Windswept deformities of the knee are challenging to manage
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(2020) 32:46
Knee Surgery & Related Research
REVIEW ARTICLE
Open Access
Windswept deformities of the knee are challenging to manage Suresh Babu* , Abhishek Vaish and Raju Vaishya
Abstract Background: Little has been published about TKA in windswept deformities of the knees where combined varus and valgus deformities present in the same patient. Windswept deformities present with unique problems and must be addressed as two halves of a complex entity. Through this review we aim to understand the interrelation between the deformities, examine outcomes following simultaneous bilateral total knee arthroplasty in windswept deformities, and develop an algorithm for the management of windswept deformities by total knee arthroplasty. Methods: An extensive online literature search for the keywords yielded 31 articles on which we based our review. Articles were analyzed in context to our research questions and are presented in a tabular format for quick reference and a better perspective. Results: The abnormal biomechanics and force moment of the knee cause progressive arthritis of the knee. The valgus deformity usually precedes a varus deformity on the contralateral knee in windswept deformities. Correct restoration of mechanical tibiofemoral angles by individualizing valgus correction angles have better outcomes after TKA. Conclusion: A well-planned and judiciously executed simultaneous bilateral total knee replacement can offer distinct advantages to the patient and surgeon and provides optimum utilization of time and resources in the management of windswept knees. Keywords: Windswept deformities, Varus deformity, Valgus deformity, Knee, Arthroplasty, Simultaneous bilateral
Introduction Windswept deformities (WSD) of the knee are not common presentations and pose unique challenges during total knee arthroplasty (TKA). In addition to resurfacing the arthritic surfaces of the joint, restoration of the normal biomechanics of the knee is essential [1]. WSD present a scenario with the knees at two extremes of the deformity spectrum in the coronal plane, and each extreme shows varied bony and soft tissue insufficiencies [2]. The etiopathology of the deformities is different and also needs to be addressed [3]. In a WSD, there is primarily medial compartment osteoarthritis (OA) on the * Correspondence: [email protected] Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India
side of varus deformity [2, 3] and lateral compartment OA on the side of the valgus deformity. The soft tissues on the medial side of the knee are contracted and need to be released in a varus knee [3], whereas in a valgus knee, the soft tissues on the lateral side of the knee are contracted and require release [1–3]. There are varying degrees of patellofemoral arthritis, and patellar tracking should be optimized to obtain superior outcomes, which in many instances, especially with valgus knees, may require a lateral retinacular release [4–6]. There is a paucity of literature t
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