A PROSPECTIVE OBSERVATIONAL STUDY ON TOTAL KNEE REPLACEMENT OUTCOMES IN OSTEOARTHRITIC KNEES WITH VARUS DEFORMITY.

Authors

  • Dr. Ch Ramesh Babu Assistant Professor, Department of Orthopaedics, Gandhi Medical College&Gandhi Hospital, Musheerabad, Padmarao Nagar, Secunderabad, Telangana, India
  • Dr. B Kiran Kumar Associate Professor, Department of Orthopaedics, Gandhi Medical College&Gandhi Hospital Musheerabad, Padmarao Nagar, Secunderabad, Telangana , India
  • Dr. Kiran Kumar Joshi Assistant Professor, Department of Orthopaedics, Govt.Medical College Sangareddy, Tadlapalle, Sangareddy, Telangana ,India
  • Dr. Pradeep Kumar Postgraduate Resident, Department of Orthopaedics, Gandhi Medical College&Gandhi Hospital Musheerabad, Padmarao Nagar, Secunderabad, Telangana,India
  •  Dr. Manoj Kumar Postgraduate Resident, Department of Orthopaedics, Gandhi Medical College&Gandhi Hospital Musheerabad, Padmarao Nagar, Secunderabad, Telangana, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i3.1689

Keywords:

Osteoarthritis knee, varus deformity, Total knee arthroplasty, Knee Society Score, functional recovery

Abstract

Background

Osteoarthritis (OA) of the knee with varus deformity is a common degenerative condition that severely impacts mobility and quality of life. Total Knee Arthroplasty (TKA) is the standard surgical treatment for end-stage OA, though varus correction poses technical challenges.

 Objectives

To evaluate the clinical, functional, and radiological outcomes of TKA using a posterior cruciate substituting prosthesis in patients with varus knee deformity.

 Methods

This prospective observational study included 30 patients (mean age: 63.2 years; 70% female) with primary OA and varus deformity (Kellgren–Lawrence grades III and IV), who underwent TKA at Mahatma Gandhi Memorial Hospital, Warangal. Clinical and functional status were assessed using the Knee Society Score (KSS), while radiological evaluation confirmed prosthetic alignment. Follow-ups were performed at 6 weeks, 3 months, 6 months, and 1 year.

 Results

The mean preoperative clinical KSS (56.4) improved significantly to 90.2 postoperatively (p < 0.01), and the functional score improved from 48.3 to 81.6 (p < 0.01). Radiographs showed that all patients achieved neutral mechanical alignment without signs of implant loosening. By 6 weeks, over 80% of patients reported substantial pain relief, restored range of motion, and improved stair-climbing ability. No intraoperative or postoperative complications, such as infection or DVT, were reported. Outcomes were favorable across all deformity severity groups (<10°, 10–20°, >20°).

 Conclusion

TKA using posterior cruciate substituting prostheses provides significant functional and radiological improvements in osteoarthritic knees with varus deformity. Proper preoperative planning and surgical precision are key to optimal outcomes.

 Recommendations

Preoperative assessment should emphasize deformity severity and soft tissue balance. Surgeons should adopt individualized soft tissue release techniques and confirm mechanical axis restoration intraoperatively. Long-term follow-up and larger sample studies are recommended to assess prosthesis survivorship and late complications.

Author Biographies

Dr. Ch Ramesh Babu, Assistant Professor, Department of Orthopaedics, Gandhi Medical College&Gandhi Hospital, Musheerabad, Padmarao Nagar, Secunderabad, Telangana, India

is a dedicated orthopedic surgeon and Assistant Professor at Gandhi Medical College, Secunderabad, Telangana. He completed his undergraduate medical education (MBBS) and MS in Orthopaedics. He is currently undergoing advanced clinical training in orthopedic surgery, with interests in trauma care, joint reconstruction, and minimally invasive techniques.

