Study of Coronal Alignment of Knee after Total Knee Replacement

Sukumaran, S S (2007) Study of Coronal Alignment of Knee after Total Knee Replacement. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: The surgeon performing a total knee arthroplasty is not only concerned with the early pain relief to the arthritic patient but should also provide the patient with stable functional knee with the maximum implant survival. Survivorship for cemented total knee arthroplasty ranges between 91% and 99% at ten years and between 91% and 96% at 15 years. Several studies have concluded that durability of the total knee replacement is dependent on the postoperative axial alignment of the lower extremity. If replacement of the knee leaves the extremity in varus or valgus mal-alignment, loosening and instability occurs at a greater rate than if the limb is well aligned by arthroplasty. Mal-alignment leads to overload of the bone and ligaments, leading to asymmetric bone loss, prosthetic wear and fracture and ligamentous instability. Preoperative axial alignment of the lower extremity is essential to assess the bony cuts to be taken during surgery as well as the ligamentous balancing to be performed intra operatively. Hence assessment of axial alignment before and after surgery is imperative in any patient undergoing a knee replacement surgery. AIM: The aim of the study is to compare the axial alignment of the lower extremity before and after surgery in patients undergoing total knee replacement by assessing the mechanical axis in the full length weight bearing radiograph taken preoperatively and post operatively. MATERIALS AND METHODS: In our hospital total knee arthroplasty is being done for various indications. This includes varus as well as valgus knees. The period of study is from June 2004 and August 2006. During the study period 18 knees were replaced in12 patients. Of them two patients with three knees lost follow-up. All patients who underwent total knee arthroplasty in our hospital during the period of June 2004 to August 2006 with regular follow-up are included in this study. This includes 10 patients with 15 knees. The patients who did not turn for follow-up were excluded from the study. This included two patients with three knees. RESULTS: The age of the patients who underwent total knee replacement in our series ranged from 42 to 76 years; average was 58.53 years. The standard deviation was 9.7823 and 53% of our patient belonged to the sixth decade. The range in our series was from 150cms to 165cms. The mean was 155.86cms and the SD was 4.9503. The range was from 48kgs to 80kgs. The average weight was 58.73kgs and the SD was 8.2415. CONCLUSION: The level of awareness among the public about the disease process, its natural course and the available treatment modalities including replacement surgery should be brought up. Valgus angle must be assessed in individual patients by taking full length radiographs pre-operatively to get axial alignment corrected. Post-operative study of mechanical axis in full length weight bearing x-ray is a must to assess the restoration of mechanical axis back to normal. Knee scores and functional scores have improved significantly in those groups of patients where there was restoration of mechanical axis. In the rest where the mechanical axis had not been restored the scores have not improved significantly.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Coronal Alignment ; Knee after Total Knee Replacement.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 17:48
Last Modified: 17 Sep 2017 14:32

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