Accuracy of Implant Positioning for Minimally Invasive Total Knee Arthroplasty in Patients With Severe Varus Deformity

Abstract 

Minimally invasive surgery (MIS) in total knee arthroplasty (TKA) reportedly yields decreased patient morbidity and a rapid return of function, but how much deformity can be accepted for MIS-TKA remains unclear. This study investigated 238 knees from 218 consecutive patients who underwent MIS-TKA. Patients were divided into groups with tibiofemoral mechanical axis (TFM) 195° or greater and TFM less than 195°, then clinical and radiographic results were compared. Similar improvements in knee score at 3 months postoperatively were obtained in the both groups, whereas radiographic accuracy of the coronal alignment in the TFM ≥195° group was inferior to that in TFM <195° group. Postoperative TFM was significantly worsened in patients with lateral bowing angle of the femoral shaft (LBFS) 4° or greater, and 53% of patients in the TFM ≥195° group displayed LBFS 4° or greater, explaining the inferior radiographic accuracy in this group compared with the TFM <195° group. These results indicate that use of MIS techniques decreases radiographic accuracy, particularly in patients with severe genu varum and increased LBFS.

Keywords: minimally invasive, total knee arthroplasty, radiographic accuracy, mechanical axis, implant positioning