Tuberous sclerosis complex(TSC)is a rare genetic disease that can lead to benign dysplasia in multiple organs such as the skin, brain, eyes, oral cavity, heart, lungs, kidneys, liver, and bones. Its main symptoms include epilepsy, intellectual disabilities, skin depigmentation, and facial angiofibromas, whilst incidence is approximately 1 in 10 000 to 1 in 6000 newborns. This case presents a middle-aged woman who initially manifested with epilepsy and nodular depigmentation. Later, she developed a lower abdominal mass, elevated creatinine, and severe anemia. Based on clinical features and whole exome sequencing, the primary diagnosis was confirmed as TSC. Laboratory and imaging examinations revealed that the lower abdominal mass originated from the uterus. CT-guided biopsy pathology and surgical pathology suggested a combination of leiomyoma and abscess. With the involvement of multiple organs and various complications beyond the main diagnosis, the diagnostic and therapeutic process for this patient highlights the importance of rigorous clinical thinking and multidisciplinary collaboration in the diagnosis and treatment of rare and challenging diseases.

Objective:To investigate the MRI imaging features of hepatocyte nuclear factor 1α- inactivated hepatocellular adenoma (H-HCA).Methods:Clinical data and MRI images of 19 H-HCA cases who were pathologically confirmed at Zhongshan Hospital Affiliated to Fudan University between August 2014 and July 2020 were retrospectively analyzed. Among them, there were 15 females and 4 males, aged 16-47 (32± 7) years old. Tumor number, location, shape, size, boundary, MRI plain scan signal intensity, dynamic enhancement features of each phase, presence or absence of intratumoral fat content, pseudocapsule, and others were analyzed. The differences in apparent diffusion coefficient (ADC) values between the lesion and the surrounding normal liver parenchyma were compared for statistical significance. t-test was used for statistical analysis. Results:There were a total of 24 lesions in 19 cases. 14 cases had solitary lesions, and five cases had multiple lesions. 15 and nine lesions were located in the right and left lobes of the liver, respectively. 20 lesions were round or quasi-round, and four were irregular or lobulated. The tumor’s maximal diameter was 0.6-8.6 (3.5 ± 2.4) cm. T 1-weighted image (WI) showed hyperintense to iso-intense signals in 20 lesions and hypointense signals in four. T 2WI showed iso-to-slightly high signal intensity in 16 lesions, with two hyperintense and six hypointense signals. Diffusion-weighted image (DWI) revealed hyperintense to iso-intense signals. Lesions mean ADC value was (1.289 ± 0.222)×10 -3 mm 2/s, while the adjacent normal liver parenchyma’s mean ADC value was (1.307 ± 0.236)×10 -3 mm 2/s, with no statistically significant difference between the two ( P > 0.05). During the arterial phase, 15 of the 18 lesions that underwent dynamic contrast-enhanced scanning with gadoxetate disodium (Gd-DTPA) were mildly to moderately enhanced and three were strongly enhanced. The portal and hepatic venous phases had no continuous enhancement, while the delayed phase showed a hypointense signal. During the arterial phase, two of the six lesions scanned by gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid ((Gd-EOB-DTPA) dynamic enhancement were mildly to moderately enhanced, while four were strongly enhanced. The portal and hepatic venous phases had no continuous enhancement, while the transition and hepatobiliary-specific phases showed hypointense signals. Intracellular steatosis occurred in 21 lesions, of which 19 were diffuse steatosis and 16 formed pseudocapsules in the delayed phase. Conclusion:H-HCA often occurs in young females as solitary lesions and has certain MRI features. T1WI anti-phase diffuse signal reduction and post-enhanced hypovascular withdrawal enhancement patterns can aid in accurately diagnosing the disease condition.

