Copyright ©The Author(s) 2015.
World J Orthop. Jul 18, 2015; 6(6): 469-482
Published online Jul 18, 2015. doi: 10.5312/wjo.v6.i6.469
Table 1 Results reported in the literature on total knee arthroplasty in valgus knee
Ref.No kneesValgus deformityTechniqueImplant SelectionResultsFollow-up
Ranawat et al[1]85> 10˚Inside-out soft-tissue release of PLC with pie-crusting of the ITB Resection of proximal part of tibia and distal part of femur to provide a balanced, rectangular spacePSKnee Society Score improved from 30 to 93 points; mean functional score improved from 34 to 81 points; mean ROM 110° 3 patients underwent revision No cases of delayed instability10 yr
Apostolopoulos et al[3]33> 10˚Lateral parapatellar arthrotomy, in combination with TTO ITB is elevated from Gerdy’s tubercle Pie-crust technique in LCL and PLC if neededCR, PS, VVC or CCK (> 20 ˚)Mean IKS score improved from 44 points preoperatively, to 91 points postoperatively, at the last follow-up In terms of alignment parameter, only 2 knees had a residual valgus deviation greater than 7°11.5 yr
Karachalios et al[5]51> 20˚Medial or lateral parapatellar arthrotomy; balancing non referredCR or PSBristol knee score 84.3% excellent to good results; 15.7% fair to poor Some deformity persisted in 14/51 patients. These patients had a significantly poorer mean clinical outcome Lateral dislocation or subluxation of the patella was found in 4 knees, with VD > 30˚5.5 yr
Elkus et al[9]85> 10˚Inside-out soft-tissue release of PCL with pie-crusting of the ITB and resection of the proximal part of the tibia and distal part of the femur to provide a balanced, rectangular spacePSThe 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 post- ROM was 110˚ No cases of delayed instability5 yr
Krackow et al[10]99Type I and II RanawatType I: Lateral soft tissue release Type II: Medial capsular ligament tighteningCRKnee Society post-operative knee score was 87.6 (± 10.6) and mean post-operative functional score was 52.32 yr
Keblish[11]79Type 2 and 3 RanawatLateral approach ITB, PLC releaseNon-constrainedScores have been good/excellent in 94.3% of cases> 2 yr
Whiteside[26]13591: 8˚-15˚ 25: 16˚-25˚ 19: > 25˚Lateral approach < 15˚: LCL release < 25˚: + ITB > 25 ˚: + POP + Lat. Head gastrocnemiusCRNeither alignment nor varus-valgus stability deteriorated during the six-year follow-up period, but the knees with greater than 25 degrees deformity had a tendency to increase posterior laxity Patellar subluxation and dislocation occurred in less than 1% of the cases6 yr
Burki et al[27]61> 10˚Lateral approach with TTO LCL releaseCRGood or excellent in 45 (88%) patients, fair in four (8%), and poor in two (4%) No postoperative tibial fractures, no delayed unions, and no nonunions at the site of the osteotomy were seen1 yr
Stern et al[31]134> 10˚Medial approach and lateral release118 PS, 8 VVC, 4 KSS, 4 CR95 knees (71%) rated as excellent, 27 knees (20%) as good, eight knees (6%) as fair, and four knees (3%) as poor Postoperatively, 76% of the knees had a tibiofemoral alignment between 5 degrees and 9 degrees valgus with an overall average of 7 degrees valgus2-10 yr (mean 4.5 yr)
Miyasaka et al[30]108> 10˚Medial approach Releasing the lateral retinaculum and ITB, followed when necessary by detaching the PCL and POP tendon from the femurPSMean Knee Society knee score was 88.7 and the mean functional score was 69.2. Postoperative knee alignment averaged 4.5 degrees with 75% of the knees corrected to between 2 degrees and 7 degrees valgus. Postoperative flexion averaged 101 degrees10-20 yr
Sekiya et al[32]476°-24°All cases required ITB release at Gerdy's tubercle, 83% ITB at joint level, 21% LCL, 17% POP in medial approach group, and 88% ITB at Gerdy's tubercle, 46% ITB at joint level, 13% LCL, 4% POP in lateral approach groupPSPre/postoperative alignment, surgical time, lateral laxity, and preoperative ROM had no significant in two groups; however, postoperative flexion was superior in lateral approach group 123.8°, 109° in medial approach group43 mo
Chalidis et al[51]57Type II RanawatLateral approach and TTOPSSignificant improvement in knee extension (P = 0.002), flexion (P = 0.006), Knee Society Pain and Function Scores (P < 0.001) and WOMAC Osteoarthritis Index (P < 0.001) The tibiofemoral angle changed from a preoperative median value of 11° (10 to 17) to a postoperative value of 3.75° (0 to 9)20-98 mo
Hadjicostas et al[52]1517°-24°Osteotomy of the lateral femoral condyle and computer navigationCRAll the knees were corrected to a mean of 0.5° of valgus (0 to 2) Flexion of the knee had been limited to a mean of 85° (75 to 110) pre-operatively and improved to a mean of 105° (90 to 130) after operation The mean Knee Society score improved from 37 (30 to 44) to 90 points (86 to 94)24-60 mo