Dr. B Kiran Kumar, Associate Professor, Department of Orthopaedics, Gandhi Medical College&Gandhi Hospital Musheerabad, Padmarao Nagar, Secunderabad, Telangana , India

is a dedicated orthopedic surgeon and Associate Professor at Kakatiya Medical College (KMC), Warangal, Telangana, with significant expertise in trauma care, arthroplasty, and orthopedic education. He completed his MBBS at KMC, Warangal (1998–2003), and subsequently served as a Civil Assistant Surgeon at MPHC, Bhopal Bhupalpally, from 2008 to 2012, gaining valuable clinical experience in primary healthcare and orthopedic practice. Pursuing his passion for orthopedics, he obtained his MS in Orthopaedics from KMC under Dr. NTR University of Health Sciences, Vijayawada (2012–2015), further honing his surgical skills and understanding of musculoskeletal disorders. Throughout his career, Dr. Kiran Kumar has performed numerous complex trauma surgeries and total knee replacement procedures, demonstrating proficiency in managing critical orthopedic cases and improving patient outcomes. In addition to his clinical work, he has contributed significantly to medical education by teaching undergraduate and postgraduate students, focusing on non-traumatic orthopedics, clinical examination techniques, and diagnostic skills. Actively involved in seminars, workshops, and CME programs, including TOSACON 2018 and events organized by the Warangal Orthopaedic Society, he remains committed to academic excellence and ongoing professional development. In recognition of his contributions, he was promoted to Associate Professor of Orthopaedics at KMC in August 2023, where he continues to advance orthopedic care and education. ORCiD: https://orcid.org/0009-0008-5476-538X.

Dr. Kiran Kumar Joshi, Assistant Professor, Department of Orthopaedics, Govt.Medical College Sangareddy, Tadlapalle, Sangareddy, Telangana ,India

is a dedicated orthopedic surgeon and Assistant Professor at Gandhi Medical College, Secunderabad, Telangana. He completed his undergraduate medical education (MBBS) and MS in Orthopaedics. He is currently undergoing advanced clinical training in orthopedic surgery, with interests in trauma care, joint reconstruction, and minimally invasive techniques.

Dr. Pradeep Kumar, Postgraduate Resident, Department of Orthopaedics, Gandhi Medical College&Gandhi Hospital Musheerabad, Padmarao Nagar, Secunderabad, Telangana,India

A Sale is a second-year postgraduate resident in the Department of Orthopaedics at Gandhi Medical College, Secunderabad, Telangana. He completed his MBBS from Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, in the 2016–2022 batch. He is currently undergoing advanced clinical training in orthopedic surgery, with interests in trauma care, joint reconstruction, and minimally invasive techniques. ORCiD: https://orcid.org/0009-0005-9368-9381.

 Dr. Manoj Kumar , Postgraduate Resident, Department of Orthopaedics, Gandhi Medical College&Gandhi Hospital Musheerabad, Padmarao Nagar, Secunderabad, Telangana, India

 is currently a final-year postgraduate resident in the Department of Orthopaedics at Gandhi Medical College, Secunderabad, Telangana. He completed his undergraduate medical education (MBBS) from ACSR Government Medical College, Nellore, Andhra Pradesh, as part of the 2015–2021 batch. With a strong academic foundation and clinical training, Dr. Manoj Kumar is pursuing advanced orthopedic surgical training with a focus on trauma, joint disorders, and musculoskeletal rehabilitation. His clinical interests include joint preservation techniques, orthopedic biomechanics, and evidence-based management of musculoskeletal conditions. https://orcid.org/0009-0000-9642-7161

References

Vail TP, Lang JE. Insall and Scott had surgery on the knee. 4th ed. Philadelphia: Churchill Livingstone, Elsevier; 2006. p. 1455-1521.