Objective:To investigate the efficacy of TiRobot navigation combined with ankle arthroscopy in the reduction and internal fixation of Hawkins type Ⅱ talus neck fracture.Methods:From January 2019 to September 2020, a total of 13 patients with Hawkins type Ⅱ talus neck fracture were admitted to Department of Foot and Ankle Surgery, Xuzhou Renci Hospital. They were 8 males and 5 females, with a mean age of 35.8 years (from 22 to 61 years). All fractures were reduced and fixated using TiRobot navigation combined with ankle arthroscopy. Time for fracture reduction assisted by intraoperative arthroscopy, time for internal fixation assisted by TiRobotic navigation, fracture union time and complications were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used at the last follow-up to evaluate the functional outcomes.Results:All the operations were finished within 2 hour. The primary screw placement succeeded in all. The time for fracture reduction assisted by intraoperative arthroscopy averaged 52.8 min (from 43 to 66 min) and the time for internal fixation assisted by TiRobotic navigation 43.6 min (from 33 to 55 min). All the patients were followed up for an average 13.3 months(from 12 to 15 monhs). They obtained bony union within 3 months. One patient developed traumatic subtalar arthritis with mild pain and was treated conservatively. None of the patients had complications like incision infection or talus necrosis. The average AOFAS ankle-hindfoot score was 91.0 points (from 83 to 94 points) at the last follow-up.Conclusion:In the reduction and internal fixation of Hawkins type Ⅱ talus neck fracture, TiRobot navigation combined with ankle arthroscopy shows advantages of minimal invasion, accurate reduction and screw placement, and limited complications, leading to fine short-term functional outcomes.

Objective:To study the clinical and MRI features of alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis to compare with those of hepatic focal nodular hyperplasia (FNH) to arrive at a correct differential diagnosis.Methods:The data of 105 patients who underwent liver surgery for alpha-fetoprotein-negative hepatocellular carcinomas without cirrhosis at Zhongshan Hospital, Fudan University and the Traditional Chinese Medical Hospital of Nantong from March 2017 to November 2020 were retrospectively studied. There were 109 lesions in 95 males and 10 females. These patients had the age of (60.2±9.9) years. The data of 88 patients who were diagnosed to have hepatic FNH during the study period were collected, and there were 99 lesions in 36 males and 52 females. These patients had the age of (32.8±9.5) years. Variables including age, history of hepatitis B virus infection, T 1 weighted imaging (T 1WI), T 2 weighted imaging (T 2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC), enhancement mode, lesion shape, lesion boundary and capsule were compared between the two groups. Results:The age and the proportion of patients with a history of hepatitis B in the alpha-fetoprotein-negative hepatocellular carcinoma and without cirrhosis group were significantly higher than those in the hepatic FNH group (both P<0.05). The proportion of lesions with quasi-circular shape, clear boundary and with capsule in hepatocellular carcinoma group were significantly higher than those in the hepatic FNH group (all P<0.05). There were also significant differences in the T 1WI, T 2WI, enhancement modes, DWI, and ADC map between the two groups of lesions (all P<0.05). The areas under the receiver operating characteristic curve for the alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis by the age >45.5 year, with a history of hepatitis B, with clear lesion boundary, with a "washin and washout" enhanced mode and with lesion encapsulation were 0.97(95% CI: 0.95-0.99), 0.79(95% CI: 0.72-0.85), 0.78(95% CI: 0.72-0.85), 0.94(95% CI: 0.90-0.97), 0.99(95% CI: 0.98-1.00) respectively. Conclusions:The presence of a capsule, clear lesion boundary and "washin and washout" enhanced mode are helpful in differentiating alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis with hepatic FNH.

Objective:To investigate the imaging characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) of undifferentiated carcinoma with pancreatic osteoclast-like giant cell (UPC-OGC).Methods:From April 2015 to November 2019, at Zhongshan Hospital, Fudan University, 11 pathologically confirmed UPC-OGC patients who received upper abdominal CT or MRI before surgery and with complete clinical and pathological data were retrospectively included. The imaging characteristics of CT and MRI were analyzed, which included lesion location, number, shape, size, boundary, plain scan and enhancement features, adjacent tissue invasion and metastasis. Independent sample t test was used for statistical analysis. Results:The tumor lesions of 11 patients with UPC-OGC were all single, and the maximum diameter of lesion was (4.84±2.96) cm (ranged from 2.00 to 12.80 cm). The lesions of 7 patients with UPC-OGC were located in the head of pancreas, 2 located in the body of pancreas, 1 located in the tail of pancreas and 1 located in the junction of body and tail of pancreas. The lesion shapes of 3 patients with UPC-OGC were round, and the lesion shapes of 8 patients were oval with lobulation. The lesion boundaries of 8 patients with UPC-OGC were clear and the lesion boundaries of 3 patients were unclear. Seven patients with UPC-OGC were examined by plain and enhanced CT scan. Plain CT scan showed that the density of solid area of the tumor was similar to that of normal pancreatic parenchyma ((37.14±6.10) HU vs. (43.14±4.55) HU), and the difference was not significant ( t=-2.85, P=0.097). Contrast-enhanced CT scan in arterial phase showed that the degree of enhancement in solid area of the tumor was weaker than that of normal pancreatic parenchyma ((67.29±12.79) HU vs. (90.43±9.81) HU), and the difference was statistical significant ( t=-4.10, P=0.004), while contrast-enhanced CT scan showed that in venous phase the solid area of the tumor continued to strengthen and the degree of enhancement was similar to that of normal pancreatic parenchyma ((84.71±15.30) HU vs. (79.57±10.73) HU), and the difference was not significant ( t=0.38, P=0.535). Both CT and MRI enhanced scans showed uneven enhancement of the lesions, the degree of enhancement of solid component in arterial phase was slightly weaker than that of normal pancreatic parenchyma and the marginal and internal separation were progressively enhanced, and the degree of enhancement in the venous phase and balanced phase was slightly higher than that of the normal pancreatic parenchyma or similar to that of the normal pancreas. Conclusions:The imaging of CT and MRI of UPC-OGC have certain characteristics, which are helpful for the diagnosis and identification of the disease.

