Primary Total Knee Arthroplasty in Patients With Fixed Valgus Deformity

Krackow, Kenneth A.; Jones, Mark M.; Teeny, Steven M.; Hungerford, David S.

doi:10.1097/00003086-199112000-00004

Cited by 162 publications

(159 citation statements)

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“…To our knowledge, Knee Society scores have been infrequently reported specifically in TKA for valgus arthritis [3,6] with comparable overall results but no relationship to technique or patient or implant variables evaluated.…”

Section: Discussionmentioning

confidence: 95%

“…The complexities of addressing the deformity, osseous deficiencies, and soft tissue imbalances have been well documented with many differing surgical techniques described [1,[3][4][5][6][7][8][9]11]. There is no consensus as to the relative indications for (or optimum sequence or technique of) the many techniques described for soft tissue balancing in the valgus knee.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, some authors have advocated the use of primary constrained components both with [3] and without [1] stem extensions. Conversely, others have published results that support the use of PCL-retaining designs with various soft tissue balancing techniques [5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

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Posterior Cruciate-retaining Total Knee Arthroplasty for Valgus Osteoarthritis

McAuley

Collier

Hamilton

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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The valgus, osteoarthritic knee is challenging technically and it is unknown whether and how technical and implant variables influence outcomes. We therefore determined the influence of surgical technique of soft tissue balancing and patient and implant factors from 100 unselected cruciate-retaining TKAs for valgus osteoarthritis in patients younger than 75 years of age. From 1987 to 1990, lateral soft tissue balancing was done with an outside-in progression in which the lateral collateral ligament and popliteus were typically released from the femur. From 1991 to 1994, an inside-out technique was use in which the lateral collateral ligament and/or popliteus were typically preserved. The minimum followup was 0.1 year (mean, 8.2 years; range, 0.1-18.2 years). Fourteen of 16 revisions were for wear and/or instability. Popliteus release, lateral collateral ligament release, or greater polyethylene shelf age increased the risk of revision. At 10 postoperative years, survival (end point, revision) was 89% (100 knees), 94% when the shelf age was less than 1 year (n = 73 knees), 97% when the popliteus or lateral collateral ligament was not released (n = 57 knees), and 100% when both conditions were met (n = 39 knees). Cruciate-retaining implants can be successfully used in knees with any degree of valgus osteoarthritis and survival is improved when the surgeon preserves at least one of the structures providing lateral stability in flexion and uses polyethylene with a short shelf life. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Posterior Cruciate-retaining Total Knee Arthroplasty for Valgus Osteoarthritis

McAuley

Collier

Hamilton

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…The anteromedial approach is used by the majority of authors and there are no contraindications even in the valgus knee [1,5]. The patellar dislocation is usually easy with this approach, because of the combination of the valgus deformity and the lateralisation of the tibial tuberosity (TT) [2].…”

Section: Anteromedial Approachmentioning

confidence: 99%

“…The described deformities can lead to a tibial external rotation and to a patellar lateral subluxation tendency [4]. Three grades of valgus deformity have been described (I, II, III) [1,5]. In grade I the deviation is less than 10°, passively correctable, with contracture of the lateral soft tissue but without elongation of the medial collateral ligament (MCL, 80 % of cases).…”

Section: Introductionmentioning

confidence: 99%

Total knee arthroplasty in the valgus knee

Rossi¹,

Rosso

Cottino

et al. 2013

International Orthopaedics (SICOT)

136

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Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10 % of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique.

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