title: Total knee arthroplasty in patients with excessive external tibial torsion >45° and patella instability--surgical technique and follow up.
abstract: Patients presenting with advanced knee osteoarthritis (OA), excessive external tibial torsion (EETT) and chronic patella subluxation pose significant surgical challenges. A combination of TKA, tibial derotation osteotomy, and tibial tuberosity transfer was performed in ten patients (twelve knees) with OA secondary to EETT and patellar instability. Six weeks of non weight-bearing and flexion limited to 45° was mandated after surgery. The mean follow-up and patient age was 81months (range, 14 to 159) and 56years (range, 49 to 62). The mean pre-operative external tibial torsion was 62°, with an average rotational correction of 30°. Significant improvement was found in the Knee Society Score, SF-12 and all WOMAC questionnaire score subscales (p<0.0001); 5 patients had complications, but no loosening or nonunion was seen.
authors.affiliation: Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East. Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Drexler
authors.forename: Tim
authors.initials: T
authors.lastname: Dwyer
authors.forename: Meir
authors.initials: M
authors.lastname: Marmor
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Reischl
authors.forename: Fahad
authors.initials: F
authors.lastname: Attar
authors.forename: John
authors.initials: J
authors.lastname: Cameron
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery*; D010329:Patella; D013977:Tibia / Q000002:abnormalities* / Q000601:surgery*; D014102:Torsion Abnormality / Q000150:complications / Q000601:surgery*