Objective:To investigate the value of multislice spiral computed tomography (MSCT) features in the differential diagnosis of pancreatic solid pseudopapillary neoplasm (pSPN) and hypovascular pancreatic neuroendocrine tumor (hypo-PNET).Methods:From January 2016 to January 2021, at Zhongshan Hospital of Fudan University, the clinical information, pathological results and imaging data of 81 patients with pSPN and 40 patients with hypo-PNET confirmed by surgical pathology were retrospectively analyzed. The tumor location, shape, growth mode, relationship between the long axis of the lesion and pancreas, boundary, whether with calcification, floating cloud sign, ring enhancement, sausage-like enhancement, intratumoral vascular sign, pancreatic duct dilatation, distal pancreatic atrophy, intratumoral cystic change, cystic-solid ratio of tumor, the maximum diameter of the lesion, the plain and enhanced computed tomography (CT) values of the solid part of the tumor of pSPN patients and hypo-PNET patients were compared and analyzed. Chi-square test, independent sample t test and Mann-Whitney U test were used for statistical analysis. The variables with statistical significance in univariate analysis were included in the binary logistic regression model to screen the independent predictors of pSPN and hypo-PNET, and the receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficiency of MSCT characteristics in the differential diagnosis of pSPN and hypo-PNET. Results:Compared with hypo-PNET patients, most of pSPN patients were female (71.6%, 58/81 vs. 45.0%, 18/40), younger (36.0 years old (27.0 years old, 46.0 years old) vs. 56.5 years old (48.2 years old, 63.7 years old), the tumors were mostly round or elliptical (76.5%, 62/81 vs. 55.0%, 22/40), most with clear boundaries (70.4%, 57/81 vs. 40.0%, 16/40), with more intratumoral calcification (53.1%, 43/81 vs. 20.0%, 8/40), with more floating cloud sign (65.4%, 53/81 vs. 35.0%, 14/40), more without intratumoral vascular sign (77.8%, 63/81 vs. 32.5%, 13/40), more without pancreatic duct dilatation (79.0%, 64/81 vs. 55.0%, 22/40), more with mixed solid and cystic mass (38.3%, 31/81 vs. 22.5%, 9/40), with longer maximum diameter of tumor (4.0 cm (3.0 cm, 5.6 cm) vs. 3.3 cm (2.6 cm, 4.2 cm), with lower enhanced CT values in the arterial and venous phases ((54.7±13.1) HU vs. (68.2±15.0) HU and (65.9±16.0) HU vs. (79.2±14.2) HU), and the differences were all statistically significant ( χ2=8.11; Z=-6.24; χ2=5.85, 10.32, 12.02, 10.03, 23.50, 7.51, 7.72; Z=-2.53; t=-5.08 and -4.46, all P<0.05). The results of binary logistic regression model indicated that the independent predictive factors for the diagnosis of pSPN and hypo-PNET included age ( OR=0.874, 95% confidence interval (95% CI) 0.827 to 0.923, P<0.001), calcification ( OR=5.412, 95% CI 1.428 to 20.506, P=0.013), intratumoral vascular sign ( OR=0.212, 95% CI 0.055 to 0.817, P=0.024), CT value in the arterial phase ( OR=0.943, 95% CI 0.899 to 0.988, P=0.015). For the combination diagnostic model based on clinical features and MSCT characteristics, area under ROC was 0.944 (95% CI 0.905 to 0.990), sensitivity was 87.7% and specificity was 92.5% ( P<0.001). The results of ROC analysis of the independent predictive factors and combined diagnostic model showed that the areas under the curve (95% CI) of the age, calcification, intratumoral vascular sign, CT value in the arterial phase and the combined diagnostic model was 0.665 (0.565 to 0.765), 0.726 (0.627 to 0.826), 0.850 (0.775 to 0.924), 0.757 (0.660 to 0.853), and 0.944 (0.905 to 0.983), respectively, and the diagnostic efficacy of the combined diagnostic model was higher ( P<0.001). Conclusion:MSCT features such as intratumoral calcification, intratumoral vascular sign, tumor density in the arterial phase combined with age can be used in the differential diagnosis of pSPN and hypo-PNET.

