The use of mobile bearing TKA in valgus deformities - A clinical study.

Background: The number of patients presenting valgus deformities undergoing total knee arthroplasty (TKA) represents approximately 10% of the total number of TKAs performed: the presence of valgus deformity requires the implant to have proper alignment, stability and balance to achieve successful clinical outcomes, especially for knees with high coronal deformities, but these have proven to be difficult goals to achieve and therefore the use of constrained prostheses is often recommended for these cases. However, even though the use of unconstrained mobile bearing for severe knee deformities is rare, it has been shown to give successful outcomes and therefore the aim of this study is to evaluate whether this surgical technique can achieve satisfactory clinical results and correct alignment, as well as good patient satisfaction.

Methods: This study presents the results of 69 TKA performed with cemented mobile bearing implants by a single surgeon on knee affected by valgus deformities. Asymmetric inserts were adopted for all the implants and an alignment surgical tool, dedicated for valgus patients, was used during the operation. Angles of valgus, WOMAC surveys and Numeric Rating Scale for pain were recorded to evaluate the results of the operations.

Results: A total of 67 pre-op WOMAC questionnaire surveys were collected, with the mean result of this evaluation being 15.9 points. The Numeric Rating Scale for pain had an average of 2.2 for 68 tests. The deformities were corrected from a mean total preoperative valgus angle of 12.5° to a postoperative valgus deformity average of 0.6°. During follow-up, only one patient had serious complications due to the rupture of the extensor apparatus following a domestic accident involving falling. Further 10 patients have mild complications related to injuries such as pain of varying intensity, burning, or swelling of the knee. The level of satisfaction from 0 to 10 (0 not at all satisfied and 10 perfectly satisfied) had an average score of 7.7.

Conclusions: The surgical approach presented, involving a less constrained model if compared to the ones usually chosen, allowed to achieve correct alignment and high patient satisfaction using mobile bearing implants on valgus knee deformities; further patient follow-up will be performed to evaluate long-term outcomes, but the results achieved already represent a significative finding.