Ilizarov技术矫治重度膝关节屈曲挛缩畸形的临床研究

[目的]探讨应用改良Ilizarov技术矫治重度膝关节屈曲挛缩畸形的方法和疗效。[方法]依据Ilizarov张力—应力法则及其应用技术,按个体化要求,设计、安装膝关节牵伸矫正器,术中穿针固定牵伸器时,两侧的关节铰链应与膝关节的旋转中心一致。术后牵伸前先牵开关节间隙5~10mm,再逐渐牵拉矫正屈膝畸形。牵伸速度应根据患者的耐受程度调整,一般不大于关节水平1mm/d。牵伸过程中应定期实施X线检查,以防止膝关节脱位和关节软骨受压。牵伸矫正的最终要求,若是单纯的软组织型屈膝孪缩,需将膝关节过度牵伸5°~10°,若合并股骨下段前弓畸形,屈膝矫正的程度应减除骨性畸形的角度。然后患肢维持牵伸位持重行走2~4周,再拆除牵伸器,配合CPM机活动膝关节,站立行走时配戴支具维持膝关节矫正位不少于3个月。8例患者因术前合并股骨下段前弓畸形,Ⅱ期实施股骨髁上截骨术矫正。[结果]49例52个膝关节,术前屈膝畸形平均58.50°±21.28°;矫正后屈曲角度平均4.12°±4.61°。38例,40个关节平均随访6.8个月,其中28个关节维持牵伸术后的效果,12个关节屈膝畸形部分复发,平均9.30°±8.24°。[结论]正确使用Ilizarov技术矫治重度的膝关节屈曲挛缩畸形,疗效满意,并发症少;是一种微创、安全、有效的治疗方法。     

不同类型假体全膝关节置换术后的运动学分析

目的观察以后稳定型、固定平台保留后十字韧带型和移动平台保留后十字韧带型假体行全膝关节置换术(TKA)后膝关节最大屈曲度,及膝关节屈曲过程中股骨假体相对胫骨假体的前后移动距离,探讨屈膝时股骨的前后移动对膝关节最大屈曲度的影响。方法选取以三种类型假体行TKA术的病例各25例,均为膝骨性关节炎;TKA术后效果优良,膝关节屈曲≥90°,术后1年以上。患者年龄63～77岁,平均68岁;男32膝,女43膝。后稳定型组、固定平台组及移动平台组术前膝关节最大屈曲度分别为77.8°±15.1°、80.1°±12.9°和76.4°±12.7°。术后拍摄膝伸直位和最大被动屈曲位侧位X线片,测量膝关节从伸直位至最大屈曲位时股骨假体相对胫骨假体的前后移动距离及膝最大屈曲度。结果三组术前屈膝度差异无显著性。后稳定型组、固定平台组和移动平台组术后最大屈曲度分别为118.0°±7.1°、108.7°±7.9°和100.2°±8.3°,三组差异有非常显著性(F=32.86,P=0.0001)。三组术后股骨假体相对胫骨假体前后移动距离分别为(6.3±2.5)mm、(?1.2±4.6)mm和(?4.7±3.7)mm(向后移为正值,向前移为负值),三组差异有非常显著性(F=57.71,P=0.0001)。股骨假体相对胫骨假体前后移动距离与膝最大屈曲度间存在相关性,股骨假体前移会使膝最大屈曲度减小。结论三     

膝外摆步态对膝内翻患者股骨-胫骨角及胫股关节外侧间隙的影响

目的探讨膝外摆(lateralthrust)步态对膝内翻患者股骨-胫骨角及胫股关节外侧间隙的影响及其临床意义。方法膝内翻伴膝外摆步态患者44例,男10例,女34例;年龄31～60岁,平均41岁。分别在静态单足和双足站立位膝关节正位X线片上测量股骨-胫骨角度数和胫股关节外侧间隙宽度。双足站立位模拟步态周期中双支撑相,即膝外摆早期;单足站立位模拟步态周期中单支撑相,即膝外摆后期,两种体位X线片上的股骨-胫骨角及胫股关节外侧间隙的改变反映了膝外摆过程中胫骨和股骨对应关系的改变。结果单足较双足支撑相的股骨-胫骨角增大(角度分别为188.50°±4.48°和185.50°±4.46°),胫股关节外侧间隙增宽[距离分别为(9.92±0.86)mm和(7.70±0.78)mm]。结论膝外摆步态中股骨-胫骨角增大、胫股关节外侧间隙增宽,使膝内翻患者的膝内侧间室承重增加,膝外侧稳定结构不稳,最终可能导致膝内翻加重及发生内侧间室骨关节炎。     