Objective:To investigate the MRI manifestations of lymphoepithelioma-like intrahep cholangiocarcinoma (LEL-ICC).Methods:MR images of 26 cases with LEL-ICC confirmed pathologically at Zhongshan Hospital Affiliated with Fudan University between March 2011 and March 2021 were retrospectively analyzed. The number, location, size, morphology, edges of lesions, non-scan signal intensity, cystic necrosis, enhancement mode, peak, and capsule, vascular invasion, lymph node metastasis, and other MR images were included for analysis. The apparent diffusion coefficient (ADC) value of the lesion and the surrounding normal liver parenchyma were measured. A paired-sample t-test was used to statistically analyze the measurement data. Results:All 26 cases of LEL-ICC had solitary lesions. Mass-type LEL-ICC was the most common [ n=23, lesion size (4.02±2.32) cm] with distribution along the bile duct [ n=3, lesion size (7.23±1.40 cm)]. Among the 23 lesions of mass type LEL-ICC, most of the lesions were close to the liver capsule ( n=20), round ( n=22), clearly bordered ( n=13), and cystic necrosis ( n=22). In the three lesions of LEL-ICC distributed along the bile duct, most of them were close to the liver capsule ( n=2), irregular ( n=3), blurred edges ( n=3), and cystic necrosis ( n=3). All 26 lesions showed a low/slightly low signal on T 1WI, a high/slightly high signal on T 2WI, and a slightly high or high signal on DWI. Three lesions showed fast-in and fast-out enhancement modes, and 23 lesions showed continuous enhancement. Twenty-five lesions showed peak enhancement in the arterial phase, and one lesion appeared in the delayed phase. The ADC value of 26 lesions and adjacent normal liver parenchyma was (1.112±0.274)×10 -3 mm 2/s and (1.482±0.346)×10 -3 mm 2/s, respectively, and the both had a statistically significant difference ( P<0.05). Conclusion:Certain manifestations of LEL-ICC in magnetic resonance imaging are advantageous for diagnosis and differential diagnosis.

