title: Total knee arthroplasty in patients with Ranawat type-II valgus arthritic knee with a marked coronal femoral bowing deformity: comparison between computer-assisted surgery and intra-articular resection.
abstract: BACKGROUND
  Proper limb and component alignments as well as soft tissue balance are vital for the longevity and optimal long-term outcomes of total knee arthroplasty (TKA). This procedure is technically demanding in patients with Ranawat type-II valgus arthritic knees with marked coronal femoral bowing. Computer-assisted surgery (CAS) and intra-articular bone resection with TKA are the treatments of choice for patients with ipsilateral extra-articular deformity. In theory, both CAS and intra-articular bone resection are beneficial in Ranawat type-II valgus arthritic knees with marked coronal femoral bowing deformity, but the literature on this topic is sparse. We compared the benefits of using these two techniques for TKA under this circumstance.
  
  
  METHODS
  Patients who had Ranawat type-II valgus arthritic knees and marked coronal femoral bowing deformity and had undergone TKA at our hospital between 2005 and 2013 were enrolled in this retrospective study. Patients treated with CAS were assigned to the CAS-TKA group; patients treated with intra-articular bone resection were assigned to the Bone-Resect-TKA group. Radiographic parameters and clinical outcomes (International Knee Society (IKS) scores and patellar scores) in both groups were compared.
  
  
  RESULTS
  Forty-seven patients (50 knees) met the inclusion criteria: 22 knees in the CAS-TKA group and 28 knees in the Bone-Resect-TKA group. Lateral retinaculum release was significantly (P = 0.008) higher in the Bone-Resect-TKA group. The joint-line was significantly properly restored in the CAS-TKA group (P = 0.011). The reconstructed mechanical axis was significantly (P = 0.012) closer to normal in the CAS-TKA group than in the Bone-Resect-TKA group. For component alignment, the femoral valgus and femoral flexion angles were significantly better in the CAS-TKA group (P = 0.002 and P = 0.006, respectively), but not the tibial valgus, tibial flexion, or patellar tilting angles. IKS scores and patellar scores were not significantly different between groups at a mean follow-up of 60.2 months.
  
  
  CONCLUSIONS
  CAS-TKA was effective for obtaining proper alignment and joint-line restoration in patients with Ranawat type-II valgus arthritic knees and marked coronal femoral bowing deformity, but not for yielding better clinical outcomes. Additional large-scale prospective randomized cohort studies with long-term follow-ups are necessary to make evidence-based recommendations.
authors.affiliation: Chang Gung Memorial Hospital, Chiayi, Taiwan. b8601081@adm.cgmh.org.tw.|Chang Gung University, Taoyuan, Taiwan. b8601081@adm.cgmh.org.tw.
authors.forename: Tsan-Wen
authors.initials: TW
authors.lastname: Huang
authors.affiliation: Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Po-Yao
authors.initials: PY
authors.lastname: Chuang
authors.affiliation: Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Chien-Yin
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Shih-Jie
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Chang Gung Memorial Hospital, Chiayi, Taiwan.|Chang Gung University, Taoyuan, Taiwan.
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Huang
authors.affiliation: Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Shih-Hsun
authors.initials: SH
authors.lastname: Shen
authors.affiliation: Chang Gung Memorial Hospital, Chiayi, Taiwan.|Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yao-Hung
authors.initials: YH
authors.lastname: Tsai
authors.affiliation: Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.|Chang Gung University, Taoyuan, Taiwan.
authors.forename: Mel S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Chang Gung Memorial Hospital, Chiayi, Taiwan. wwh@cgmh.org.tw.|Chang Gung University, Taoyuan, Taiwan. wwh@cgmh.org.tw.
authors.forename: Robert Wen-Wei
authors.initials: RW
authors.lastname: Hsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000592:standards; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005269:Femur / Q000002:abnormalities* / Q000000981:diagnostic imaging; D056304:Genu Valgum / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods* / Q000592:standards
keywords: Bowing deformity of femur; Computer-assisted surgery; Genu valgus deformity; Intra-articular bone resection; Total knee arthroplasty