Insall J, Ranawat CS, Scott WN, Walker P. Total condylar knee replacement. Preliminary report. Clin Orthop Relat Res 1976;120:149-54. https://doi.org/10.1097/00003086-197610000-00023

Kim RH, Scott WN. Operative techniques: total knee replacement. Philadelphia: Saunders-Elsevier 2009. p. 91-103. https://doi.org/10.1016/B978-1-4160-4984-5.50012-7

Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet; 2011 Jun 18;377:2115-26. https://doi.org/10.1016/S0140-6736(11)60243-2

John N Insall, Lawrence D Dorr, Richard D Scott, W. Norman Scott. Rationale of The Knee Society Clinical Rating System. Clin Orthop 1989 Nov;248:13-14. https://doi.org/10.1097/00003086-198911000-00004

Stuart MJ. Anatomy and surgical approaches in Joint replacement arthroplasty. 3rd ed. 2003. p. 945.

Kettlekamp DB, Pryor P, Brady TA. Selective use of the variable axis knee. Clin Orthop Relat Res 1979;3:301-2.

Frankel VH, Burstein AH. Orthopaedic Biomechanics. The Application of Engineering to the Musculoskeletal System. Philadelphia: Lea and Febiger; 1970. p. 24-8.

Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 1993;286:40-7. https://doi.org/10.1097/00003086-199301000-00008

Rodriguez JA, Bhende H, Ranawat CS. Ranawat Orthopaedic Center, New York, NY 10021, USA Total condylar knee replacement: A 20-year follow-up study. Clin Orthop Relat Res 2001;(388):10-7. https://doi.org/10.1097/00003086-200107000-00004

Martin SD, McManus JL, Scott RD, Thornhill TS. Press-fit condylar total knee arthroplasty. 5- to 9-year follow-up evaluation. J Arthroplasty. 1997 Sep;12(6):603-14. https://doi.org/10.1016/S0883-5403(97)90132-7

Clayton RAE, Amin A et al., Five-Year follow-up of the PFC Sigma Total Knee Arthroplasty J Bone J OInt Surg Br; 88:SUPP II, 2006 https://doi.org/10.1016/j.knee.2006.06.003

Asif S, Choon DSK. Mid-Term results of Cemented Press-Fit Condylar Sigma Total Knee Arthroplasty System, Journal of Orthopaedic Surgery 2005;13(3):280-4 https://doi.org/10.1177/230949900501300311

Alemparte J, Cabezas A, Azocar O, Hernandez R, Acevedo M. Midterm results of an AGC total knee arthroplasty system survival and function analysis: 2 to 8 years follow --up results. J Arthroplasty 2003;18:420-5. https://doi.org/10.1016/S0883-5403(03)00017-2

Buehler KO, Venn - Waston E, D" Lima DD, Colwell CW Jr. The press fit condylar total knee system: 8 to 10-year results with a posterior cruciate-retaining design J Arthroplasty 2000;15:698-701. https://doi.org/10.1054/arth.2000.8189

Dixon MC, Brown RR, et al. Modular Fixed Bearing Total Knee Arthroplasty with Retention of Posterior Cruciate Ligament. J Bone Joint Surg. Am 2005;87:598. https://doi.org/10.2106/JBJS.C.00591

Insall JN, Hood RW, Flawn LB, Sullivan DJ. The total condylar knee prosthesis in gonarthrosis: A five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Joint Surg Am 1983;65:619. https://doi.org/10.2106/00004623-198365050-00006

Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003;85:259-265. https://doi.org/10.2106/00004623-200302000-00012

Scott DF, Smith RR. A prospective, randomized comparison of posterior stabilized versus cruciate-substituting total knee arthroplasty: a preliminary report with minimum 2-year results. J Arthroplasty. 2014;29:179 181. doi: 10.1016/j.arth.2014.03.050. https://doi.org/10.1016/j.arth.2014.03.050

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Published

2025-03-31

How to Cite

Babu, C. R. ., Kumar, D. B. K. ., Joshi, K. K. ., Sale, P. K. A. ., & Kumar, M. . (2025). A PROSPECTIVE OBSERVATIONAL STUDY ON TOTAL KNEE REPLACEMENT OUTCOMES IN OSTEOARTHRITIC KNEES WITH VARUS DEFORMITY. Student’s Journal of Health Research Africa, 6(3), 10. https://doi.org/10.51168/sjhrafrica.v6i3.1689

Issue

Section

Section of Orthopedics