Preliminary application of sagittal flexion osteotomy technique of femoral condyle and observation of"head down"installation of femoral condyle prosthesis in TKA
Objective In total knee arthroplasty(TKA),the selection of femoral condyle prosthesis may be difficult if the pros-thesis is wider than the coronal plane or the measurement data are between two models of prosthesis.This study is to evaluate the feasibility of femoral condylar sagittal flexion osteotomy("head down"osteotomy)to address this challenge,and to observe the effect of proper"head down"installation of femoral condylar prosthesis on early postoperative outcomes.Methods A retro-spective analysis was performed on 72 cases of severe knee osteoarthritis treated by TKA from October 2015 to October 2021.During the operation,two cases of femoral condyle prosthesis were wider than the coronal plane,and four cases of measurement data were between two models of prosthesis,requiring manual modification of the distal femoral condyle after osteotomy.Postop-erative radiographs were taken to measure anterior cortical angle.Thirty-six cases with anterior cortical angle ≥6° were includ-ed in the head down group while 36 cases with anterior cortical angle＜6° were included in the non-head down group.HSS scores of two groups were compared 3,6 and 12 months after surgery to evaluate the function of knee.Results The manual"head down"osteotomy in 6 cases cost 2 to 4 min,with an average of 3 min.After that,the measurement marks could be accu-rately adjusted to the scale line of the expected correction model,and there was no anterior femoral cortical notch or wider pros-thesis at coronal plane,and the balance of flexion and extension space was satisfactory.The other 30 cases in the head down group had low position of femoral medullary point.The anterior cortex angle of head down group ranged from 6° to 15°.There was no significant difference in HSS score between head down group and non-head down group at 3,6 and 12 months after sur-gery(P＞0.05).All 72 cases were followed up for 13 to 16 months,with an average of 14 months.There were no significant com-plications in head down group during follow-up,and none of the patients required joint revision.Conclusion The femoral con-dyle prosthesis can be installed after properly head down osteotomy in TKA,which will not affect the early postoperative effica-cy.Therefore,when the femoral condyle prosthesis is wider than the coronal plane or the measurement data are between two models,the distal osteotomy surface of the femoral condyle can be properly corrected by hand,which is practical and simple to operate,and does not affect the balance of flexion and extension space and the postoperative function of knee.
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