Total Knee Arthroplasty in the Valgus Knee – A Surgical Challenge (Part 1)

Abstract

The valgus knee presents a unique set of problems that must be addressed during total knee arthroplasty.  Both bone and soft-tissue deformities complicate restoration of proper alignment, positioning of components, and attainment of joint stability.  The variables that may need to be addressed include lateral femoral condyle or tibial plateau deficiencies secondary to developmental abnormalities, and/or wear; primary or acquired contracture of the lateral capsular and ligamentous structures; and, occasionally, laxity of the medial collateral ligament.  Understanding the specific pathologic anatomy associated with the valgus knee is a prerequisite to selecting the proper surgical method to optimize component position and restore soft-tissue balance. 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