title: Total knee arthroplasty in the valgus knee.
abstract: Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10% of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique.
authors.affiliation: AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Largo Turati 62, 10129, Turin, Italy, rossir@fastwebnet.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossi
authors.forename: Federica
authors.initials: F
authors.lastname: Rosso
authors.forename: Umberto
authors.initials: U
authors.lastname: Cottino
authors.forename: Federico
authors.initials: F
authors.lastname: Dettoni
authors.forename: Davide Edoardo
authors.initials: DE
authors.lastname: Bonasia
authors.forename: Matteo
authors.initials: M
authors.lastname: Bruzzone
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D017760:Bone Malalignment / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D016916:Joint Deformities, Acquired / Q000601:surgery*; D007593:Joint Instability / Q000453:epidemiology / Q000517:prevention & control; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D012307:Risk Factors