Surgical Technique: Computer-assisted Sliding Medial Condylar Osteotomy to Achieve Gap Balance in Varus Knees During TKA

Abstract

Background Extensive posteromedial release to correct severe varus deformity during TKA may result in mediolateral or flexion instability and may require a constrained implant. We describe a technique combining computer navigation and medial condylar osteotomy in severe varus deformity to achieve a primary goal of ligament balance during TKA.

What Factors Are Associated With Femoral Component Internal Rotation in TKA Using the Gap Balancing Technique?

“…Although there are numerous medial release techniques that differ in sequence and structures released, Hunt et al [17] noted that there is a lack of evidence supporting current methods. Furthermore, it is difficult to distinguish each medial fiber structure during surgery, therefore alternative medial release methods other than the traditional medial subperiosteal release technique have been proposed [2,33]. In addition, preoperative medial ligamentous laxity or contracture, which can affect medial gaps, was not evaluated.…”

Total Knee Arthroplasty in Combination with Osteotomies around the Knee

“…In these circumstances, specific adjustment of bone cuts with ligament releases or ligament advancements must be performed. 23,24 To compensate for the extra-articular deformity, asymmetrical gaps are created instead of rectangular gaps. To ascertain correct alignment of the components, recreating the rectangular space in extension, as well as in flexion, the asymmetrical gaps need to be compensated for with ligamentous releases and ligament advancements, e.g., by sliding condylar osteotomies.…”

“…To ascertain correct alignment of the components, recreating the rectangular space in extension, as well as in flexion, the asymmetrical gaps need to be compensated for with ligamentous releases and ligament advancements, e.g., by sliding condylar osteotomies. 24,25 The resultant altered geometry of the femur and/or tibia often needs to be compensated for by using bone cement, structural bone grafts, or wedges to allow adequate component position and fixation.…”

Navigation in TKA surgery – Evolutionary technique or blind alley?

“…On the medial side the technique is quite similar, however, often a shift in both directions (distal and posterior) is needed because the severe fixed varus deformities are mostly fixed varus in extension and in flexion. Mulaji et al (2013) 23 have described their similar CAS based technique recently.…”