Total knee arthroplasty for severe valgus knee deformity

To investigate the surgical methods and clinical effects of total knee arthroplasty (TKA) in patients with severe valgus knee deformity. From January 2005 and January 2009, 16 patients with 18 severe valgus knee deformity underwent TKA by means of medial parapatellar approach, standard osteotomy and only lateral soft tissue release were retrospectively analyzed. All implants were cemented. Clinical and radiographic evaluations including range of motion (ROM), The Knee Society's Knee Scoring System (KSS) and Limb alignment, patellar position, and evidence of loosening or osteolysis using standing radiographs were performed at follow-up. The average KSS score improved from 18.5 points preoperatively to 85.6 points at the time of the last follow-up. The average ROM improved from 39.5 degrees preoperatively to 109.5 degrees. The mean tibiofemoral alignment improved from valgus 31.2 degrees at preoperative period to 5.5 degrees at the final follow-up (P<0.05). A normal patellar position was observed in all knees. Two patients developed transient peroneal nerve palsies. Lateral instability after soft tissue releasing was found in one knee during the surgery. One patients developed symptomatic deep vein thrombosis. Prosthetic survival rate was 100% at a mean of mean 7 years postoperatively. The techniques of medial parapatellar approach, standard osteotomy and only lateral soft tissue release can deal with a severe valgus knee deformity very successfully in patients undergoing primary total knee arthroplasty, and provide excellent results.