title: Total knee arthroplasty using a pie-crusting technique for valgus deformity.
abstract: Valgus deformity correction with total knee arthroplasty is challenging. We hypothesized selective release of the tight lateral structures (pie-crusting technique), and of the lateral retinaculum in case of patellar maltracking, would obtain and maintain correction of the frontal plane deformity, restore patellar tracking and function, and avoid the complications of the extensive releases, including lateral condyle avascularity and residual lateral instability. We followed 48 patients with 53 valgus knees who underwent TKA and were followed a minimum of 5 years (mean, 8 years; range, 5-12 years). Soft tissue balancing of the lateral structures was performed with the pie-crusting technique. We employed either a fixed posterior stabilized or a mobile implant. A lateral release was performed in 67% of the cases. We observed one postoperative complication, a transient postoperative peroneal nerve palsy that spontaneously completely recovered. In 51 of the 53 knees (96%) we achieved alignment within 5 degrees from neutral. One patient had varus instability in extension. No component was revised. The pie-crusting technique reliably corrects moderate to severe fixed valgus deformities with a low complication rate and reasonable mid-term results. The multiple punctures allow gradual stretching of the lateral soft tissues and preservation of the popliteus tendon reducing the risk of posterolateral instability.
  
  
  METHODS
  Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: First Orthopaedic Clinic, University of Florence, Florence, Italy. ortosec@unifi.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Aglietti
authors.forename: Domenico
authors.initials: D
authors.lastname: Lup
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Cuomo
authors.forename: Andrea
authors.initials: A
authors.lastname: Baldini
authors.forename: Lapo
authors.initials: L
authors.lastname: De Luca
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D016916:Joint Deformities, Acquired / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D012720:Severity of Illness Index