title: Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up.
abstract: BACKGROUND
  In 1985, the senior author (C.S.R.) developed a new soft-tissue release technique to balance valgus knees to avoid unacceptably high rates of late-onset instability and the need for primary constrained implants. This report describes the soft-tissue release technique and its long-term results when performed in primary total knee arthroplasty in patients with a severe valgus knee deformity.
  
  
  METHODS
  Four hundred and ninety consecutive total knee arthroplasties were performed by one surgeon between January 1988 and December 1992. In this group, seventy-one patients (eighty-five knees) had a valgus deformity of > or =10 degrees . Thirty-two patients (thirty-six knees) died, and four patients (seven knees) were lost to follow-up, leaving thirty-five patients (forty-two knees) followed for a minimum of five years. These twenty-seven women and eight men had a mean age of sixty-seven years at the time of the index operation. The technique included an inside-out soft-tissue release of the posterolateral aspect of the capsule with pie-crusting of the iliotibial band and resection of the proximal part of the tibia and distal part of the femur to provide a balanced, rectangular space. Cemented, posterior stabilized implants were used in all knees. Clinical and radiographic evaluations were performed at one, five, and ten years postoperatively.
  
  
  RESULTS
  The mean modified Knee Society clinical score improved from 30 points preoperatively to 93 points postoperatively, and the mean functional score improved from 34 to 81 points. The mean range of motion was 110 degrees both preoperatively and postoperatively. The mean coronal alignment was corrected from 15 degrees of valgus preoperatively to 5 degrees of valgus postoperatively. Three patients underwent revision surgery because of delayed infection, premature polyethylene wear, and patellar loosening in one patient each. There were no cases of delayed instability.
  
  
  CONCLUSIONS
  The inside-out release technique to correct a fixed valgus deformity in patients undergoing primary total knee arthroplasty is reproducible and provides excellent long-term results.
  
  
  METHODS
  Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Lenox Hill Hospital, 130 East 77th Street, William Black Hall 11th Floor, New York, NY 10021, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Elkus
authors.forename: Chitranjan S
authors.initials: CS
authors.lastname: Ranawat
authors.forename: Vijay J
authors.initials: VJ
authors.lastname: Rasquinha
authors.forename: Sushrut
authors.initials: S
authors.lastname: Babhulkar
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossi
authors.forename: Amar S
authors.initials: AS
authors.lastname: Ranawat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016916:Joint Deformities, Acquired / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D016019:Survival Analysis