Recently, total knee arthroplasty has been widely applied in clinic, and the replacement techniques and prosthetic design concept have been greatly improved. But osteotomy order has not been reported.OBJECTIVE:
To discuss the clinical effect of the improved osteotomy in total knee athroplasty.METHODS:
The total knee arthroplasty was performed in 60 patients (60 knees), including 52 cases of osteoarthritis, six cases of rheumatoid arthritis and two cases of traumatic arthritis, and posterior stabilized knee joints were used for total knee arthroplasty, such as the PFC-Sigma PS prosthesis or LINK Gemini PS prosthesis. The femoral osteotomy was performed firstly under extreme knee bending, including oblique osteotomy anterior and posterior to the distal femur (some types contained intercondylar osteotomy). Patella un-conventional replacement was performed followed by the tibial plateau osteotomy. The operation time, postoperative drainage volume, range of motion of knee joint as well as Hospital for Special Surgery knee scores before replacement and 6 and 12 weeks after replacement were recorded and statistically analyzed.RESULTS AND CONCLUSION:
All the 60 patients were followed-up for 3-14 months. The average operation time was (51.3±12.5) minutes; the postoperative drainage volume was (302±39) mL. The range of motion of knee joint and Hospital for Special Surgery knee scores 6 and 12 weeks after replacement were improved compared with those before replacement (P < 0.01). At 1 month after replacement, two cases had low-grade infection which was improved after anti-infection therapy without prosthesis rejection. Femoral osteotomy before total knee arthroplasty can obtain the great space for tibial operation, which is beneficial to removal of the meniscus, and further loosens the surrounding soft tissue safely. This method has the advantages of simple operation, shortening the operation time, reducing the intraoperative blood loss, and better repairing effect.