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| Anmerkungen: |
Date Completed 09.06.2021 Date Revised 09.06.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.otsr.2019.12.001 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM305237357 |
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| 100 | 1 | |a Kim, Changwan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Postoperative alignment but not femoral coronal bowing is a significant longevity factor after total knee arthroplasty |
| 264 | 1 | |c 2020 | |
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| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Revised 09.06.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 Elsevier Masson SAS. All rights reserved. | ||
| 520 | |a BACKGROUND: Femoral coronal bowing (FCB) has been reported to be a risk factor for mechanical malalignment after total knee arthroplasty (TKA). However, the effects of FCB on the long-term survivorship (when postoperative mechanical alignment (MA) is neutral after TKA) have not been determined | ||
| 520 | |a HYPOTHESIS: The effects of FCB on the cumulative survivorship after TKA may be significantly smaller compared with those of MA | ||
| 520 | |a PATIENTS AND METHODS: Consecutive 328 knees of 211 patients (10 males, 201 females) who underwent TKA between 1995 and 2009 (mean age of 64.2±6.7 years at the time of TKA, mean follow-up period of 11.9±2.5 years) were retrospectively evaluated. FCB and MA were evaluated using preoperative and immediate postoperative whole-leg anteroposterior radiographs, respectively. The patients were grouped according to FCB and postoperative MA, which included group A (FCB≤5°, MA≤3°), B (FCB>5°, MA≤3°), C (FCB>5°, MA>3°), and D (FCB≤5°, MA>3°). Primary end-point was defined as aseptic mechanical failures requiring revision TKA. Survivorship was assessed using the Kaplan-Meier method and compared using log-rank tests. Factors associated with the risk of aseptic mechanical failures were analyzed by Cox regression analysis. Preoperative and final follow-up clinical outcomes were assessed using Hospital for Special Surgery (HSS) scores | ||
| 520 | |a RESULTS: Group A, B, C, and D included 190, 73, 40, and 25 knees, respectively. The 10-year survivorship was similar between group A and B (96.3±1.4% vs. 98.6±1.4%; p=0.733) and group C and D (87.3±5.3 vs. 87.6±6.7%; p=0.974); however, it was significantly higher in group B than in group C (p=0.036) and in group A than in group D (p=0.005). Age (OR=0.991; 95% CI 0.906-1.085; p=0.002) and MA>3° (OR=3.645; 95% CI 1.744-7.604; p=0.001) were associated with the risk of aseptic mechanical failures. The mean preoperative and final HSS scores in the four groups were not significantly different | ||
| 520 | |a DISCUSSION: Marked FCB was not associated with long-term survivorship for knees with neutral alignment after TKA. However, non-neutral postoperative alignment reduced long-term survivorship for knees with marked FCB | ||
| 520 | |a LEVEL OF EVIDENCE: III, Retrospective comparative cohort study | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Alignment | |
| 650 | 4 | |a Femoral coronal bowing | |
| 650 | 4 | |a Longevity | |
| 650 | 4 | |a TKA | |
| 700 | 1 | |a Bin, Seong-Il |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Jong-Min |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Bum-Sik |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Jun-Gu |e verfasserin |4 aut | |
| 700 | 1 | |a Yoon, Gi-Woon |e verfasserin |4 aut | |
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