Objective:To investigate the value of imaging features of contrast-enhanced computed tomography (CT) of pancreatic neuroendocrine neoplasm (panNEN) in predicting preoperative pathological grade.Methods:From February 2009 to August 2020, at Zhongshan Hospital affiliated to Fudan University, the CT data of 136 patients with panNEN diagnosed by surgery and pathology were retrospectively analyzed. According to World Health Organization classification of digestive tumors (5th edition, 2019), panNEN was classified into G1, G2, G3 neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC). The differences in CT values and correlative parameters of solid part of lesions with different pathological grades were compared. The receiver operator characteristic curve was drawn and the area under the curve (AUC) was calculated to evaluate the CT value and related parameters in the differential diagnosis of panNEN of different pathological grades. The Kruskal-Wallis test and chi-square test were used for statistical analysis.Results:A total of 142 tumor lesions were detected in 136 panNEN patients, of which the numbers of G1, G2, G3 NET and NEC were 58, 73, 7 and 4, respectively. Along with the increase of pathological grade, the degree of CT enhancement in the solid part of panNEN lesions gradually decreased. The CT value, CT value difference and relative density of arterial phase and venous phase of patients with G2 NET were all lower than those of patients with G1 NET (Arterial phase: 105 HU, 46 to 251 HU vs. 126 HU, 57 to 195 HU; 62 HU, 6 to 212 HU vs. 81 HU, 23 to 166 HU; 1.1, 0.4 to 2.5 vs. 1.4, 0.7 to 2.0. Venous phase: 90 HU, 49 to 159 HU vs. 107 HU, 63 to 162 HU; 49 HU, 9 to 134 HU vs. 62 HU, 24 to 128 HU; 1.1, 0.5 to 2.0 vs. 1.4, 0.9 to 2.0), and the differences were statistically significant ( Harterial phase=2.880, 2.607 and 3.482, Hvenous phase=3.426, 3.323 and 3.891, all P<0.05). The CT value difference, the percentage of lesion enhancement, the index of lesion enhancement in arterial phase, and the CT value difference and the index of lesion enhancement in venous phase of patients with G3 NET were all lower than those of patients with G2 NET (31 HU, 27 to 52 HU vs. 62 HU, 6 to 212 HU; 67%, 59% to 153% vs. 151%, 15% to 705%; 0.6 HU, 0.5 to 0.9 HU vs. 1.3 HU, 0.1 to 5.8 HU; 40 HU, 36 to 52 HU vs. 49 HU, 9 to 134 HU; 0.9, 0.7 to 1.6 vs. 1.5, 0.2 to 5.4), and the differences were statistically significant ( H=2.634, 2.801, 3.267, 2.264 and 2.882, all P<0.05). The relative density index of arterial phase and venous phase to identify G1 and G2 NET received maximum AUC value of 0.679 (95% confidence interval ( CI) 0.587 to 0.771, P<0.01) and 0.701 (95% CI 0.609 to 0.793, P<0.01), respectively. The index of lesion enhancement in arterial phase and venous phase to identify G2 and G3 NET received maximum AUC value of 0.875 (95% CI 0.793 to 0.956, P=0.001) and 0.828 (95% CI 0.700 to 0.956, P=0.004), respectively. Conclusion:The enhanced CT parameters of panNEN can be used to predict the pathological grade before operation.

Objective:To investigate the influence of correction degree on the clinical effect of valgus knee after total knee arthroplasty(TKA).Methods:Clinical data of 91 patients with unilateral valgus knee who underwent TKA from January 2015 to December 2018 at Department of Orthopaedic Surgery,Zhongda Hospital,Southeast University were retrospectively analyzed. According to postoperative hip-knee-ankle angle(HKA),these patients were divided into neutral group (-3°≤HKA≤3°) and residual valgus group(HKA>3°). There were 70 patients in the neutral group,with a median age of 71.5 years(range:57 to 91 years),and 21 patients in the residual valgus group,with a median age of 71.5 years(range:60 to 85 years). The postoperative clinical indicators,including the range of motion (ROM),American Knee Society score(KSS),Western Ontario and McMaster University(WOMAC) osteoarthritis index,forgotten joint score (FJS-12) were collected. Meanwhile,the imaging indexes of femoral angle,tibial angle,femoral prosthesis flexion angle,tibial prosthesis posterior slope angle,patella tilt angle,congruence angle were also collected. Additionally,postoperative complications were recorded. The clinical data were analyzed by independent sample t test,Mann-Whitney U test or χ 2 test. Results:There were no differences between the two groups in postoperative ROM (122.5°±8.5° vs. 119.4°±7.1°, t=1.534, P=0.128),KSS(159.8±8.9 vs. 150.0±8.9, t=-0.103, P=0.918),WOMAC osteoarthritis index(10.0(3.0) vs. 9.0(5.0), Z=-0.733, P=0.464),FJS-12(52.1(8.4) vs. 50.1(7.5), Z=-0.594, P=0.553)and femoral angle(94.0°(4.0°) vs. 94.0°(5.0°), Z=-0.209, P=0.835),tibial angle(90.0°(3.0°) vs. 91.0°(2.5°), Z=-1.226, P=0.220),femoral prosthesis flexion angle(3.0°(1.0°) vs. 3.0°(1.0°), Z=-0.652, P=0.514),tibial prosthesis posterior slope angle(4.0°(2.0°) vs. 4.0°(2.0°), Z=-0.763, P=0.445),patella tilt angle(9.0°(3.0°) vs. 9.0°(3.5°), Z=-1.429, P=0.153),congruence angle(14.0°(4.0°) vs. 15.0°(4.0°), Z=-1.690, P=0.091). However,abnormal proportions of patella tilt angle(33.3% vs.11.4%, χ2=5.630, P=0.018) and congruence angle(38.1% vs.17.1%, χ2=4.136, P=0.042) were apparent in the residual valgus group. The patients were follow-up for (32.1±5.2) months(range:24 to 40 months). Six weeks after operation,one case of joint stiffness occurred in the residual valgus group, which was improved after manual relaxation and rehabilitation exercises. At the last follow-up,two cases in the residual valgus group suffered patella instability which were fixed by patella braces and strengthening of the medial femoral muscles. There were no cases requiring reoperation for dislocation of patella,joint instability and aseptic loosening of the prosthesis in both groups. Conclusions:Residual valgus after TKA for valgus knee has no significant effect on the short-term clinical outcome,but it is more likely to cause abnormal proportions of patella tilt angle and congruence angle which may induce the risk of postoperative patella instability. The mid-and long-term outcomes need to be further investigated.