膝关节伸直位僵硬的人工关节置换治疗

目的 探讨膝关节伸直位僵硬的人工关节置换的手术方法及近期临床疗效.方法 对9例膝关节伸直位僵硬患者(12膝)行人工关节置换术,术中采用二次截骨加软组织松解的方法,分别记录手术前后膝关节HSS评分及关节活动度,并进行统计分析.结果 经过 12～56(36.2±9.61)个月的随访,膝关节HSS评分由术前13～45(28.6±7.12)分提高到术后56～89(65.45±6.25)分(P<0.01).关节活动度由术前0°提高到术后70°～110°(85.5°±10.18°)(P<0.01).结论 膝关节伸直位僵硬可以进行人工膝关节置换,手术效果满意.掌握熟练的手术技巧及正确术后康复至关重要.     

体重负荷下正常胫股关节6个自由度的运动学

[目的]定量分析正常胫股关节在体重负荷下6个自由度的运动学特征.[方法]双平面X线摄取10名健康志愿者一侧膝关节从伸直位到120°屈曲多角度下应力位的二维影像.螺旋CT扫描同一侧膝关节,并用获取的影像重建成三维模型.应用三维模型配准二维影像的方法测出股骨相对于胫骨全自由度的运动学数据.[结果]从伸直位到120°屈曲过程中,股骨后移(5.1±2.3) mm,外移(3.1±1.8) mm,远移(4.1±1.2) mm,外旋(17.3±6.9)°;股骨基本处于内翻(3.9±2.2)°;股骨外侧髁后移(12.6±3.4) mm,内侧髁前移(0.4±3.9) mm.[结论]正常膝关节在体重负荷下屈曲过程中,股骨相对于胫骨发生后移、外移、远移和外旋,内翻变化小;股骨内外侧髁的运动有差别.     

胫骨内侧关节线改变程度对单髁置换术患者膝关节屈伸功能的影响

目的探讨膝关节单髁置换术后胫骨内侧关节线改变程度对患者膝关节屈伸功能的影响。方法回顾性分析自2014-07—2017-05行单髁置换术治疗的48例原发性膝关节骨性关节炎。测量术前与术后3个月膝关节正位X线片胫骨内侧关节线改变程度;术后3个月记录膝关节屈曲0°、30°、60°、90°、120°时膝关节在内侧应力下小腿外翻的角度以评估胫骨平台内侧间隙,分析胫骨内侧关节线改变程度与膝关节KSKS评分、膝关节屈伸角度及不同屈曲角度应力下小腿外翻角度的相关性。结果胫骨内侧关节线改变程度与膝关节屈曲0°应力下小腿外翻的角度呈正相关(r=0.314,P=0.029),胫骨内侧关节线改变程度与膝关节屈伸改善角度呈负相关(r=-0.49,P 0.001)。胫骨内侧关节线改变3.6 mm者膝关节屈伸改善角度高于关节线改变≥3.6 mm者,差异有统计学意义(P=0.004)。胫骨内侧关节线改变3.6 mm者膝关节KSKS评分优于关节线改变≥3.6 mm者,差异有统计学意义(P=0.013)。结论单髁置换术后胫骨内侧关节线改变程度与膝关节屈伸改善程度、膝关节KSKS评分改善程度呈负相关,胫骨内侧关节线改变≥3.6 mm可能导致术后患者膝关节屈伸功能改善不佳。     

