Total Knee Arthroplasty for Severe Valgus Deformity

Elkus, Mark; Ranawat, Chitranjan S.; Rasquinha, Vijay J.; Babhulkar, Sudhir; Rossi, Roberto; Ranawat, Amar S.

doi:10.2106/00004623-200412000-00013

Cited by 142 publications

(133 citation statements)

References 7 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…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%

“…Many authors have advocated the use of PCL-substituting implant designs, avoiding concerns with PCL balancing and dealing with a potentially abnormal native ligament [1,3,4,7,9]. In fact, some authors have advocated the use of primary constrained components both with [3] and without [1] stem extensions.…”

Section: Discussionmentioning

confidence: 99%

“…This, by definition, has the potential to result in lateral instability in flexion. To address this concern, we used an alternative approach (from 1991 to 1994) developed by Ranawat, the results of which were subsequently published by Elkus et al [4]. This ''insideout'' approach allowed the potential for preserving lateral stability in flexion but was described in combination with a PCL-substituting implant and without a comparison group.…”

Section: Discussionmentioning

confidence: 99%

“…The surgeon used an ''outside-in'' progression of lateral soft tissue releases (LCL and popliteus from the lateral epicondyle followed by deeper structures) in 46 knees from 1987 to 1990 and an ''inside-out'' [4] technique (selective release in extension after bony resections) in 32 knees thereafter (1991 to 1994). Because of potential concerns of controlling the depth of scalpel penetration and to improve visualization of the release, cutting cautery was used to transversely release contracted structures at the level of the meniscal bed.…”

Section: Methodsmentioning

confidence: 99%

“…Concerns that this could result in lateral instability in flexion resulted in the development of an alternative technique of selective release of the tight lateral structures in extension with the goal of preserving one or more anatomic structures and maintaining lateral stability in flexion [4]. However, 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 nor is there consensus on the degree of implant constraint that should be used in these cases.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Posterior Cruciate-retaining Total Knee Arthroplasty for Valgus Osteoarthritis

McAuley

Collier

Hamilton

et al. 2008

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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.

show abstract