Objective:To investigate the influence of correction degree on the clinical effect of valgus knee after total knee arthroplasty(TKA).Methods:Clinical data of 91 patients with unilateral valgus knee who underwent TKA from January 2015 to December 2018 at Department of Orthopaedic Surgery,Zhongda Hospital,Southeast University were retrospectively analyzed. According to postoperative hip-knee-ankle angle(HKA),these patients were divided into neutral group (-3°≤HKA≤3°) and residual valgus group(HKA>3°). There were 70 patients in the neutral group,with a median age of 71.5 years(range:57 to 91 years),and 21 patients in the residual valgus group,with a median age of 71.5 years(range:60 to 85 years). The postoperative clinical indicators,including the range of motion (ROM),American Knee Society score(KSS),Western Ontario and McMaster University(WOMAC) osteoarthritis index,forgotten joint score (FJS-12) were collected. Meanwhile,the imaging indexes of femoral angle,tibial angle,femoral prosthesis flexion angle,tibial prosthesis posterior slope angle,patella tilt angle,congruence angle were also collected. Additionally,postoperative complications were recorded. The clinical data were analyzed by independent sample t test,Mann-Whitney U test or χ 2 test. Results:There were no differences between the two groups in postoperative ROM (122.5°±8.5° vs. 119.4°±7.1°, t=1.534, P=0.128),KSS(159.8±8.9 vs. 150.0±8.9, t=-0.103, P=0.918),WOMAC osteoarthritis index(10.0(3.0) vs. 9.0(5.0), Z=-0.733, P=0.464),FJS-12(52.1(8.4) vs. 50.1(7.5), Z=-0.594, P=0.553)and femoral angle(94.0°(4.0°) vs. 94.0°(5.0°), Z=-0.209, P=0.835),tibial angle(90.0°(3.0°) vs. 91.0°(2.5°), Z=-1.226, P=0.220),femoral prosthesis flexion angle(3.0°(1.0°) vs. 3.0°(1.0°), Z=-0.652, P=0.514),tibial prosthesis posterior slope angle(4.0°(2.0°) vs. 4.0°(2.0°), Z=-0.763, P=0.445),patella tilt angle(9.0°(3.0°) vs. 9.0°(3.5°), Z=-1.429, P=0.153),congruence angle(14.0°(4.0°) vs. 15.0°(4.0°), Z=-1.690, P=0.091). However,abnormal proportions of patella tilt angle(33.3% vs.11.4%, χ2=5.630, P=0.018) and congruence angle(38.1% vs.17.1%, χ2=4.136, P=0.042) were apparent in the residual valgus group. The patients were follow-up for (32.1±5.2) months(range:24 to 40 months). Six weeks after operation,one case of joint stiffness occurred in the residual valgus group, which was improved after manual relaxation and rehabilitation exercises. At the last follow-up,two cases in the residual valgus group suffered patella instability which were fixed by patella braces and strengthening of the medial femoral muscles. There were no cases requiring reoperation for dislocation of patella,joint instability and aseptic loosening of the prosthesis in both groups. Conclusions:Residual valgus after TKA for valgus knee has no significant effect on the short-term clinical outcome,but it is more likely to cause abnormal proportions of patella tilt angle and congruence angle which may induce the risk of postoperative patella instability. The mid-and long-term outcomes need to be further investigated.