Ilizarov牵伸器治疗创伤性膝关节伸直位僵硬

[目的]探讨Ilizarov牵伸器治疗创伤性膝关节伸直位僵硬的临床效果,并同膝关节软组织松解联合CPM机锻炼进行比较。[方法]2012年3月～2017年3月因膝关节周围骨折术后发生关节伸直位僵硬在漯河市中心医院创伤骨科住院治疗的患者共22人,分为Ilizarov牵伸器治疗组12例(Ilizarov组),膝关节软组织松解联合CPM锻炼组10例(松解组)。记录术前术后膝关节最大屈曲度、术后自主屈曲活动度达到60°所用时间、膝关节功能优良率等数据,对比分析两组患者的临床效果。[结果]Ilizarov组术后膝关节最大屈曲度为(102.87±1.84)°;松解组为(85.45±2.24)°,差异有统计学意义(P0.05)。Ilizarov组术后自主屈曲活动度达到60°所用时间为(28.50±0.71)d,松解组为(61.36±3.46)d,差异有统计学意义(P0.05)。参照Judet疗效评定法对膝关节功能进行评定,Ilizarov组优7例,良3例,可2例,优良率为83.3%;松解组优2例,良3例,可5例,优良率为50%。[结论]Ilizarov牵伸器治疗创伤性膝关节僵直具有治疗时间短、术后膝关节活动功能好等优点,是治疗膝关节僵直的有效方法。     

膝关节囊对膝关节周围骨折术后膝关节功能的影响

目的评价膝关节周围骨折治疗过程中,膝关节囊的损伤及手术切开情况对膝关节远期功能的影响。方法选取江苏大学附属医院骨科自2010-10—2013-07诊治的膝关节周围骨折129例,原发性关节囊损伤者36例纳入关节囊损伤组,受伤时关节囊完整的93例按治疗过程中关节囊是否切开分为关节囊切开组(58例)和关节囊未切开组(35例)。比较3组末次随访时膝关节功能HSS评分、膝关节活动度、X线片测量膝关节冠状位胫股角。结果所有患者均获得12~45(24.8±12.9)个月随访。3组间冠状位胫股角的差异无统计学意义(F=2.021,P=0.137)。3组间膝关节功能HSS总评分差异有统计学意义(F=28.732,P0.001)。膝关节活动度比较中,无论是屈曲还是伸直,3组间差异均有统计学意义(P0.05)。关节囊未切开组关节屈曲和伸直活动度优于其他2组(P0.05),关节囊损伤组关节屈曲和伸直活动度最差(P0.05)。结论在膝关节周围骨折的治疗过程中,尽量修复损伤的关节囊,避免术中切开关节囊,能够提高远期膝关节功能,包括关节稳定性、活动度和行走能力,从而提高治疗效果和患者生活质量。     

屈曲畸形患者初次膝关节置换术后关节线改变的临床研究

[目的]探讨屈曲畸形患者初次膝关节置换术后关节线改变情况,并与非屈曲畸形患者进行对比。[方法]回顾性分析2012年06月~2014年06月河南省人民医院关节外科以膝骨性关节炎为诊断入院患者。共纳入分析患者114例,其中非屈曲组61例,屈曲组53例。分别测量术前术后股骨内上髁至关节线距离及腓骨头最外侧点至关节线距离,并比较组间差异。[结果]屈曲组股骨内上髁至关节线距离的术前、术后及差值分别为(29.65±3.68)mm、(30.01±3.25)mm和(-0.36±1.76)mm,非屈曲组分别为(29.48±4.01)mm、(30.26±4.17)mm和(-0.78±1.31)mm。屈曲组腓骨头最外侧点至关节线距离的术前、术后及差值分别为(30.77±3.37)mm、(32.97±3.04)mm和(-2.25±2.11)mm,非屈曲组分别为(32.41±2.53)mm、(33.03±2.47)mm和(-0.62±1.34)mm。屈曲组与非屈曲组腓骨头最外侧点至关节线距离术前及手术前后差值均具统计学意义(P0.01)。屈曲组13例(24.5%)关节线改变超过4 mm,非屈曲组关节线改变均未超过4 mm。[结论]屈曲畸形患者初次膝关节置换术后关节线改变较无屈曲畸形患者明显,且术后关节线具升高趋势。对于屈曲畸形患者术中应同时考虑纠正屈曲畸形与重建关节线问题,避免过度软组织松解及截骨。     

改良Pie-crusting技术在初次全膝关节置换术内侧松解中的应用

目的评估改良Pie-crusting技术(简称PC技术)在初次全膝关节置换术(total knee arthroplasty,TKA)内侧松解中应用的安全性和有效性。方法 2014年3月~2016年6月由同一术者采用改良PC技术完成膝内翻畸形初次TKA 30例(34膝)。使用特制带弧形刀柄限宽3 mm、限深5 mm的手术刀进行横行点戳,以紧张部位优先松解的原则,伸直紧时松解内侧副韧带浅层后束纤维及后内侧关节囊,屈曲紧时松解内侧副韧带浅层前束纤维。记录松解前后伸直、屈曲位内外侧间隙值;根据术中测量值分为伸直屈曲均紧张组(10膝)、仅伸直紧张组(13膝)和仅屈曲紧张组(11膝),间隙≤1 mm为软组织平衡,分别计算平衡矫正率。术后定期拍摄患膝负重位片测量下肢力线,记录膝关节活动度(range of motion,ROM)、HSS评分、WOMAC评分,并与术前比较。结果 31膝达到屈伸间隙、内外侧间隙平衡。1膝伸直间隙内外侧相差2 mm,2膝屈曲间隙内外侧相差2 mm,总体平衡矫正率91.2%(31/34)。3例术中应用限制性垫片。未发生因该技术导致的其他并发症。仅伸直紧组松解后屈曲间隙增加中位数1 mm(1~3 mm),仅屈曲紧组松解后伸直间隙增加中位数1 mm(1~2 mm),无统计学差异(Z=-1.118,P=0.264)。术前患者膝关节ROM为83.3°±14.7°,机械轴偏移角度中位数11.5°(7°~32°),HSS评分为(42.7±16.3)分、WOMAC评分为(76.2±8.2)分,术后膝关节ROM为100.7°±14.2°(t=-7.714,P=0.000)、机械轴偏移角度中位数1°(0°~4°)(Z=-5.092,P=0.000)、HSS评分(88.1±9.9)分(t=-21.868,P=0.000)、WOMAC评分(11.4±9.7)分(t=31.726,P=0.000),均较术前明显改善。结论在初次TKA中使用改良PC技术做内侧松解是安全、有效的。仅松解伸直或屈曲位触摸紧张的纤维,也会同时影响两个间隙。     

The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee

Posteroanterior weight-bearing radiographs, made with the knee in 45 degrees of flexion, were compared with conventional radiographs for fifty-five patients who had surgical treatment for a lesion causing pain in one knee. Narrowing of the cartilage space of two millimeters or more was defined as indicative of major degeneration (grade III or IV). Comparison of the intraoperatively observed degeneration with the narrowing that was seen on the radiographs revealed that the posteroanterior weight-bearing radiographs that were made with the knee in 45 degrees of flexion were more accurate (p less than 0.01), more specific (no false-positives) (p less than 0.01), and more sensitive (fewer false-negatives) than the conventional extension weight-bearing anteroposterior radiographs.     

The posteroanterior 45° flexion weight-bearing radiograph of the knee

Biomechanical studies suggest that radiographs of the osteoarthritic knee taken in 30° to 60° of flexion more accurately demonstrate the true degree of articular cartilage loss than radiographs taken with the knee in full extension. Conventional anteroposterior weight-bearing full-extension radiographs were compared with posteroanterior 45° flexion weight-bearing radiographs of 35 patients with 45 symptomatic knees (90 compartments) presenting with suspected osteoarthritis. In 35 compartments, there was a 2-mm or greater loss of joint space in the 45° flexion views compared with those taken in full extension. Also, in 11 compartments (10 knees), there was a normal joint space on the full extension radiographs, but marked narrowing on the flexion view. Both results are statistically significant. It is concluded that the posteroanterior 45° flexion weight-bearing radiograph is a useful additional tool in the assessment of knees with early degenerative change.     

Anteroposterior radiographs of the osteoarthritic knee

Destruction of the articular cartilage is the first change seen on gross examination of the knee in osteoarthritis. Weight-bearing radiographs are conventionally taken with the knee in full extension. Biomechanical studies have shown, however, that the major contact stresses in the femorotibial articulation occur when the knee is flexed about 28 degrees. Arthroscopy has confirmed that cartilage loss occurs in a more posterior portion of the femoral condyles than is revealed by radiographs taken in full extension. The 'standing tunnel view' is a weight-bearing postero-anterior radiograph taken with the knee in 30 degrees of flexion. The radiographs of 64 patients have been used to compare the conventional with the standing tunnel view. In 10 knees in which the conventional view suggested normal cartilage the standing tunnel view revealed severe degeneration.     

Plain radiography in the degenerate knee. A case for change.

We took posteroanterior weight-bearing radiographs, both with the joint fully extended and in 30 degrees of flexion, in a consecutive series of 50 knees in 37 patients referred for the primary assessment of pain and/or stiffness. These radiographs were reported 'blind' both by an orthopaedic surgeon and a radiologist. Direct measurement of the joint space, together with grading of the severity of erosion according to the Ahlback criteria, was undertaken. Any other abnormality present was also documented. The radiographs of the knees in 30 degrees of flexion consistently showed more advanced erosion in both the medial (p = 0.001) and the lateral (p = 0.0001) tibiofemoral compartments, when compared with those of knees in full extension. The Ahlback classification of 25 joints was altered, in some cases by several grades, by the flexed position of the joint. In every case in which another abnormality was identified on the radiograph in full extension, it was also noted on that of the knee in 30 degrees of flexion. In a further four cases, additional pathology could only be seen in the flexed knee. Every patient was able to complete the radiological examination without difficulty. Our study supports the adoption of a weight-bearing view in 30 degrees of flexion as the standard posteroanterior radiograph for the assessment of tibiofemoral osteoarthritis in patients over 50 years of age.     

Radiographic measurement of joint space height in non-osteoarthritic tibiofemoral joints. A comparison of weight-bearing extension and 30 degrees flexion views

There have been many reports which suggest that in patients with tibiofemoral osteoarthritis, a reduction in joint space is demonstrated better on weight-bearing radiographs taken with the knee in semiflexion than in full extension. The reduction has been attributed to the loss of articular cartilage in the contact area in a semiflexed arthritic knee. None of these studies have, however, included normal knees. We have therefore undertaken a prospective, double-blind, randomised study in order to evaluate the difference in the joint-space of arthroscopically-proven normal tibiofemoral joints as seen on weight-bearing full-extension and 30 degrees flexion posteroanterior radiographs. Twenty-two knees were evaluated and the results showed that there may be a difference of up to 2 mm in the two views. This difference could be attributed to the inherent differential thickness of the articular cartilage in different areas of the femoral and tibial condyles and a change in the areas of contact between them.     

Anteroposterior weight-bearing radiography of the knee with both knees in semiflexion,using new equipment

In order to obtain high reproducibility and sensitivity in the evaluation of joint space in osteoarthritic knees, we used new equipment, and established an anteroposterior weight-bearing radiograph with both knees in semiflexion taking into account our investigation of the posterior slope angle. We compared our method with the Rosenberg method, and the coefficient of variation of our method showed higher reproducibility than that of the Rosenberg method. The most essential issue is whether the bilateral leg loading radiograph can show the same sensitivity as the homolateral leg loading radiograph. We compared standing radiographs of the knee in 26° flexion with those of 26° flexion in both knees. We assessed the widths of the narrowest points of the joint spaces in the medial and lateral compartments, the condylar plateau angle, and the femorotibial angle, in 47 knees in 24 patients. The data were analyzed statistically by single regression and each correlation was of statistical significance. Our method has better reproducibility and is more comfortable for the subject than conventional methods. Received: February 27, 2001 / Accepted: July 13, 2001     

膝骨关节炎骨赘放射学大小与负重位下肢力线相关性分析

[目的]探讨膝OA患者膝关节放射学骨赘大小与负重位下肢力线的关系。[方法]对40例接受人工全膝关节置换术的原发性骨关节炎患者(共40膝),利用躯体X线测量系统进行负重位下肢力线的测量。将膝关节正位X线片导入计算机,应用Photoshop软件长度测量工具分别测量股骨远端、胫骨平台宽度和骨赘长度。骨赘长度与骨端宽度的比值,称为骨赘突起指数。应用SPSS软件通过Pearson相关检验,评价测量者内及测量者间骨赘突起指数重复性,探索膝OA患者膝关节放射学骨赘大小和负重位下肢力线之间的关系。[结果]40例膝OA患者负重位下肢力线平均为:12.53°±5.62°。测量者内及测量者间骨赘突起指数有较好相关性,r接近1(P<0.001)。负重位下肢力线与股骨内侧髁骨赘突起指数呈正相关(r=0.530,P<0.001),与胫骨平台内侧骨赘突起指数呈正相关(r=0.618,P<0.001)。负重位下肢力线与股骨外侧髁(r=-0.008,P=0.961)、胫骨平台外侧(r=0.244,P=0.129)骨赘突起指数间无相关性存在。[结论]膝OA患者股骨内侧髁骨赘突起指数、胫骨平台内侧骨赘突起指数与负重位下肢力线呈正相关,机械应力通过...     

A comparative study of weight-bearing and non-weight-bearing 3-dimensional lower extremity alignment in knee osteoarthritis

BackgroundLower extremity alignment is an important variable with respect to the development and progression of knee osteoarthritis. It is very essential for the preoperative planning of realignment surgeries such as total knee arthroplasty and high tibial osteotomy. Nevertheless, there have been no reports comparing 3D lower extremity alignment between weight-bearing upright and non-weight-bearing horizontal states in osteoarthritic knees in the same subject. Therefore, we determined whether the alignment of the lower extremity in the weight-bearing upright state differed from that in the non-weight-bearing horizontal or supine position in patients with knee osteoarthritis.MethodsAdduction–abduction, flexion–extension, and rotational angle of osteoarthritic knees were assessed in weight-bearing upright and non-weight-bearing supine positions. Knee alignment in the supine position was determined from preoperative computed tomography data. In the weight-bearing upright state, alignment was determined using a technique that utilized 2D-3D image-matching with biplanar computed radiography and 3D bone models of the complete lower extremity rebuilt using computed tomography-based information.ResultsWe assessed 81 limbs from osteoarthritic knee patients (74 women, 7 men; mean age 75.3 years, range 59–86 years). In the coronal plane, there were varus deformities in both the supine and standing positions, while there was flexion in both the supine upright state and position at the sagittal plane. In the axial plane, the rotation of the tibia to the femur was neutral in the supine position and internal in the upright state.ConclusionPatient position significantly affects lower extremity alignment in osteoarthritic knees. This study provides important data regarding the preoperative evaluation of realignment surgery in total knee arthroplasty and high tibial osteotomy. We believe that these results are an important contribution to the knowledge regarding knee osteoarthritis.     

A radiographic analysis of anterior-posterior translation in total knee arthroplasty

We performed radiological analyses to examine the relationship between the knee flexion angle and the anteroposterior translation movement relative to the prosthetic components (NexGen type) after total knee arthroplasty (TKA). Cruciate-retaining (CR) type TKA was performed in 12 knees with osteoarthritis (OA) and 9 knees with rheumatoid arthritis (RA) in which no posterior cruciate ligament (PCL) tear was present. Posterior-stabilized (PS) type TKA was performed in 7 OA knees and 7 RA knees in which the PCL was defective or resected. The measurements were performed according to the methods of Watanabe. The contact point ratio (percentage) was calculated by dividing the distance to the contact point (CP; the closest point of contact between the femoral and tibial components) by the antero-posterior length of the tibial component. After TKA, the CP at full extension was positioned more posteriorly than in the normal knee both under weight-bearing and non-weight-bearing conditions. Except for the RA knees in the PS group, the CP translated anteriorly in the early phase of flexion and then posteriorly. Under weight-bearing conditions, the posterior translation occurred earlier and was smaller in magnitude. For RA knees in the PS group, the CP moved gently posteriorly right from the beginning. Received: May 16, 2000 / Accepted: April 10, 2001     

Radiological changes five years after unicompartmental knee replacement

Failure of a unicompartmental knee replacement (UKR) may be caused by progressive osteoarthritis of the knee and/or failure of the prosthesis. Limb alignment can influence both of these factors. We have examined the fate of the other compartments and measured changes in leg alignment after UKR. A total of 50 UKRs was carried out on 45 carefully selected patients between 1989 and 1992. At operation, deliberate attempts were made to avoid overcorrection of the deformity. Four patients died, one patient was lost to follow-up and two knees were revised before review which was at a minimum of five years. Standard long-leg weight-bearing anteroposterior views of the knee and skyline views of the patellofemoral joint were taken before and at eight months and five years after operation. The radiographs of the remaining 43 knees were reviewed twice by blind and randomised assessment to measure the progression of osteoarthritis within the joints. Overcorrection of the deformity in the coronal plane was avoided in all but two knees. Only one showed evidence of progression of osteoarthritis within the patellofemoral joint, and this was only identified in one of the four assessments. Deterioration in the state of the opposite tibiofemoral compartment was not seen. Varus deformity tended to recur. Recurrent varus of 2 degrees was observed between eight months and five years after operation. There was no correlation between the postoperative tibiofemoral angle and the extent of recurrent varus recorded at five years. Changes in alignment may be indicative of minor polyethylene wear or of subsidence of the tibial component. The incidence of progressive osteoarthritis within the knee was very low after UKR. Patients should be carefully selected and overcorrection of the deformity be avoided.